bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring relationships among gait, balance, and physical activity in individuals with Huntington's disease
Authors: Tueth Lauren E. , Haussler Allison M. , Baudendistel Sidney T. , Earhart Gammon M.
Published: December 2024

Background

Individuals with Huntington's disease (HD) experience a variety of motor and non-motor symptoms, but little is known about how these symptoms are related to one another. It is important to characterize the deficits present and explore the relationships among these symptoms in order to provide high quality clinical care.

Objective

The purpose of this study was to characterize gait, balance, and physical activity level in individuals with HD and explore the relationships among motor and non-motor symptoms.

Methods

Individuals completed one lab visit and wore a sensor for seven days to capture physical activity level. During the lab visit, gait, balance, and cognitive status were assessed using validated measures. A 2 × 2 ANOVA (Group×Condition) was used to assess differences in gait between individuals with HD vs. controls, while t-tests were used for other clinical measures. Correlations as well as a mixed effects model explored relationships among clinical measures in the HD group.

Results

Individuals with HD walk significantly slower and have significantly worse balance than controls. Gait velocity and balance were significantly correlated with cognitive status in individuals with HD. Additionally, balance performance and balance confidence were not significantly correlated, indicating that there may be a lack of self-awareness of deficits present in individuals with HD. In-lab measures were not significant predictors of physical activity.

Conclusions

Motor impairments in individuals with HD are correlated with cognitive impairment. Clinicians should be aware of the impact of cognitive impairment when selecting interventions to address motor symptoms in individuals with HD.
Microbial Dysbiosis in Nasopharyngeal Carcinoma: A Pilot Study on Biomarker Potential
Authors: Lu Yen-Ting , Hsin Chung-Han , Chuang Chun-Yi , Huang Cheng-Chen , Su Mao-Chang , Wen Wei-Sheng , Wang Shao-Hung , Chen Yih-Yuan , Lee Cheng-Yang , Li Yu-Xuan , Lu Ying-Chou , Chang Tzu-Hao , Yang Shun-Fa
Published: December 2024

Importance

Nasopharyngeal carcinoma (NPC) is closely linked to microorganisms, especially intra-tumoral microbiota. However, the role of commensal microbiota in NPC remains underexplored, with implications for understanding disease mechanisms.

Objective

This study aims to analyze and compare the bacterial microbiota in the nasopharynx and middle meatus (MM) of individuals with NPC and those without NPC. Additionally, the study seeks to identify potential microbial biomarkers that can distinguish between NPC and non-NPC (nNPC) individuals.

Design

Cross-sectional study.

Setting

Study conducted in a clinical setting with NPC and non-NPC participants to evaluate microbial diversity relevant to NPC.

Participants

Ten NPC cases and 15 non-NPC controls were recruited based on clinical eligibility.

Main Outcome Measures

Bacterial microbiota sampling from the nasopharynx and MM was analyzed by 16S rRNA sequencing. Microbiota diversity (alpha and beta diversity indices), presence of bacterial taxa with biomarker potential, and prediction model accuracy [area under the curve (AUC)].

Results

Microbiota diversity was significantly lower in NPC patients versus controls. In nasopharyngeal samples, alpha diversity (Chao1 index, P = .02) and beta diversity (PERMANOVA, P = .001) differed notably between groups, though MM samples showed no significant difference (Chao1 index, P = .23). Machine learning identified Pseudomonas, Cutibacterium, and Finegoldia as potential NPC biomarkers (AUC = 0.86).

Conclusions and Relevance

This pioneering study highlights dysbiosis in nasopharyngeal microbiota among NPC patients. Findings suggest that Pseudomonas, Cutibacterium, and Finegoldia may be useful biomarkers for NPC diagnosis, warranting further investigation into microbial roles in NPC pathogenesis.
New-onset cutaneous lichen planus following Vaxzevria (Oxford-AstraZeneca) COVID-19 vaccination
Authors: Muftah Amira , Lee Stephen , Abbas Mariam
Published: December 2024

We report a 56-year-old male who developed cutaneous lichen planus (LP) following Vaxzevria (Oxford-AstraZeneca) COVID-19 vaccination. Multiple topical and systemic therapies were tried with limited success; however, partial improvement was observed with narrow-band UVB (NB-UVB) phototherapy. This report adds to the growing evidence of new-onset LP following COVID-19 vaccination and underscores the need for careful reporting, monitoring, and management of vaccine-related adverse effects.
Cutaneous metastases from rectal adenocarcinoma: A case report
Authors: Rahman Samia , Grewal Parbeer
Published: December 2024

Cutaneous metastases from colorectal cancer are an uncommon but critical finding, typically signaling advanced disease with poor prognosis. This case report describes a 64-year-old woman with a limited past medical history who presented to our outpatient dermatology practice with rapidly spreading erythematous, indurated, and nearly verruciform plaques in the groin, vaginal, and perineal region. Biopsy confirmed metastatic adenocarcinoma of colonic origin, and diagnostic imaging, and colonoscopy revealed stage IV colorectal cancer involving extensive cutaneous, lymphatic, and visceral metastases. Unfortunately, the patient had not received routine colorectal cancer screening, despite a positive family history. Due to extensive disease, palliative radiation was not an option, and systemic chemotherapy was initiated. This case emphasizes the need for awareness of cutaneous metastases as a potential initial presentation of undiagnosed malignancies, the importance of routine colorectal cancer screening, and timely biopsy of suspicious skin lesions for early diagnosis and management.
Exploring ways to improve knee osteoarthritis care: The role of mobile apps in enhancing therapeutic exercise—a systematic review
Authors: Paolucci Teresa , Pezzi Letizia , Bressi Federica , Russa Raffaele La , Zobel Bruno Beomonte , Bertoni Gianluca , Farì Giacomo , Bernetti Andrea
Published: December 2024

