Engineered lipid nanoparticles loaded with LL-37 peptide as inhalable drug delivery carriers for the treatment of bacterial infections

Human cathelicidin LL-37 is a promising antibacterial agent; however, conventional administration routes limit its efficacy. This study aimed to develop cetyl palmitate (CP)-based lipid nanoparticles loaded with LL-37 peptide (LL) for pulmonary delivery. The nanoparticles manufactured using emulsification method with different CP:LL ratios were spherical with median diameters of 35-42 nm. Encapsulation efficacy was approximately 30%, resulting in a maximum peptide loading of 6.1%. The unloaded CP nanoparticles were negatively charged, while those loaded with LL-37 were neutral (CP + LL20:1) or positively charged (CP + LL10:1, CP + LL5:1). Increased zeta potential and the presence of mucopenetrative poly(vinyl alcohol) molecules at the nanoparticles surface (as evidenced by XPS studies) allowed effective adsorption of mucins on the surface of nanoparticles and enhanced penetration through mucus. The nanoparticles were cytocompatible with BEAS-2B lung epithelial cells. Encapsulation of LL-37 in CP protected cells from the negative impact of the peptide. In the presence of nanoparticles, Calu-3 lung epithelial cells were able to maintain their barrier properties in the advanced air-liquid interface model. The nanoparticles prevented the formation of the Pseudomonas aeruginosa biofilm and were also able to disrupt the existing early biofilm. The dose of LL-37 required to reduce biofilm viability was lower in the case of CP + LL5:1 nanoparticles, than for LL-37 alone (LD50: 103 μg/ml and 310 μg/ml, respectively). The developed nanoparticles exhibited suitable properties for inhalation, the ability to migrate through mucus, cytocompatibility, and antibiofilm properties against P. aeruginosa. This paves the way for their use for pulmonary administration by nebulization.

Changes in Sagittal Balance of Motion at the Thumb Metacarpophalangeal Joint After Sequential Trapeziectomy, Suspensionplasty, and Extensor Pollicis Brevis Tenodesis: A Cadaveric Study

BACKGROUND

We hypothesized that hyperextension metacarpophalangeal (MP) thumb deformity may be caused by trapeziectomy alone due to telescoping of the first metacarpal without trapezial support.

OBJECTIVE

To explore the relationship of trapeziectomy with hyperextension thumb MP joint deformity and contribute novel data on the underlying pathomechanics.

METHODS

This basic anatomical research study examined thumb MP joint kinematics at 6 surgical stages in 10 cadaveric specimens: stage 1, baseline; 2, volar plate of the thumb MP joint division; 3, trapeziectomy; 4, Weilby's ligament reconstruction and tendon interposition (LRTI); 5, extensor pollicis brevis (EPB) tenotomy; and 6, MP volar plate reconstruction by tenodesis with EPB. Six infrared cameras were used in a motion capture system to determine three-dimensional angles of the first MP joint during 10 cycles of thumb flexion-extension, measuring angles in maximum flexion and extension and the complete flexion-extension arc.

RESULTS

In comparison to baseline, the angle in extension and MP-ROM were significantly increased after stages 3 (trapezium extraction), 4 (LRTI), and 5 (EPB tenotomy). In comparison to values after stages 3, 4, and 5, the hyperextension was significantly corrected after stage 6 (tenodesis).

CONCLUSIONS

In a cadaveric model of trapeziectomy, secondary thumb column shortening favors an MP joint hyperextension deformity that is not corrected by LRTI or EPB tenotomy and requires a stabilization procedure.

Utilisation of the minimally invasive chevron akin (mica) osteotomy for severe hallux valgus: a systematic review

BACKGROUND AND AIM

Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the minimally invasive Chevron and Akin osteotomies (MICA) technique has become very popular. The aim of this review was to assess if MICA technique is a reliable procedure for treating severe hallux valgus.

METHODS

A systematic review was performed according to the Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed Medline and Cochrane library. To minimise the number of missed studies, no filters were applied to the search strategy. To be considered for this review, the articles needed to comply with the following inclusion criteria: Minimally invasive Chevron and Akin osteotomy (MICA) for severe hallux valgus (HVA > 40°, IMA > 16°), patient age over 18 years and minimum follow-up of 6 months.

RESULTS

Following the PRISMA flow chart 7 studies met the inclusion criteria and were taken into consideration in the review. We reached a population of 582 patients for a total of 676 feet. Males and females were 64 and 518, respectively. The mean age was 54.15 ± 8.25. The mean follow-up was 23.74 ± 9.60 months. All the studies reported an improvement in clinical results, in terms of function and quality of life. Radiological variables, mostly IMA and HVA, assessed pre- and postoperatively showed significant improvement in all studies included.

CONCLUSIONS

Despite the limited number of published studies in the literature, the available evidence reveals good clinical outcomes and high levels of patient satisfaction. Percutaneous surgery for severe hallux valgus can achieve great deformity correction with reasonable rates of residual deformity. Patient satisfaction and quality of life following third-generation MICA surgery is very high.

Arthroscopically Assisted Reduction and Internal Fixation for Tibial Plateau Fractures

Tibial plateau fractures are complex intra-articular injuries resulting from high-energy trauma in young patients or low-energy mechanisms in osteoporotic individuals. Proper management is crucial to restore joint congruity, stability, and function, ultimately preventing long-term complications such as post-traumatic osteoarthritis. Open reduction and internal fixation have been the traditional approach but are associated with significant morbidity, including extensive soft-tissue damage and infection risk. Arthroscopically assisted reduction and internal fixation have emerged as a minimally invasive alternative that allows for precise fracture reduction, direct assessment of intra-articular soft-tissue injuries, and lower complication rates. This review discusses the indications, surgical technique, advantages, limitations, outcomes, and future perspectives of ARIF in the management of tibial plateau fractures.

