Critical Role of Nrf2 in Experimental Ischemic Stroke

Ischemic stroke is one of the leading causes of death and long-term disability worldwide; however, effective clinical approaches are still limited. The transcriptional factor Nrf2 is a master regulator in cellular and organismal defense against endogenous and exogenous stressors by coordinating basal and stress-inducible activation of multiple cytoprotective genes. The Nrf2 network not only tightly controls redox homeostasis but also regulates multiple intermediary metabolic processes. Therefore, targeting Nrf2 has emerged as an attractive therapeutic strategy for the prevention and treatment of CNS diseases including stroke. Here, the current understanding of the Nrf2 regulatory network is critically examined to present evidence for the contribution of Nrf2 pathway in rodent ischemic stroke models. This review outlines the literature for Nrf2 studies in preclinical stroke and focuses on the in vivo evidence for the role of Nrf2 in primary and secondary brain injuries. The dynamic change and functional importance of Nrf2 signaling, as well as Nrf2 targeted intervention, are revealed in permanent, transient, and global cerebral ischemia models. In addition, key considerations, pitfalls, and future potentials for Nrf2 studies in preclinical stroke investigation are discussed.

Intraoperative robotic measurements of coronal alignment in total knee arthroplasty correlate with pre- and post-operative long-leg radiographs

Purpose

This study sought to validate intraoperative robotic measurements of femoral and tibial component coronal alignment in total knee arthroplasty (TKA) by comparing to pre- and post-operative standing, double stance, long-leg radiographs (LLR).

Methods

This retrospective cohort study included 59 unique patients undergoing primary TKA at a single institution. Pre- and post-operative femoral and tibial coronal alignment were measured on LLRs using a deep learning artificial intelligence model and compared to measurements obtained from the imageless robotic system to evaluate the robot's accuracy and reliability.

Results

Robotic measurements were highly correlated with measurements from preoperative LLR (Pearson r 2 = 0.68). There was no significant difference in preoperative constitutional alignment between the two methodologies (p = 0.28). Additionally, the intraoperative and post-operative alignment of femoral and tibial implants were not significantly different (p = 0.12 and p = 0.95, respectively) and were strongly correlated (Pearson r 2 = 0.5 and Pearson r 2 = 0.6 respectively). The mean difference in femoral alignment was 0.43° and the mean difference in tibial alignment was 0.01°.

Conclusions

The findings of this study suggest that there were no significant differences in the coronal alignment of TKA when assessed by a robotic system compared to LLR. This signifies the robotic system's high intraoperative accuracy and reliability in determining coronal alignment.

Level of Evidence

Level III.