Objective

Osteoarthritis (OA), particularly knee OA, is a leading cause of disability and poses significant challenges in healthcare management. Mobile applications (apps) have emerged as potential tools to support therapeutic exercise by providing tailored programs, instructional content, and progress tracking. This systematic review evaluates the efficacy of mobile apps in enhancing therapeutic exercise for knee OA management.

Methods

A systematic review was conducted, analyzing randomized controlled trials (RCTs) to assess the impact of mobile apps on pain and knee function in patients with OA. The review followed the Cochrane Handbook guidelines and was registered with PROSPERO. Inclusion criteria focused on RCTs involving adults aged 40 and above with knee OA, and outcomes were measured based on pain intensity and knee function.

Results

Five RCTs met the inclusion criteria. The results varied: while some studies demonstrated minor improvements in pain and function with app-based interventions, others showed comparable effectiveness to traditional methods. The review highlights the potential of mobile apps to offer benefits in managing knee OA, though outcomes were inconsistent due to intervention and population heterogeneity.

Conclusion

Despite the low certainty of evidence, mobile app-based interventions appear to have a positive impact on reducing pain and improving physical function in patients with knee OA. Continued research is essential to better understand the effectiveness and long-term impact of mobile technology in OA management, underscoring the value of digital health interventions in enhancing patient care.
Feasibility of a mobile app for traumatic stress management using neurofeedback-based meditation and binaural beat music: A pilot randomized controlled trial
Authors: Choi Yun-Jung , Cho Dong-Hee , Lee Na-Rae
Published: December 2024

Objective

Individuals who have experienced traumatic events often encounter a variety of changes in their lives and and may suffer from them. To help and alleviate these traumatic stress, we developed an evidence-based mobile application (app) for easy accessibility. This study aimed to test the effects of the mobile app for traumatic stress management using neurofeedback-based meditation and binaural beat music.

Method

Fifty-eight participants were enrolled in a pilot randomized controlled trial (Trial Registration Number: KCT007724) consisting of two groups: (a) experimental group (n = 28) and (b) control group (n = 30). Participants used the mobile app 3 days a week at home for 4 weeks, engaging in neurofeedback-based meditation and binaural beat music. Participants completed self-report measures (SCL-47-R, Psychological Well-Being Post-traumatic Changes questionnaire) and EEG test (emotional stability, anti-stress) at a pretreatment and 1-month follow-up.

Results

Participants in the experimental group demonstrated significant improvements in psychological well-being (F = 16.37, p < 0.001), emotional stability (F = 10.38; p = 0.002), and the anti-stress index (F = 11.37; p = 0.001).

Conclusion

The results of this pilot trial, involving a neurofeedback-based meditation and binaural beat-centered music intervention, provide preliminary support and a readily accessible option for individuals seeking to recover from the effects of traumatic events. Additionally, we have established the groundwork for subsequent research to study the efficacy of a neurofeedback-based meditation program and a binaural beat-centered music intervention for those who have experienced traumatic events.
Business as Usual? Assessing Amplified Political Posts Across Social Media Platforms During the COVID-19 Pandemic
Authors: Jacobsen Roy Aulie , Larsson Anders Olof
Published: December 2024

Social media platforms, such as Facebook, Instagram, and Twitter (now X), play a crucial role in facilitating connections between politicians and citizens, particularly during a crisis like the COVID-19 pandemic. This article examines the characteristics of viral social media posts in Norway and Sweden during the initial wave of the pandemic. Despite their geographical proximity and cultural similarities, Norway and Sweden adopted different approaches to the pandemic, providing a compelling basis for comparative analysis. Employing a visual computational approach, this study maps viral posts by analyzing engagement metrics such as likes, reactions, shares, and comments. A close reading of popular posts investigates the communication strategies employed across platforms and national contexts. The findings reveal that political criticism on Twitter attracted substantial engagement, while Instagram posts leaned toward self-promotion. On Facebook, popular posts exhibited a more varied use of communication strategies, reflecting a nuanced approach to engagement across different social media environments.
Evaluation of Tone Quality in Piano Performance by Sight and Sound: A Performer's Perspective
Authors: Sarac Julijana
Published: December 2024