[Five myths around hallux valgus]

Hallux valgus, also known as a bunion, is one of the most frequent deformities of the forefoot. The prevalence is 23% in people between the ages of 18 and 65 years and 36% in people over 65 years of age. Hallux valgus deformity normally begins between the ages of 30 and 60 years. Women are overall more frequently affected than men. Hallux valgus is characterized by the valgus deviation of the big toe and the varus deviation of the first metatarsal bone (MT-I), also known as metatarsus primus varus. This deformity can lead to a pressure point on the medial MT‑I head due to shoe conflict and can restrict mobility. Hallux valgus is typically identifiable by a physical examination. Imaging techniques are important to assess the severity of the deformity and to rule out possible differential diagnoses, such as hallux rigidus. Hallux rigidus is a degenerative change of the first metatarsophalangeal joint (MTP‑I joint) and the second most common cause of pain in the MTP‑I joint. A combination of hallux valgus and hallux rigidus is not uncommon. The treatment of hallux valgus initially focuses on nonsurgical approaches such as wider shoes, orthoses and nocturnal splints. If conservative treatment is not effective, surgical treatment provides a proven therapeutic benefit. In recent years minimally invasive techniques have also made progress in foot surgery. In addition to the reduced soft tissue trauma, the extra-articular approach in particular shows a significant advantage. This article provides a current overview of hallux valgus by addressing five widespread myths.

Balancing benefits and risks of aerobic exercise for aging and musculoskeletal health

BACKGROUND

Long-term exercise is recognized as one of the most effective means of maintaining health after aging, but the relationship between moderate exercise and health in the older population is often overlooked.

OBJECTIVE

The present study was conducted to investigate the effects of excessive endurance exercise on the old mice musculoskeletal system.

RESULTS

The 8 weeks of normal endurance exercise significantly improved skeletal muscle mitochondrial biogenesis and increased femoral osteogenesis in young and old mice. However, the continued accumulation of total exercise volume as the exercise cycle was prolonged resulted in the younger and older mice exhibiting different exercise effects. After 8-16 weeks of moderate-intensity endurance exercise, young mice showed consistent effects of increased mitochondrial biogenesis in skeletal muscle. However, after 12-16 weeks of moderate-intensity endurance exercise, the original effects of exercise-induced mitochondrial biosynthesis were instead impaired in older mice. After 16 weeks of exercise, the aged mice showed a produces consumptive weight loss, an increase inflammation level in adipose tissue, and a decrease in femoral bone mineral density. Interestingly, with an increase in total exercise, the level of skeletal muscle inflammation in old mice did not increase significantly, while a longer exercise cycle reduced the level of skeletal muscle apoptosis, thereby maintaining the state of skeletal muscle.

CONCLUSIONS

Appropriate moderate-intensity endurance exercise has a significant gain in maintaining musculoskeletal health in aged mice. However, excessive endurance impairs the health of the musculoskeletal system in aged mice.

Vitamin D in the Transition from Acute to Chronic Pain: A Systematic Review

BACKGROUND

The transition from acute to chronic pain is an important clinical phenomenon that significantly impacts the healthcare system. Despite decades of research, preventing this transition remains a complex challenge. Many studies have explored the various factors that contribute to the development of chronic pain, but the underlying mechanisms are still largely unclear. In this frame, vitamin D (VD) plays an important role in pain mechanism development, with emerging evidence suggesting it influences pain perception, inflammation, and nerve function.

METHODS

A total of 14 eligible original research articles were identified.

RESULTS

Our qualitative analysis showed that VD did not directly influence the transition from acute to chronic pain, but it affected pain intensity, improving outcomes in patients at risk of developing chronic pain.

CONCLUSIONS

Additional randomized clinical trials, particularly double-blind, placebo-controlled studies, which are regarded as the gold standard in clinical research, are warranted to evaluate the role of vitamin D in the progression from acute to chronic pain.

Ranolazine as a therapeutic agent for diabetic cardiomyopathy: reducing endoplasmic reticulum stress and inflammation in type 2 diabetic rat model

BACKGROUND

Diabetic cardiomyopathy (DCM) is a significant cardiovascular complication of diabetes, characterized by structural and functional heart muscle dysfunction. Oxidative stress, endoplasmic reticulum (ER) stress, and inflammation are pivotal in the pathogenesis of DCM. Ranolazine, primarily used for angina, has demonstrated potential cardioprotective effects. This study investigates the effects of ranolazine on oxidative stress, ER stress, and inflammation in the heart tissue of type 2 diabetic rats.

METHODS

Diabetes was induced in male Wistar rats using Nicotinamide (110 mg/kg) and Streptozotocin (60 mg/kg). The rats were then divided into control and diabetic groups, with further subdivision into ranolazine-treated and untreated subgroups. Ranolazine was administered via gavage for eight weeks. Various parameters, including body weight, heart weight, serum glucose, troponin-I levels, oxidative stress markers, ER stress markers, and inflammatory markers, were assessed.

RESULTS

Diabetic rats showed increased heart weight and decreased body weight over eight weeks. Ranolazine treatment improved body weight but didn't affect serum glucose levels. The treatment significantly lowered serum troponin-I and oxidative stress markers, increased superoxide dismutase (SOD) and glutathione (GSH) levels, and decreased malondialdehyde (MDA) concentrations. Additionally, ranolazine reduced the expression of stress-related genes (GRP78, XBP1, and NLRP3) and lowered serum IL1β levels.

CONCLUSIONS

The results indicate that ranolazine protects against DCM by attenuating oxidative stress, ER stress, and inflammation. Its potential as a therapeutic agent for DCM warrants further investigation.

