The number of athletes engaged in climbing sports has risen. Specific physical and psychological skills are required. The objective of this review was to determine factors for high climbing performance. We evaluated physiological, biomechanical and psychological characteristics that simplify the ascent. We also assessed training and recovery strategies. Medline (Pubmed), Cochrane Library and Google scholar up to September 2018. A low skinfold thickness, body fat and large forearm volume were anthropometric traits in successful climbers. Well-trained forearm flexors with high aerobic capacities lead to an efficient style. Hand grip strength and endurance, postural stability and optimized kinematic motions were favourable. Elite climbers had long finger and bent-arm hang times. Psychologically, an "iceberg profile" was typical. Constant training with fingerboard and dynamic eccentric-concentric training helped to push the "red-point grade". Hand, forearm strength and endurance are highly important elements in elite climbers. An efficient climbing style with perpetual focus and accuracy, high speed and low exhaustion due to adaption to repeated isometric exercise is helpful in the ascent, while low body fat and a large bone-to-tip pulp make it easier. Constant training is essential, e.g. eccentric-concentric training of finger flexors, which should be followed by active recovery.

Skeletal muscle has the capacity of regeneration after injury. However, for large volumes of muscle loss, this regeneration needs interventional support. Consequently, muscle injury provides an ongoing reconstructive and regenerative challenge in clinical work. To promote muscle repair and regeneration, different strategies have been developed within the last century and especially during the last few decades, including surgical techniques, physical therapy, biomaterials, and muscular tissue engineering as well as cell therapy. Still, there is a great need to develop new methods and materials, which promote skeletal muscle repair and functional regeneration. In this review, we give a comprehensive overview over the epidemiology of muscle tissue loss, highlight current strategies in clinical treatment, and discuss novel methods for muscle regeneration and challenges for their future clinical translation.

The high prevalence of sarcopenia in an aging population has an underestimated impact on quality of life by increasing the risk of falls and subsequent hospitalization. Unfortunately, the application of the major established key therapeutic—physical activity—is challenging in the immobile and injured sarcopenic patient. Consequently, novel therapeutic directions are needed. The transcription factor Forkhead-Box-Protein O3 (FOXO3) may be an option, as it and its targets have been observed to be more highly expressed in sarcopenic muscle. In such catabolic situations, Foxo3 induces the expression of two muscle specific ubiquitin ligases (Atrogin-1 and Murf-1) via the PI3K/AKT pathway. In this review, we particularly evaluate the potential of Foxo3-targeted gene therapy. Foxo3 knockdown has been shown to lead to increased muscle cross sectional area, through both the AKT-dependent and -independent pathways and the reduced impact on the two major downstream targets Atrogin-1 and Murf-1. Moreover, a Foxo3 reduction suppresses apoptosis, activates satellite cells, and initiates their differentiation into muscle cells. While this indicates a critical role in muscle regeneration, this mechanism might exhaust the stem cell pool, limiting its clinical applicability. As systemic Foxo3 knockdown has also been associated with risks of inflammation and cancer progression, a muscle-specific approach would be necessary. In this review, we summarize the current knowledge on Foxo3 and conceptualize a specific and targeted therapy that may circumvent the drawbacks of systemic Foxo3 knockdown. This approach presumably would limit the side effects and enable an activity-independent positive impact on skeletal muscle.

The vision of gluing two bone fragments with biodegradable and biocompatible adhesives remains highly fascinating and attractive to orthopedic surgeons. Possibly shorter operation times, better stabilization, lower infection rates, and unnecessary removal make this approach very appealing. After 30 years of research in this field, the first adhesive systems are now appearing in scientific reports that may fulfill the comprehensive requirements of bioadhesives for bone. For a successful introduction into clinical application, special requirements of the musculoskeletal system, challenges in the production of a bone adhesive, as well as regulatory hurdles still need to be overcome. In this article, we will give an overview of existing synthetic polymers, biomimetic, and bio-based adhesive approaches, review the regulatory hurdles they face, and discuss perspectives of how bone adhesives could be efficiently introduced into clinical application, including legal regulations.

Dexterous control of upper limb prostheses with multiarticulated wrists/hands is still a challenge due to the limitations of myoelectric man-machine interfaces. Multiple factors limit the overall performance and usability of these interfaces, such as the need to control degrees of freedom sequentially and not concurrently, and the inaccuracies in decoding the user intent from weak or fatigued muscles. In this article, we developed a novel man-machine interface that endows a myoelectric prosthesis (MYO) with artificial perception, estimation of user intention, and intelligent control (MYO-PACE) to continuously support the user with automation while preparing the prosthesis for grasping. We compared the MYO-PACE against state-of-the-art myoelectric control (pattern recognition) in laboratory and clinical tests. For this purpose, eight able-bodied and two amputee individuals performed a standard clinical test consisting of a series of manipulation tasks (portion of the SHAP test), as well as a more complex sequence of transfer tasks in a cluttered scene. In all tests, the subjects not only completed the trials faster using the MYO-PACE but also achieved more efficient myoelectric control. These results demonstrate that the implementation of advanced perception, context interpretation, and autonomous decision-making into active prostheses improves control dexterity. Moreover, it also effectively supports the user by speeding up the preshaping phase of the movement and decreasing muscle use.