In the present study, a classically trained pianist aimed to investigate whether the visual cues in her performance influenced observers’ evaluation of her singing tone quality. The research experiment consisted of audiovisual stimuli in which some performances were mimicked to a preexisting track while others contained matching or mismatching musical material and body movements. Thirty-seven music students from the Sydney Conservatorium of Music and the Faculty of Music, University of Arts in Belgrade observed these audiovisual stimuli and rated the quality of a singing tone on a scale of 1 (poor) to 7 (excellent). Analysis of variance with one repeated factor of hand movement (minimal, medium, and large) was used to test the effects of movement type on the rating of singing-quality tone production in the mimicking part of the experiment, while a two-factorial, repeated-measure analysis of variance was used for the mismatching part of the experiment. The results for the mimicking part revealed no significant differences in ratings. Conversely, the results of the mismatching part of the experiment revealed that the effect of hand movement was significant, while the effect of sound and the interaction between hand movement and sound were not significant. Altogether, the results indicate that perception of tone quality is a complex phenomenon in which the visual aspect of a pianist's movements could play a vital role, as suggested by prior research. Further studies are needed to investigate other factors influencing the perception of tone quality, such as the possible connection between performers’ somatic senses and audience recognition of them.
A rare homozygous CAPN3 variant with distinct clinical features in unrelated families of Iraqi Jewish descent
Authors: Assia Batzir Nurit , Orenstein Naama , Yaron Yuval , Kuzminsky Alla , Nevo Yoram , Konen Osnat , Bazak Lily , Lidzbarsky Gabriel , Basel-Salmon Lina , Aharoni Sharon
Published: December 2024

CAPN3 encodes a calcium-activated skeletal muscle-specific protease. Pathogenic variants in CAPN3 are associated with autosomal recessive and dominant limb-girdle muscular dystrophy. We report on three children and one adult from four unrelated Iraqi Jewish families, who harbor the same homozygous variant in CAPN3, p.Gln123Lys. Patients shared recognizable features of toe-walking and elevated creatine phosphokinase since childhood. The variant affects a conserved protein domain common to the calpain super family and likely represents a founder mutation in individuals of Iraqi Jewish ancestry. Our findings have potential implications on screening in relevant populations, allowing for more prompt diagnoses and future therapies.
Cognitive Behavioral Therapy Reduces Unhelpful Thinking Among People with Musculoskeletal Symptoms: A Meta-Analysis
Authors: Patel Deven Niraj , Pathapati Rajeev , Hand Catherine , Varma Ashwin , Ramtin Sina , Ring David
Published: December 2024

Background

Greater unhelpful thinking is associated with greater musculoskeletal discomfort and incapability. Cognitive-behavioral therapy (CBT) fosters healthy thinking to help alleviate symptoms.

Questions

In a meta-analysis of randomized control trials (RCT) of CBT for unhelpful thinking among people with musculoskeletal symptoms, we asked: 1) Does CBT reduce unhelpful thinking and feelings of distress, and improve capability, in individuals with musculoskeletal symptoms? 2) Are outcomes affected by CBT delivery methods?

Methods

Following QUOROM guidelines, we searched databases using keywords of pain catastrophizing, kinesiophobia, cognitive-behavioral therapy, musculoskeletal and variations. Inclusion criteria were RCT's testing CBT among people with musculoskeletal symptoms. Study quality was assessed with Cochrane Review of Bias 2. Meta-analysis of means and standard deviations was performed.

Results

CBT led to modest reductions in catastrophic thinking (−0.44 CI: −0.76 to −0.12; P = .01, kinesiophobia (−0.60 CI: −1.07 to −0.14; P = .01) and anxiety symptoms (−0.23 CI: −0.36 to −0.09; P < .01) over six months compared to usual care. There were no improvements in levels capability (−0.28 CI: −0.56 to 0.01; P = .05). CBT led by mental health professionals reduced catastrophic thinking more than CBT led by other clinicians (QB Test = 4.73 P = .03). There were no differences between online and in-person sessions, group versus individual therapy, or surgical versus non-surgical interventions.

Conclusion

The evidence that CBT delivered by various clinicians in various settings fosters healthier thinking in people presenting for care of musculoskeletal symptoms, supports comprehensive care of musculoskeletal illness. More research is needed to develop indications and interventions that also improve levels of capability. Level-I, meta-analysis of RCT's
‘Deep Deltoid Paradox Sign’ - Anterior Talofibular Ligament Laxity Prevents Development of Deep Deltoid Ligament Laxity in the Presence of Unstable Planus - A Cadaveric Study
Authors: Li Zhikai , Li Zhiheng , Jarvis Gavin , Potten Stephanie , Brassett Cecilia , Pasapula Chandra
Published: December 2024

Category:

Hindfoot; Sports

Introduction/Purpose:

Adult Acquired Flatfoot Deformity (AAFD)/Progressive collapsing foot deformity (PCFD) starts with failure of the medial longitudinal arch. Determining which feet progress to anteromedial instability of the tibiotalar joint, prior to complete deltoid ligament rupture, is not fully understood. We have observed clinically that, in the presence of anterior talofibular ligament (ATFL) laxity, deep deltoid ligament (DD) laxity and anteromedial ankle instability does not develop (indicated by a negative neutral heel external rotation test/anteromedial drawer test). To date, the protective effect that ATFL rupture/laxity (the most common foot ligament injury) has on preventing DD laxity and anteromedial ankle instability developing in AAFD/PCFD has not been investigated. This understanding is crucial for accurate staging, treatment, and prognosis of both AAFD/PCFD and ATFL repairs.

Methods:

Unstable planus was induced in 12 cadaveric feet from 6 donors by complete sectioning of the plantar fascia, spring ligament and the plantar 1st tarsometatarsal joint. Paired feet were randomly assigned to having ATFL sectioned or ATFL intact. Feet underwent cyclic loading (2000 cycles) on a custom mounted jig and photos were taken with positional markers on the medial malleolus, fibula, and the talus before and after antero-posterior force application. ImageJ quantified anteromedial and anterolateral ankle joint displacement to reflect DD and ATFL laxity respectively.