Knee functional outcomes and quadriceps hypotrophy after ACL reconstruction: a prospective observational study

BACKGROUND

ACL injuries are common among athletes and individuals experiencing trauma, leading to instability and functional impairments. Post-ACL reconstruction, patients often face challenges like pain and reduced knee function, impacting their daily lives and sports participation. The aim of this study was to describe knee functional outcomes of patients with ACL tears over three months through three subsequent visits.

METHODS

This prospective observational study involved patients with ACL tears who were assessed pre-ACLR and at 1 and 3 months post-ACLR. Measures included Tegner Activity Scale, IKDC Subjective Knee Evaluation, Lysholm Knee Scoring Scale, pain scales, quadriceps thickness via ultrasound, and Rectus femoris and Vastus lateralis muscle activation via surface electromyography.

RESULTS

A total of 98 patients were included in the study. Significant improvements were observed in Tegner Activity Scale scores (p < 0.001), IKDC scores (p < 0.001), Lysholm scores (p < 0.001), and pain scores (p < 0.001) over the study period. Ultrasonography and surface electromyography revealed ongoing quadriceps muscle hypotrophy and reduced neuromuscular function, highlighting the need for targeted rehabilitation.

CONCLUSION

Structured rehabilitation post-ACL reconstruction significantly improves functional outcomes and reduces pain. Challenges like muscle hypotrophy and decreased activation post-surgery emphasize the need for targeted rehabilitation strategies in the initial stages of recovery. Tailored programs focusing on these early deficits are crucial for optimizing recovery trajectories, enhancing knee stability, and preventing long-term complications. Immediate attention to these issues can help refine rehabilitation protocols, ensuring more effective outcomes as patients progress through their recovery. Further research should also focus on the long-term sustainability of these improvements.

An automated hip fracture detection, classification system on pelvic radiographs and comparison with 35 clinicians

Accurate diagnosis of orthopedic injuries, especially pelvic and hip fractures, is vital in trauma management. While pelvic radiographs (PXRs) are widely used, misdiagnosis is common. This study proposes an automated system that uses convolutional neural networks (CNNs) to detect potential fracture areas and predict fracture conditions, aiming to outperform traditional object detection-based systems. We developed two deep learning models for hip fracture detection and prediction, trained on PXRs from three hospitals. The first model utilized automated hip area detection, cropping, and classification of the resulting patches. The images were preprocessed using the Contrast Limited Adaptive Histogram Equalization (CLAHE) algorithm. The YOLOv5 architecture was employed for the object detection model, while three different pre-trained deep neural network (DNN) architectures were used for classification, applying transfer learning. Their performance was evaluated on a test dataset, and compared with 35 clinicians. YOLOv5 achieved a 92.66% accuracy on regular images and 88.89% on CLAHE-enhanced images. The classifier models, MobileNetV2, Xception, and InceptionResNetV2, achieved accuracies between 94.66% and 97.67%. In contrast, the clinicians demonstrated a mean accuracy of 84.53% and longer prediction durations. The DNN models showed significantly better accuracy and speed compared to human evaluators (p < 0.0005, p < 0.01). These DNN models highlight promising utility in trauma diagnosis due to their high accuracy and speed. Integrating such systems into clinical practices may enhance the diagnostic efficiency of PXRs.

Innovative colorimetric thermal study of methylcellulose hydrogel via smartphone imaging

A novel colorimetric analysis of methylcellulose (MC) hydrogel was conducted using a standard smartphone camera to measure its thermo-optical properties. As demonstrated for the first time, the temperature of MC gels was directly determined from photographs by exploiting a unique one-to-one correlation between temperature and mean pixel intensity in the blue channel of RGB images, all color channels showed strong hysteresis. Two innovative procedures for gelation assessment are introduced: variance analysis and histogram analysis with normal distribution fitting. The variance analysis confirms known gelation related temperatures, validating the effectiveness of the new method. Histogram analysis reveals a significant increase in RMSE (root mean square error) near gelation related points, offering a new indicator for gelation status. This methodology underscores the untapped potential of colorimetry to extract valuable data from hydrogels in general and MC gel in particular.

Abnormalities of insular functional connectivity in patients with musculoskeletal pain: A meta-analysis of resting-state fMRI studies

BACKGROUND

Resting-state functional magnetic resonance imaging (fMRI) studies have shown abnormal functional connectivity (FC) of the insula (INS) in patients with musculoskeletal pain (MSP). However, there is a lack of consistency in previous studies, which is an obstacle to understanding the underlying neuropathology of MSP.

METHOD

Seven databases, including PubMed, Web of Science, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chongqing VIP, were systematically searched from inception to 15 May 2024. The meta-analysis of the aberrant INS-based FC in MSP patients was performed using the anisotropic effect-size signed differential mapping (AES-SDM).

RESULTS

A total of eleven neuroimaging studies with 276 patients and 253 HCs were included in the meta-analysis. The results indicate that MSP patients have increased FC between INS and the right median cingulate gyri, right inferior frontal gyrus, right paracentral lobule, and right supplementary motor area, and decreased FC between INS and the right posterior cingulate gyrus, left precuneus, and left angular gyrus. Heterogeneity and sensitivity analysis showed that most of the results of INS-based FC were highly reproducible and robust. Meta-regression analysis showed that revealed a negative association between the Visual Analog Scale (VAS) score and the reduction in FC between the INS and the left precuneus.

CONCLUSION

The meta-analysis reveals that patients with MSP show abnormal FC between the INS and multiple brain regions, which are involved in emotional, cognitive, sensory, visuospatial and motor regulation of pain. These findings provide important insights into the underlying neuropathological mechanisms of musculoskeletal disorders.

Functional Outcome of Intraarticular Osteotomy and Osteosynthesis for Calcaneal Malunion with Salvageable Subtalar Joint: A Retrospective Case Series

Background and Objective

Calcaneal malunion, a frequent complication of calcaneal fractures, disrupts hindfoot anatomy, causing pain, deformity, stiffness, and gait abnormalities. While conservative management can be effective in selected cases, surgical intervention is often required. This study evaluates the efficacy of intraarticular osteotomy and osteosynthesis as a joint-preserving procedure to manage calcaneal malunion and prevent subtalar arthrodesis.