Results:

In ATFL-intact feet, anteromedial displacement increased by 3.46 ± 0.41 µm/cycle (mean ± SD; P = 0.000005; two-tailed, one-sample t-test). In ATFL-sectioned feet, displacement increased 0.61 ± 0.66 µm/cycle (p = 0.072), an 82% reduction in DDL laxity development (P = 0.00006; two-tailed, paired t-test). There was minimal cycle-induced change in anterolateral displacement (ATFL-intact: 0.50 ± 0.50 µm/cycle (p = 0.06); ATFL-sectioned: -0.04 ± 0.90 µm/cycle (p = 0.17). However, absolute anterolateral displacement increased in ATFL-sectioned feet by 7.40 ± 0.12 mm (p = 0.00002).

Conclusion:

These findings corroborate our clinical findings; in AAFD/PCFD, feet with ATFL laxity paradoxically do not develop DD instability (negative heel external test and anteromedial draw test), which we ascribe the ‘deep deltoid paradox sign’. This phenomenon has significant implications in determining which feet progress to DD laxity in AAFD/PCFD and ultimately DD rupture. Furthermore, surgical management of ATFL ruptures may require patient counselling regarding the development of DD laxity after ATFL repair if AAFD/PCFD is also present. Finally, we propose putative mechanisms based on differential axes of talar rotation and navicular abduction during stance, straining DD when ATFL is intact.
2D or Not 2D, That Is the Question? Weight-Bearing Radiography vs Weight-Bearing Computed Tomography in the Preoperative Evaluation of Charcot-Marie-Tooth Deformity
Authors: Blough Christian , Song Jaehwang , Michalski Max P. , Pfeffer Glenn
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

This is the first study to compare weight-bearing radiographs to weight-bearing computed tomography (WBCT) in the preoperative evaluation of Charcot-Marie-Tooth patients. This comparison is important as WBCT is not widely available, and its current role in preoperative planning remains unclear.

Methods:

We performed a retrospective review of CMT patients with cavovarus deformity with weight-bearing radiographs (WBR) and WBCT. Lateral talus-first metatarsal angle, calcaneal pitch, anteroposterior (AP) talus-first metatarsal angle, and talonavicular coverage angle were measured on WBR on WBCT. Intraclass correlation coefficients (ICC) between raters and imaging modalities were calculated. ICC values were interpreted as follows: ICC < 0.50 = poor agreement; 0.50 < ICC < 0.75 = moderate agreement; 0.75 < ICC < 0.90 = good agreement; and ICC > 0.90 = excellent agreement.

Results:

38 feet from 34 patients, 21 female, 13 male, with an average age of 42 years old (range 19-72) were included. Interrater reliability was good or excellent for all measures except talonavicular coverage angle, which was moderate for both WBR and WBCT (Table 1A). Inter-method reliability was good for all measures except talonavicular coverage angle which was moderate (Table 1B).

Conclusion:

In the 38 CMT feet assessed in this study, we found good agreement between WBR and WBCT measurements, except for talonavicular coverage angle. For surgeons without access to WBCT, these results may ease concern regarding surgical planning using weight-bearing radiographs alone.
9 Out of 10 Patients Participate in Sports after Talar Osteoperiostic Grafting from the Iliac Crest for Large Osteochondral Lesions of the Talus
Authors: Dahmen Jari , Rikken Quinten , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M
Published: December 2024

Category:

Ankle

Introduction/Purpose:

Osteochondral lesions of the talus (OLT) are often caused by sports. The Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is an autologous press-fit bone grafting technique for large (cystic) primary- and non-primary OLT. The purpose of this study was to prospectively evaluate sport outcomes after the TOPIC surgery. The purpose of this study was to prospectively evaluate sports outcomes for patients with OLT who were treated with the TOPIC procedure.

Methods:

61 patients who underwent the TOPIC procedure for a symptomatic OLT were prospectively included up-to 24 months follow-up. Using digital questionnaires, an in-depth telephone interview, and electronic patient files, the return to any level of sport (primary outcome), the return to preoperative level of sport, the return to preinjury level of sport, the return to performance, the participation in improved preoperative level of sport and participation in desired level of sport rates were determined 1- and 2-years after TOPIC. On top of that the Ankle Activity Scale (AAS), Numeric Rating Scale (NRS) for pain while running preoperatively, 1- and 2-years after TOPIC were assessed. Lastly complication and reoperation types and rates were presente

Results:

2 years after TOPIC surgery, 98% of patients returned to any level of sport. Of the 61 participants, 90% participated in an improved level of sports compared to pre-operatively, 59% returned to their preinjury level of sports and 3% returned to perform on a higher level of sports than preinjury. The AAS increased significantly from 2 to 5 out of 10 (p < 0.01) both 5 points both 1- and 2-years post-TOPIC. The NRS for pain during running improved from 9 to 5 out of 10 (p < 0.01) 5 points both 1- and 2-years post-TOPIC. Any complication occurred in 3% of cases and in 31% of cases a reoperation was conducted, primarily due to hardware removal.