Methods

A retrospective analysis was conducted on ten male patients (aged 23-52 years) with symptomatic calcaneal malunion who underwent intraarticular osteotomy and osteosynthesis between March 2015 and March 2023. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Clinical, radiological, and procedural parameters were analyzed.

Results

The average follow-up duration was 42.9 months (range 15-108 months). Type II malunion (60%) was the most common. Postoperative functional outcomes showed improvement, with a mean MFS of 92.4 and an AOFAS score of 84. Wound breakdown primarily in diabetic patients, was managed successfully with negative pressure wound therapy. Significant enhancements in radiological alignment and functional parameters were observed in all patients.

Conclusion

Intraarticular osteotomy and osteosynthesis are effective surgical options for managing calcaneal malunion, facilitating subtalar joint preservation and obviating the need for subtalar arthrodesis. This procedure optimizes functional recovery and preserves joint mobility in carefully selected patients.

Can MRI predict return to sport after anterior cruciate ligament reconstruction? A systematic review of the literature

PURPOSE

To analyze whether magnetic resonance imaging (MRI) can predict return to sport after anterior cruciate ligament (ACL) reconstruction and whether a correlation exists between return to sports, level of activity and MRI signals.

METHODS

The search terms selected for inclusion in the title, abstract, and keyword fields were as follows: 'anterior cruciate ligament' OR 'ACL' AND 'graft maturation' OR 'MRI' AND 'return to sport' OR 'sports activity.' For each study, patient data and the MRI protocol used to assess graft maturation were extracted. An analysis of the correlations between MRI and ACL reconstruction was performed.

RESULTS

A total of 394 patients were included from 7 studies. The mean radiological follow-up was 19.06 ± 11.02 months. Three studies reported no correlations between graft bending angle, signal/noise ratio, signal intensity or Howell score and return to sport. One study revealed that T2* was correlated with return to sport. A further investigation demonstrated that those who were able to regain their preinjury athletic performance exhibited considerably lower ACL/PCL ratio and ACL/muscle ratio of the ACL mid-substance compared to those who were unable to attain the same level of athletic performance. Only one study reported correlations between 12-month SNRs and 60-month Cincinnati, Lysholm and Tegner activity scales, whereas Biercevicz revealed that the combination of volume and the SI predicted the KOOS score at the 5-year follow-up.

CONCLUSIONS

There are no reliable radiological parameters available that correlate with return to sport after anterior cruciate ligament reconstruction, but MRI can potentially play a key role in closing this gap.

LEVEL OF EVIDENCE

Systematic review of level IV.

STUDY REGISTRATION

PROSPERO-CRD42024574365.

Hydrogel contact lenses modified by quaternary chitosan and epigallocatechin gallate with enhancement of antimicrobial for bacterial keratitis

Bacterial keratitis (BK) is an acute or chronic transient keratopathy that, in extreme circumstances, can result in blindness. Conventional contact lens (CL) materials also have drawbacks of insufficient antimicrobial properties. The research aims to develop a new potion-containing gel CL based on pHEMA hydrogel with a radius of 15 mm and a thickness of 0.3 mm, using quaternized chitosan and EGCG, which can combine the advantages of natural bio macromolecular materials and active ingredients of traditional Chinese medicine. The resulting hydrogel CL has good antibacterial activity against S. aureus and E. coli, as well as appropriate water content (>40 %), anti-swelling, light transmittance (>90 %), and mechanical qualities. The resulting hydrogel CL was biocompatible, had strong antioxidant qualities, good ROS scavenging ability and did not negatively impact normal cells due to the presence of EGCG. Additionally, studies on animals revealed that the hydrogel CL produced reduced the duration of BK therapy without causing any harm to the eye's tissue and was more effective than the antibiotic levofloxacin, offering a more successful plan for the clinical management of BK.

Development of an artificial intelligence powered software for automated analysis of skeletal muscle ultrasonography

Muscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of muscle size and quality. We aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and comparability of expert manual analysis quantifying lower limb muscle ultrasound images. Quadriceps complex (QC) and tibialis anterior (TA) muscle images of healthy, intensive care unit, and/or lung cancer participants were captured with portable devices. Manual analyses of muscle size and quality were performed by experienced physiotherapists taking approximately 24 h to analyze all 180 images, while automated analyses were performed using a custom-built deep-learning model (MyoVision-US), taking 247 s (saving time = 99.8%). Consistency between the manual and automated analyses was good to excellent for all QC (ICC = 0.85-0.99) and TA (ICC = 0.93-0.99) measurements, even for critically ill (ICC = 0.91-0.98) and lung cancer (ICC = 0.85-0.99) images. The comparability of MyoVision-US was moderate to strong for QC (adj. R2 = 0.56-0.94) and TA parameters (adj. R2 = 0.81-0.97). The application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong comparability compared with human analysis across healthy, acute, and chronic population.

Effectiveness of Microwave Therapy Combined with Berberine /GelMA via COX-2/IL-1β Pathway to Treat Skeletal Muscle Injury: An in vivo Study in Rats

Introduction

Skeletal muscle injuries are short-term, that occur in people who play sports and train. Regular exercise and sports populations undergo repetitive tearing and regeneration of skeletal muscle, in which muscle damage is a necessary component to produce an oxidative inflammatory response and tissue reconstruction. The primary goals of treating this illness are to reduce the disease process cycle and get rid of symptoms like swelling and inflammation at the site of localized injury. Berberine (BBR) has several pharmacological effects, including anti-inflammatory, anti-tumor, and anti-arrhythmic properties.

Methods

In order to treat skeletal muscle injuries, a safe and non-toxic nanogel (BBR/GelMA) was developed for efficient berberine delivery. It also investigated whether BBR/GelMA had anti-inflammatory properties via the NF-κB pathway. Microwave irradiation was added to promote the uptake of BBR in BBR/GelMA by injured skeletal muscle and to accelerate the process of injury recovery.

Results

It turns out that the survival rates of NIH313 and L929 cells decreased to varying degrees in GelMA loaded with different concentrations of BBR, but the survival rates of the two cell lines were the highest at a concentration of 0.125 mg/mL.

Conclusion

In this experiment, the inhibitory effect of BBR/GelMA on inflammation was studied. After NIH-313 and L929 cells were treated with GelMA loaded with different doses of BBR, it was found that the concentration of BBR/0.5 mg/mL had the best inhibitory effect on these two inflammation-inducing cell lines, and this inhibitory effect was related to the drug loading concentration. On the other hand, BBR/GelMA and microwave therapy can play an anti-inflammatory and repairing role in skeletal muscle through NF-κB pathway. In addition, microwave can accelerate the diffusion of BBR in BBR/GelMA within injured skeletal muscle, speeding up the healing process after skeletal muscle injury and shortening the disease cycle.

Proximal Hip Fracture: Does Canal Width Matter?

Background/Objectives: Proximal femur fractures are common in the older population and are related to bone quality. Our work evaluates bone parameters from pelvic anteroposterior (AP) radiographs in patients with trochanteric and sub-capital fractures to determine if there are predictive morphology parameters for each fracture type. Methods: Data from 237 medical records were extracted from patients who arrived at our hospital with trochanteric and sub-capital femoral fractures. Descriptive data and radiological evaluation of the calcar-to-canal ratio (CCR), cortical thickness index (CTI), and Dorr classification were measured by two observers and statistically evaluated. Results: A total of 202 patients were found to be eligible for the study. The mean patient age was 81.41 ± 7.27 years old. The mean age of the trochanteric group was significantly higher than that of the sub-capital group (p = 0.005). There were no statistically significant differences in gender and comorbidities. The CCR showed significance, but the CTI and Dorr classification did not show a significant difference (p = 0.001, p = 0.78, and p = 0.98). A high degree of reliability was shown for all measurements. The ICC for CTI and CCR was p = 0.791 and p = 0.770 (p < 0.001), and Cronbach's alpha was 0.815 and 0.796, respectively. Logistic regression was found to be significant in predicting 60.4% of correct forecasts with an odds ratio of 0.011 and 95% confidence interval (p = 0.001). For CTI, the correct forecasting rate was 48%, with an odds ratio of 0.615 (p = 0.78). Conclusions: We found that, out of the measured parameters, the CCR stood out as important, showing that higher CCR levels are linked to an increased likelihood of trochanteric fractures.

Intra-Individual Differences of the Femoral Cortical Thickness Index in Elderly Patients with a Proximal Femoral Fracture

Background/Objectives: Osteoporosis is prevalent in the elderly and increases fracture risk. Bone density is commonly assessed using dual-energy X-ray absorptiometry (DEXA). The femoral cortical thickness index (CTI) also provides indirect information for osteoporosis. It remains unclear whether there are intra-individual differences and if a correlation to fracture risk of the CTI in fractured femora results due to fracture related malrotation during X-rays. The aim of this study was to investigate the individual bilateral CTI in patients with proximal femoral fractures. Methods: A retrospective analysis of 200 surgically treated patients (100 trochanteric, 100 femoral neck fractures) was performed. Measurements included the bilateral CTI at 10 and 15 cm below the lesser trochanter. Analysis of the correlation of those examinations, in comparison to the contralateral CTI at 15 cm, and correlation of the CTI with the body mass index (BMI) and age was performed. Results: Results showed significant differences (p < 0.001) in bilateral CTIs for both fracture types at 15 cm with a strong inter-rater reliability (ICC > 0.9). There was no significant correlation between age and CTI, as well as BMI and CTI in both cohorts (p > 0.1). Sex-specific subgroup analyses revealed that females exhibited significant differences in CTI between fractured and non-fractured sides (p < 0.001). Conclusions: In conclusion, CTI, and the modified CTI at 15 cm below the lesser trochanter in fractured proximal femora, is lower compared to the non-fractured side. The femoral CTI could help in daily clinical routines and circumstances, where more detailed risk prediction tools are lacking.

A cross-sectional study on the correlation between fasting blood glucose and bone turnover markers in Chinese patients with osteoporotic fractures

Background

Recent studies suggest that metabolic factors, such as fasting blood glucose (FBG), may significantly affect bone health, influencing the risk and severity of osteoporotic fractures (OPFs). This study examined the association between FBG levels and bone turnover markers (BTMs) in patients hospitalized for OPFs requiring surgical intervention.

Methods

A retrospective cross-sectional analysis was conducted on 888 patients treated for OPFs at Kunshan Hospital affiliated with Jiangsu University from November 2018 to August 2023. Serum levels of FBG, procollagen type 1 N-terminal propeptide (P1NP), and β-C-terminal telopeptide of type I collagen (β-CTX) were measured, with FBG serving as an independent variable, and P1NP and β-CTX as outcome variables. Patients were stratified into tertiles based on FBG levels, and multiple regression models were adjusted for confounding variables, including age, gender, BMI, and clinical parameters. Non-linear relationships and threshold effects were analyzed.

Results

Adjusted regression models identified a negative association between FBG and BTMs. For each 1 mmol/L increase in FBG, β-CTX levels decreased by 0.02 ng/mL (95% CI: -0.04 to -0.01; p < 0.01), and P1NP levels decreased by 2.91 ng/mL (95% CI: -4.38 to -1.45; p < 0.01). Non-linear relationships were observed, with an inflection point at 7.93 mmol/L for both markers. Below this threshold, higher FBG levels were associated with a steeper decline in BTMs.