Conclusion:

The TOPIC procedure for large OLT results in high return to sport and participation in sport rates 1- and 2-years postoperatively making it a suitable treatment option for the athletic population suffering from OLT.
A Step in the Right Direction. An Analysis of the Most Popular Online Ankle Fracture-Related Patient Education Materials
Authors: Arif Haad A. , Lebrun Gavin , Moore Simon , Friscia David A.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Due to the increasing accessibility of Internet access, it is becoming more and more important to ensure that the informational material available online for patient education is both accurate and readable to promote a greater degree of health literacy. This study sought to investigate the quality and readability of the most popular online resources for ankle fractures.

Methods:

After conducting a Google search using six terms related to ankle fractures, we collected the first 20 non-sponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI) instruments. Quality was evaluated using an author-created Ankle Fracture Index (AFI).

Results:

A total of 46 out of 120 articles met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 8.4 ± 0.5, 57.5 ± 3.2, and 10.5 ± 0.5, respectively. The average AFI score was 15.4 ± 1.4, corresponding to an “acceptable” quality rating. Almost 70% of articles (n = 32) were written at or below the recommended eighth grade reading level. Most articles discussed the need for imaging in diagnosis and treatment planning while neglecting to discuss the risks of surgery or potential future operations.

Conclusion:

Ankle fractures are a common injury among young and old patients alike. With a varied range of treatments available, patients are likely to perform their own Internet searches before arriving at the doctor’s office. Current, online patient education materials on ankle fractures diverge from the overall trend in orthopaedics by demonstrating an eight grade average reading grade level and an acceptable quality on content analysis. Further work should surround increasing information regarding risk factors, complications for surgery, and long-term recovery.
Are there Differences between Osteosynthesis of the Posterior Malleolus with Plates or with Posteroanterior Screws?
Authors: Gonzalez Alonso Marcos , Lajara Heredia Alfonso , Jose Madera Gonzalez Francisco , Rosa Trapote Cubillas Ana , Antonio Sanchez Lazaro Jaime , Fernandez Hernandez Oscar
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Cadaver studies suggest that the use of a plate allows a biomechanically more stable osteosynthesis than screws alone in posterior malleolus fractures. The objectives of this study are to test the subjective functional outcomes and the development of radiographic signs of early osteoarthritis in a cohort of patients with the two treatment groups.

Methods:

This is a retrospective study of patients operated on between 2020 and 2022 for ankle fractures with osteosynthesis of the posterior malleolus. Patients without preoperative CT scan, follow-up of less than one year and fractures without posterior malleolus synthesis were excluded. A total of 42 patients with a mean age of 53.39 years (± 17.25) and the median follow-up was 12 months (range: 12-45) were included. The Olerud-Molander Ankle Score (OMAS) subjective scale was used and the last follow-up radiograph was analyzed to assess the presence of early osteoarthritis using the Takakura classification. There were no differences in the immobilization time (p=0.843) or in the moment of loading (p=0.275) between both groups.

Results:

65% of the patients were women. 52.4% of fractures corresponded to Bartonicek type 3 fractures, followed by type 2 (35.7%) and type 4 (11.9%). The predominant method of osteosynthesis for the posterior malleolus was posteroanterior screws in 24 patients, compared to 18 patients treated with plate and screws. No differences were found between the two groups when analyzing mean age, Bartonicek classification or the proportion of fragment size measured in the axial plane. The OMAS scale obtained a mean of 64.0 points (± 21.58) in the group treated with screws and 58.75 points (± 21.86) in the group treated with screws and plates, finding no significant differences (p=0.06). Ddifferences were found in the radiological results (p=0.511). No secondary displacements were observed in either group.

Conclusion:

We found no significant differences in the variables studied between the two methods of osteosynthesis in our cohort. These data suggest that posteroanterior screw synthesis may be a valid treatment alternative, although studies with a higher level of evidence are needed to confirm this theory.
Articular Contact Mechanics in Osteochondral Lesions of the Talus: A Weightbearing-CT study
Authors: Peiffer Matthias , Hollander Julian , Arne Burssens Bsc , Stufkens Sjoerd , Ashkani-Esfahani Soheil , Audenaert Emmanuel , M.M.J. Kerkhoffs Gino M , Kwon John Y. , DiGiovanni Christopher W.
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

Osteochondral Lesions of the Talus (OLT) may progress into a cascade of cartilage degeneration. While edge-loading on the surrounding tibiotalar articular surfaces has been proposed as principal determinant of cartilage degeneration, the pathophysiological pathways have not yet been clarified. The present study aims to evaluate the patient-specific influence of OLTs on the mechanical behaviour of the surrounding cartilage of the talus and tibia. More specifically, this study aims to investigate whether the location of the OLTs influences their loading characteristics during the range of motion of the ankle joint.

Methods:

Patient-specific 3D models from 36 patients with an OLT, derived from weightbearing CT, were used to analyse the contact stress on the tibiotalar articulation using Discrete Element Analysis (DEA). A matched, virtual healthy control group was developed for each talus. Mean- , peak contact-stress and contact area were calculated during simulated ankle flexion.

Results:

The mean talar contact-stress was elevated in the OLT cases, with a notable correlation between ankle flexion and OLT location. Edge loading occurred predominantly in anteromedial lesions during dorsiflexion (2.9 MPa (IQR: 1.3) for OLT versus 2.4 MPa (IQR: 0.9) for the controls), while posteromedial lesions were mostly loaded during plantarflexion (3.5 MPa (IQR: 1.7) for the OLT versus 2.9 MPa (IQR: 1.1) for the controls).

Conclusion:

OLTs influence the whole-joint articular contact mechanics of the ankle, leading to increased stress on both the talus and the opposing tibia. More specifically, a clear pattern of edge-loading on the surrounding OLT cartilage was found. Anterior lesions had the highest stresses in neutral and dorsiflexion, while Posterior lesions experienced higher stress during plantarflexion. OLT versus Healthy Twin Contact Stress Contact stress plot, depicting the difference between OLT (upper) and the matched, healthy twin (lower) for increasing plantarflexion
Effectiveness and Safety of Sodium-Glucose Cotransporter-2 Inhibitor Continuation in Patients With Type 2 Diabetes and Late-Stage Chronic Kidney Disease
Authors: Denny Olivia , Albanese Nicole P. , Meaney Calvin J. , Siwarski Nicole E. , Monte Scott V.
Published: December 2024

Background: Expansion of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in chronic kidney disease (CKD) prompted a pragmatic study of their safety and effectiveness in patients with type 2 diabetes mellitus (T2DM) and late-stage CKD. Objective: The primary clinical endpoint was change in HbA1c. Secondary clinical endpoints included change in body weight and blood pressure. Safety endpoints included kidney function indices, mycotic or urinary tract infection, acute kidney injury, dehydration, and ketoacidosis. Methods: Adult patients with T2DM and late-stage CKD prescribed an SGLT2i between June 1, 2018 and June 1, 2023 were included in this retrospective cohort study. Late-stage CKD was defined as CKD stage G3b, G4, or G5, including requiring dialysis or kidney transplantation. Endpoints were compared between patients who continued an SGLT2i versus those who discontinued. Results: Fifty-nine patients were included. Short-term follow-up over 4.2 ± 1.7 months revealed no difference in HbA1c between groups. Extended follow-up in a truncated sample over 10.4 ± 2.6 months showed modest, yet significantly lower HbA1c with continuation (median: –0.3 vs 0.1%; P = 0.04). Weight loss was greater when treatment continued (median: –1.8 vs 0.2 kg; P = 0.01), whereas blood pressure did not differ. No differences in safety endpoints were observed. Kidney function mildly, but significantly worsened with continuation (median estimated glomerular filtration rate [eGFR]: –2.7 vs 0 mL/min/1.73 m2; P = 0.03). Conclusions: Patients with T2DM and late-stage CKD had similar glucose control and safety profiles irrespective of SGLT2i continuation or discontinuation. This may favor clinical decision-making toward benefits of SGLT2i reduction in weight, cardiovascular events, CKD progression, and hospitalizations over potential safety concerns in these patients.
Platelet spleen tyrosine kinase is a key regulator of anti-PF4 antibody-induced immunothrombosis
Authors: Zlamal Jan , Ripoll Nunez Vera , Lee Christine Shu Mei , Toma Filip , Althaus Karina , Rigoni Flavianna , Witzemann Andreas , Whittaker Shane , Capraro David , Uzun Günalp , Bakchoul Tamam , Chen Vivien M
Published: December 2024

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but serious prothrombotic adverse event following vaccination with adenovector-based COVID-19 vaccines. Laboratory findings indicate that anti-platelet factor 4 (PF4) immunoglobulin G antibodies are the causing factor for the onset of thromboembolic events in VITT. However, molecular mechanisms of cellular interactions, signaling pathways and involvement of different cell types in VITT antibody-mediated thrombosis are not fully understood. Moreover, uncertainty exists regarding current treatment protocols since the sole anticoagulation was shown to be inefficient to prevent thrombosis progression in severe VITT cases. In this study, we demonstrate that platelet spleen tyrosine kinase (SYK) modulates anti-PF4 VITT-mediated thrombus formation in an ex vivo model of immunothrombosis. Our study showed that the selective inhibition of SYK can abrogate VITT antibody-driven procoagulant platelet formation, activation of plasmatic coagulation as well as platelet-leukocyte interplay. Most importantly, the specific inhibition of SYK in platelets but not in neutrophils prevented VITT antibody-induced multicellular thrombus formation, without perturbing the platelet function. Our findings indicate that the specific targeting of platelet SYK might be a promising therapeutic approach to prevent thrombotic complications in patients with antibody-mediated immunothrombosis.
The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review
Authors: Migliorini Filippo , Cocconi Federico , Bardazzi Tommaso , Masoni Virginia , Gardino Virginia , Pipino Gennaro , Maffulli Nicola
Published: December 2024

Background

The ligamentum teres (LT) has received attention in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). Indeed, a better understanding of the function of the LT and its implications for clinical outcomes in the presence of a torn LT is required. This systematic review analyses the patient-reported outcome measures (PROMs) and the complication rate when an intact or torn LT is encountered during HA for FAI.

Methods

Studies that compared patients with an intact to those with a torn LT managed with debridement during hip arthroscopy for FAI were identified from the Web of Science, PubMed, and Embase. The minimum follow-up for inclusion was 24 months. The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias. Patient characteristics and PROMs were assessed at the baseline and last follow-up.