Conclusion

FBG levels exhibit a negative non-linear association with P1NP and β-CTX in patients with OPFs. Elevated FBG levels may adversely affect BTMs, potentially contributing to the progression of osteoporosis (OP). These findings underscore the importance of glycemic control in managing bone health among patients with OPFs.

The impact of corrective exercises, kinesiology taping, and mechanical correction on pain and foot shape in women with hallux valgus

Background

This study aimed to assess the effect of corrective exercises and exercises supplemented by kinesiology taping or an orthosis on pain and foot alignment in women with hallux valgus (HV).

Methods

Eighty-two women with HV were randomly divided into groups: E (n = 24) who exercised for 12 weeks; EKT (n = 18) who exercised and used kinesiology taping on HV; EMC (n = 15) who performed exercise and used an orthosis to correct their big toe position; and CHV (25 women with HV without therapy). Additional control group C: (n = 31) women with normal hallux. The Wejsflog index, Clarke's angle, alpha and beta angles, and pain intensity in the big toe area were assessed at the beginning and after therapy.

Results

The Wejsflog index was significantly lower in women with HV and increased significantly after therapy in the E and EKT groups. Clarke's angle did not differ between women with and without HV, and Clarke's angle did not change after therapy. The HV angle decreased significantly in groups E and EKT but was still significantly greater than that in group C. The fifth toe varus angle did not differ between women with and without HV and decreased significantly in the right foot after therapy in group E. Pain in the HV area decreased significantly in all groups undergoing therapy.

Conclusion

Women with HV have a greater forefoot width, but their longitudinal arch and fifth toe position do not differ. Exercises significantly reduce pain and improve hallux alignment. Combining exercises with kinesiology taping or an orthosis does not increase the therapeutic effect. Although the observed effects of conservative therapy are promising, it should be remembered that long-term effects have not been studied.

Trial registration

The Australian New Zealand Clinical Trials Registry (ACTRN12621000902897).

Impact of Adequate Disinfection Techniques for Ultrasound-Guided Injections in Musculoskeletal Rehabilitation: A Scoping Review

Background: Interventional physiatry is a branch of medicine that uses minimally invasive ultrasound-guided techniques for diagnosis and treatment in the musculoskeletal system. The aim of this scoping review is to investigate the sterilisation techniques used and the rate of infection with ultrasound-guided injections. Methods: PubMed was searched up to 30 September 2024 using the following search terms ("Ultrasound, Interventional"[mesh]) AND "Injections, Intra-Articular"[mesh]; "Ultrasound-guided intra-articular injection". The inclusion criteria were randomised clinical trials, written in English, involving US-guided mini-invaexercissive procedures. Results: The search identified a total of 256 potentially relevant publications. After screening for duplication, inclusion, and exclusion criteria, 105 articles were eligible for data extraction. In 51 studies, the method of skin disinfection was not specified, 18 RCT reported a 'sterile condition', 9 studies used povidone-iodine solution, 5 used alcohol, and 2 used chlorhexidine 0.5%. In 64 trials, the method of probe preparation was not specified, 11 trials described the use of sterile gel, 10 trials reported the use of a probe cover, sterile pad, or barrier, and 2 trials reported the use of chlorhexidine 0.5%; 41 studies reported mild adverse events and 4 serious adverse events. Conclusions: Taken together, the findings of this scoping review did not show a clear relationship between current sterilisation protocols and the prevention of the microbial contamination of the probes or the patient's skin. The variation in protocols highlights the need for standardised guidelines and more rigorous studies to accurately determine the most effective disinfection practices.

The posterior cruciate ligament angle in the setting of anterior cruciate ligament deficient knees: the effect of gender, age, time from injury and tibial slope

PURPOSE

This study aimed to assess the posterior cruciate ligament (PCL) angle in anterior cruciate ligament (ACL) deficient knees and correlate it with anatomical and demographic factors such as tibial slope, anterior tibial translation, age, gender, and time of injury.

MATERIAL AND METHODS

Patients were eligible for inclusion if they were clinically diagnosed with an ACL tear confirmed by MRI. For each patient, the following parameters were evaluated: PCL angle (PCLA), medial tibial slope (MTS), lateral tibial slope (LTS), medial anterior tibial translation (MATT), and lateral anterior tibial translation (LATT).

RESULTS

A total of 193 patients were included in the study, comprising 91 (47.2%) females and 102 (52.8%) males, with a mean age of 30.27 ± 12.54 years. The mean time from injury to MRI was 14.18 ± 55.77 days. In the overall population, the mean PCL angle was 128.72 ± 10.33°, the mean medial tibial slope was 3.57 ± 2.33°, and the mean lateral tibial slope was 6.07 ± 3.52°. The mean medial and lateral anterior tibial translations were 4.76 ± 2.02 mm and 7.01 ± 2.48 mm, respectively. In 190 cases (98.4%), the PCL angle was ≥ 105°. The PCL angle negatively correlated with medial and lateral anterior tibial translation (p < 0.05). Females exhibited a higher PCL angle compared to males (p = 0.019).

CONCLUSION

In the context of ACL lesions, the PCL angle has a normal value in acute injuries (> 105°) and decreases over time. The PCL angle is negatively correlated with anterior tibial translation, and females have a higher PCL angle compared to males.

LEVEL OF EVIDENCE IV

Retrospective Cohort.

The association between occupational lead exposure and serum levels of vitamin D3 and a bone turnover biomarker in smelter workers

OBJECTIVE

Bone tissue is the chief target for lead (Pb) in chronic exposure. This study aimed to demonstrate the relation between the blood lead levels (BLL) and serum levels of 1,25 dihydroxy cholecalciferol (vitamin D3) and type I collagen cross-linked C-telopeptide (CTX-1) as a biomarker of bone turnover among some Egyptian workers occupationally exposed to Pb in the smelting process. The study also targeted to identify any clinical manifestations indicative of skeletal system affection and their association with the performed investigations.