Results

The systematic review identified two studies comprising 611 patients. No statistically significant difference was found in pain, Harris Hip Score, and the activities of daily living and sports subscales of the Hip Outcome Score between patients with an intact LT and those with a torn LT treated with debridement, both of whom underwent HA for FAI.

Conclusions

In patients undergoing arthroscopic management for FAI, an intact or torn ligamentum teres managed with debridement does not influence postoperative PROMs. Given the importance of the LT as a structure of the hip joint and the increasing interest in HA for FAI, further standardised studies will be a valuable source for surgeons encountering this pathology.
Heart failure patients’ experiences of self-care neglect: a content analysis
Authors: Bahrodi Parisa Sadat , Safa Azade , Ajorpaz Neda Mirbagher , Avanji Fatemeh Sadat Izadi
Published: December 2024

Background

Heart failure is a chronic and common disorder worldwide. Patients with heart failure need self-care behaviors to manage their condition. Despite the importance of self-care in positive health outcomes, many patients with heart failure neglect their self-care behaviors. Therefore, the present study was conducted to explain heart failure patients’ experiences of self-care neglect.

Methods

This qualitative study was conducted using conventional content analysis method. Participants included 15 patients with heart failure. Data were collected through semi-structured interviews and using purposive sampling method. Sampling continued until data saturation was reached. Data analysis was performed concurrently with data collection. Lincoln and Guba’s four criteria were used to ensure the trustworthiness of the data. Data management was performed using MAXQDA version 24 software.

Results

The results were presented in the form of four main categories and 10 subcategories. In analyzing the data of the study, four main categories emerged in the participants’ experiences: “false cultural beliefs in self-care”, “weakening of mental-psychological power”, “synergy of physical problems”, and “inappropriate support”.

Conclusion

The patients in their experiences of neglect in self-care pointed to false cultural beliefs in self-care, weakening of mental-psychological power, synergy of physical problems, and inappropriate support. Knowing the factors that influence self-care neglect and preventing their occurrence can improve self-care skills and prevent neglect-related side effects in patients with heart failure. Healthcare providers can help improve the health of these patients by developing interventions to mitigate these factors. It is suggested that future research be designed in the form of an intervention to reduce the effect of each of these factors.

Trial registration

This is a qualitative study and has not been registered in Iranian Registry of Clinical Trials.
Troponin-T as predictor of mortality in patients attending the emergency department with atrial fibrillation
Authors: Celik Serkan , Eriksson Linus Bodeström , Hytting Jakob , Waldemar Annette , Mallios Panagiotis , Berggren Amanda , Oscarsson Ellen , Digerfeldt Christofer , Wijkman Magnus , Hubbert Laila
Published: December 2024

Background

High-sensitive Troponin-T (hsTnT) is often increased in acute illness and may be of prognostic importance in patients with atrial fibrillation (AF). The aim of this study was to analyse the characteristics and data of patients attending the emergency department (ED) with AF to determine whether age-adjusted hsTnT levels can predict mortality.

Methods

This retrospective, single centre, register-based cohort study included all patients ≥ 18 years attending the emergency department during 2018 and 2020 with a primary diagnosis at the ED of AF and sampled for hsTnT. Symptoms, comorbidities, lab results, and characteristics were registered. Patients were divided into groups based on hsTnT level (< 15, 15–50, and > 50 ng/L). Primary outcomes: 30-day and 1-year mortality.

Results

A total of 625 patients were included (median age 72, and 45% female). All-cause mortality was 2% at 30 days and 8% at 1-year. The hazard ratio (HR) for 30-day mortality was 4.17 (95% confidence interval (CI) 0.49–35.79, p = 0.192) for hsTnT 15–50 ng/L and 9.64 (95% CI 0.98–95.30, p = 0.053) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age. The HR for 1-year mortality was 4.82 (95% CI 1.81–12.82, p = 0.002) for hsTnT 15–50 ng/L and 9.70 (95% CI 3.27–28.74, p < 0.001) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age.

Conclusions

Elevated hsTnT levels increase the risk for 30-day and 1-year mortality independently of age. Both mild and major elevation of hsTnT levels is associated with increased risk for 1-year mortality regardless of age.
Association between number of functional teeth and physical function among community-dwelling older adults: Korean Frailty and Aging Cohort Study
Authors: Lim Nahyun , Lee Daehyun , Shin Seung-Yun , Won Chang Won , Kim Miji
Published: December 2024

Background

Functional teeth are important for maintaining appropriate masticatory function and nutritional intake, affecting physical function in older adults. This study aimed to evaluate the association between number of functional teeth and physical function in community-dwelling older Korean adults.

Methods

This cross-sectional study was conducted among a total of 2,527 participants (mean age, 76.5 ± 3.9; 53.4% women) who were enrolled in the Korean Frailty and Aging Cohort Study (2016–2017). Participants were categorized based on the number of functional teeth into two groups: < 20 and ≥ 20 functional teeth. Functional teeth were defined as the remaining natural teeth with visible crowns, with or without restorations, prosthetic pontics, or dental implants on panoramic radiography. Physical function was assessed using handgrip strength, gait speed, five-times sit-to-stand test (5TSTS) duration, and the Short Physical Performance Battery (SPPB) score. Multivariate linear and logistic regression models were used to evaluate the association between number of functional teeth and physical function.