METHODS

A total of 48 smelter workers and 48 administrative controls participated in the study. All subjects underwent comprehensive medical and occupational history taking and detailed clinical examinations, with a particular focus on symptoms indicative of skeletal system involvement. These symptoms included generalized bony aches, low back pain, joint pain, restricted joint movement, a history of fractures from minor trauma, and delayed fracture healing. BLL, as well as serum levels of vitamin D3 and CTX-1, were measured in all participants.

RESULTS

Smelter workers exhibited significantly higher prevalence of bony aches, low back pain, joint pain, and past fractures from minor trauma compared to controls. The BLL and serum CTX-1 levels were significantly elevated in the exposed group, while serum vitamin D3 levels were notably lower. Logistic regression analysis revealed that BLL significantly predicted bony aches and low back pain. Additionally, serum vitamin D3 and CTX-1 levels were significant predictors of low back pain and joint pain, respectively, among exposed workers. The measured parameters were significantly correlated with one another and with the duration of employment in the exposed group.

CONCLUSION

Significant associations between manifestations of skeletal system affection, BLL, and serum levels of vitamin D3 and CTX-1 were detected among smelter workers with chronic occupational exposure to Pb.

Physical Parameters in Young Competitive Padel Players: Strength, Power, Agility, and Smash Velocity Assessments

The main objective of this study was to analyze the physical fitness parameters of young competitive padel players, compare potential differences between male and female players, and examine the relationships among various physical fitness variables in this population. The sample consisted of 18 players (10 boys and 8 girls) aged between 12 and 16 years old belonging to the Technification program for minors of the Valencian Padel Federation. The players completed a test battery that consisted of different tests: CMJ jump, internal and external shoulder rotator strength, manual dynamometry, functional upper body strength (forehand throw, backhand throw, bilateral overhead throw, and serve throw), smash speed, 5 × 10 m agility test, and tapas test. Data analysis was carried out with SPSS software for Windows (Version 25.0, IBM Corp., Armonk, NY, USA). The results showed that the boys obtained significantly higher values in the tests of dynamometry, speed, agility (tapas test), and throws (forehand, backhand, serve, and over the head), and the girls obtained significantly higher values in the test of shoulder external rotation (non-dominant). At the same time, the force variables were significantly and positively related to each other. The CMJ values are also significantly and positively correlated with the variables of shoulder rotation, sprint speed, and medicine ball throws. Regarding agility, significant and positive correlations were found in the tapas test. However, the 5 × 10 m test showed negative and significant correlations with some variables. It has been observed that the results obtained coincide with the results found in other studies carried out with players of the same age in other sports, such as tennis and soccer.

Influence of low bone mineral density on risk of falls and gait in post-menopausal women and elderly: A systematic review

BackgroundLow bone mineral density (LBMD) significantly contributes to loss of independence, gait impairment, and increased fall risk. Instrumental gait analysis provides an accurate evaluation of walking ability, that represent the first step for a personalized rehabilitation.ObjectiveTo collect and describe the available literature on the effect of LBMD on walking characteristics and the use of motion analysis systems in patients with LBMD.MethodsWe performed a literature search of the last ten years on PubMed, Web of Science and Scopus of papers on older people and patients with LBMD in terms of gait parameters, balance, and fall risk. The review protocol was registered on PROSPERO (CRD42024590090).ResultsThe database search identified totally 756 records; after duplicates deletion, 13 were considered eligible. The results reported that subjects with LBMD had kinematic alterations of the walk, alterations of posture, speed of walking and the strength generated in the gait. Patients with osteoporosis show a reduction of gait speed and trunk asymmetry; moreover, there is a a decrease in body rotation and lower hip and ankle moments in post-menopausal women.ConclusionsPatients with LBMD showed gait alterations that can higher the risk of falls. In this context, gait analysis can be useful in detecting variations in pattern, symmetry, gait speed and posture in elderly patients, that can represent an essential step for a personalized rehabilitation program.

Platelet-rich plasma with versus without hyaluronic acid for hip osteoarthritis: a systematic review and meta-analysis

Background

The use of intra-articular orthobiologics in hip osteoarthritis (HOA) has been presented as a therapeutic option and to postpone arthroplasty. There is little scientific evidence on the clinical application of platelet-rich plasma (PRP) associated with hyaluronic acid as dual therapy. Thus, the aim of our systematic review is to compare the clinical improvement with the use of PRP with versus without hyaluronic acid (HA) in hip osteoarthritis.

Methods

We systematically searched Cochrane, PubMed, and Embase databases for studies evaluating patients with HOA who received PRP with vs. without HA. Pain and functional score were collected and pooled at 3-, 6-, and 12-months follow-up. Mean differences (MD) and 95% intervals were calculated, and heterogeneity was assessed using I2 statistics. All statistical analysis was performed using R with the meta package.

Results

We included 2 randomized controlled trials (RCTs) and 1 cohort study, comprising 190 patients, of whom 88 received the PRP plus HA. Relative to PRP alone, dual therapy led to significantly higher pain scores at 3 months (SMD 0.35; 95% CI 0.06 to 0.64; p < 0.01; I2 = 0%) and at 12 months (MD 11.92 points; 95% CI 3.87 to 19.97; p < 0.01; I2 = 0%), translating into worsening of pain including HA. There was no difference between groups at any follow-up regarding functional score or pain at 6 months.

Conclusion

Joint infiltration in HOA with PRP combined to HA showed higher perception of pain scores. Our findings suggest that the addition of HA in PRP treatment does not bring significant improvement and worsens patients' quality of life. However, more randomized trials with larger populations may increase robustness.

Systematic Review Registration

identifier, CRD42024581335.