Results

Of all the participants, 869 (34.3%) had < 20 functional teeth. After full adjustment for sociodemographic factors, lifestyle, health condition, and oral health, an increase in one functional tooth was associated with a corresponding increase in gait speed (men: B = 0.002, p = 0.032; women: B = 0.002, p = 0.013) and SPPB (men: B = 0.019, p < 0.001; women: B = 0.018, p < 0.001) in both men and women. The time taken for the 5TSTS was shorter for an increase in one more functional tooth (men, B=-0.033, p = 0.006; women, B=-0.036, p = 0.021) in both men and women. An increase in one functional tooth was associated with a corresponding increase in handgrip strength only in men (men, B = 0.049, p = 0.009; women, B=-0.003, p = 0.814). The associations between < 20 functional teeth and low handgrip strength [odds ratio (OR) = 1.46, 95% confidence interval (CI): 1.03–2.06], long 5TSTS duration (OR = 1.47, 95% CI: 1.07–2.02), and low SPPB scores (OR = 1.64, 95% CI: 1.07–2.53) were significant in fully adjusted model compared with ≥ 20 functional teeth only in men.

Conclusions

Fewer functional teeth were associated with low physical function in older adults. Our results emphasize the importance of maintaining adequate functional teeth to preserve physical function in community-dwelling older adults.
Sexual health after childbirth in Dutch women: prevalence, associated factors and perceived need for information: a cross-sectional study
Authors: Wassenaar EL , Lont F , Verhoeven CJ , Henrichs J , Titulaer LML , Warmelink JC , Geerts CC
Published: December 2024

Background

After childbirth, women often experience changes in sexual health. Little is known about the associated factors for the development of sexual health problems. Therefore, in this study we aim to investigate (1) how many women report changes in sexual health; (2) the prevalence and associated factors of women’s postpartum sexual health problems and (3) whether women want to be better informed about postpartum sexual health after childbirth.

Methods

From March to May 2021, 641 postpartum Dutch women participated in a cross-sectional study through an online survey, distributed via social media. At a mean time of 11.6 months (SD = 6.23) after birth, women reported information on maternal, pregnancy and childbirth characteristics and childbirth experience, sexual dysfunction (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), relationship satisfaction (Relationship Assessment Scale) and “perceived need for information” to discuss sexual health with their maternity care provider.

Results

Postpartum changes in sexual health were found in 88% of women. Of the women who participated, 43.7% reported sexual dysfunction and 52.3% reported sexual distress. Overall, 46% of women perceived more need for information. Multivariable logistic regression analyses showed that negative sexual experiences were associated with increased odds of sexual dysfunction (odds ratio (OR) 1.58, 95% CI 1.04–2.40) and sexual distress (OR 1.70, 1.17–2.46). Perineal damage (OR 1.54, 1.03–2.29) was associated with increased odds of sexual dysfunction, and a BMI ≥ 30 kg/m2 (OR 0.46, 0.28–0.70) was associated with decreased odds of sexual dysfunction. A higher level of relationship satisfaction was associated with decreased odds of sexual dysfunction (OR 0.36, 0.25–0.51) and sexual distress (OR 0.47, 0.35–0.63). A positive childbirth experience was associated with decreased odds of sexual distress (OR 0.88, 0.81–0.96) and decreased odds of “perceived need for information” (OR 0.86, 0.79 to 0.94).

Conclusion

Sexual health problems are experienced by half of postpartum women. Midwives should inform women and their partners about these possible problems, taking into account birth-related factors, e.g. birth experience and perineal damage. Care providers should pay special attention to women with negative sexual experiences.
Challenges and opportunities in perinatal public health: the utility of perinatal health inequality dashboards in addressing disparities in maternal and neonatal outcomes
Authors: Olakotan Olufisayo , Lim Jennifer N. W. , Pillay Thillagavathie
Published: December 2024

Introduction

In clinical settings, digital dashboards display medical data, with the aim of identifying trends and signals. In so doing these contribute towards improving service delivery and care within hospitals. It is not clear whether the utility of perinatal health equity dashboards could be used to identify health inequality trends that could potentially impact on health service delivery, care and public health interventions. This study aims to evaluate the implementation of health inequality dashboards that address disparities in maternal and neonatal outcomes, with a specific focus on identifying key challenges encountered during their deployment and use in healthcare settings.

Methods

Three databases, namely Embase, CINAHL, and Medline were searched to identify relevant studies in English Language published between 2010 and 2022. All findings were reported according to PRISMA guidelines for scoping reviews.

Results

Of 670 identified articles, only 13 met the inclusion criteria. The study identified three key themes: dashboard functionality, data accuracy, and challenges in collecting health inequality data. Dashboards were used to visualize disparities, with functionalities focusing on specific audiences, contents, and utility. Issues with data completeness, standardization, and challenges in collecting consistent health inequality data, especially from diverse ethnic groups, hindered the accurate tracking of maternal and neonatal disparities.

Conclusion

The use of perinatal health inequality dashboards is a critical step forward in optimizing maternal and neonatal care by providing targeted interventions. However, further research is needed to assess their long-term impact on reducing health inequalities, while addressing challenges related to data accuracy, completeness, and standardization to improve their effectiveness.