Preparation of SF-gel-CS-Hap bionic biphasic porous scaffolds and evaluation of physical, mechanical and biological properties

Objective: Full-thickness cartilage defect are usually accompanied by subchondral bone damage, which is difficult to self-repair once damaged due to the lack of vascularization and innervation. In this study, a biphasic composite scaffold was developed by combining vacuum freeze-drying and iterative freeze-thawing with gelatin, chitosan, silk fibroin, and hydroxyapatite as the basic materials to explore the feasibility of using them for the repair of total cartilage defects. Methods and Results: Six groups of SF-CS-Gel-nHap porous scaffolds (Hap-0%, Hap-1%, Hap- 2%, Hap-3%, Hap-4%, Hap-5%) were prepared by vacuum freeze-drying and chemical cross-linking using filipin protein (SF), gelatin (Gel), chitosan (CS) and hydroxyapatite (Hap) as the base materials. A series of characterization methods were used to systematically analyze and test the morphological features as well as physical and mechanical properties of the scaffolds. Then a novel bionic biphasic porous scaffold was developed by a combination of freeze-drying and freeze-thawing using the SF-CS-Gel as the cartilage phase and the SF-CS-Gel-2%Hap as the subchondral bone phase. Finally, it was co-cultured with chondrocytes to verify the biological properties of the SF-CS-Gel/SF-CS-Gel-2%Hap bionic biphasic porous composite scaffold in vitro. The results showed that the SF-CS-Gel/SF-CS-Gel-2%Hap biphasic scaffolds had a highly porous mesh structure, with an average pore size of 156.06 ± 42.36 μm in the cartilage phase and 214.38 ± 65.82 μm in the subchondral bone phase. Co-cultured with chondrocytes, the live and dead cells stained, cck-8 growth and proliferation curves showed that the bionic scaffolds had good biocompatibility and cytotoxicity. Cytoskeletal staining showed that the morphology of chondrocytes in the bionic scaffolds could maintain three-dimensional growth as in vivo. Conclusion: The results showed that SF-CS-Gel/SF-CS-Gel-2%Hap biphasic scaffolds have good biocompatibility, biodegradability, stability, appropriate mechanical properties and porosity, and are suitable for repairing articular cartilage and subchondral bone. It is expected to be used as a repair material for articular cartilage in clinical applications.

Developing a nomogram for postoperative delirium in elderly patients with hip fractures

BACKGROUND

Postoperative delirium (POD) is a prevalent complication, particularly in elderly patients with hip fractures (HFs). It significantly affects recovery, length of hospital stay, healthcare costs, and long-term outcomes. Existing studies have investigated risk factors for POD, but most are limited by single-factor analyses or small sample sizes. This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.

AIM

To investigate POD incidence in elderly patients with HF and the independent risk factors, according to which a nomogram prediction model was developed and validated.

METHODS

This retrospective study included elderly patients with HF who were surgically treated in Dongying People's Hospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into the modeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into the delirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. The incidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independent risk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probability interval by the decision curve were utilized to statistically validate the accuracy of the nomogram prediction model, developed according to each factor's influence intensity.

RESULTS

This study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison of baseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities (P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell (RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperative platelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), and postoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participants were randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram prediction model was developed after screening key POD features using Lasso regression, support vector machine, and the random forest method. The nomogram showed excellent discriminatory capacity with area under the curve of 0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in the validation group. Calibration curves demonstrated good agreement between predicted and actual probabilities, and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively. The model has strong accuracy and clinical utility for predicting the risk of POD.

CONCLUSION

This study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBC transfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independent risk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracy and stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimize postoperative management and reduce delirium incidence.

Evaluating the impact of movement representation techniques on recovery outcomes in post-orthopaedic surgery individuals: a systematic review and meta-analysis

BACKGROUND

Although movement representation techniques has originally been used in neurological rehabilitation, growing researches suggests that it may also introduce advantageous effects to individuals with orthopaedic injuries. This systematic review and meta-analysis aimed to investigate the effects of these techniques on pain, range of motion, muscle strength, functional performance and fear of movement in individuals after orthopaedic surgeries.

METHOD

Five electronic databases were searched until April 2024. Two reviewers independently conducted study selection and data extraction. Randomized controlled studies containing individuals after limb surgeries were identified. The quality of enrolled studies and the overall certainty of evidence was assessed by scales, respectively. Egger's test and funnel plot were used to assess publication bias. Subgroup analysis was also conducted to explore the source of heterogeneity.

RESULTS

Twenty-one randomized controlled trials involving 659 postsurgical participants were identified. The meta-analysis suggested moderate-quality evidence of a positive effect on pain intensity (SMD=-0.85; 95% CI -1.26, -0.43; p < 0.001). A low quality of evidence pointed toward a positive effect on functional scales (SMD=-0.84, 95% CI -1.27, -0.41, p < 0.001) and range of motion (SMD = 0.8, 95% CI 0.24, 1.35, p = 0.005). The very low quality of evidence suggested a significant effect on the functional test results (SMD=-0.8, 95% CI -1.01, -0.58, p < 0.001). The results remained nonsignificant for muscle strength and fear of movement. Intervention quantity, Disability of Arm, Shoulder, and Hand (DASH) score and intervention content were the sources of heterogeneity for pain intensity, functional scale score and range of motion, respectively.

CONCLUSION

Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. Our results support the use of mental practice techniques in individuals after orthopaedic surgeries, with moderate to very low-quality evidence.

REVIEW REGISTRATION

This trial was registered on PROSPERO on 10 August, 2024 (CRD42024583380).

Effects of Autologous Tenocyte Injection for Overuse and Degenerative Tendinopathies: A Systematic Review

Background: The term tendinopathy commonly describes a series of alterations in the tendon, leading in functional impairment and pain, treated with several approaches, including exercises, physical agents, and injection therapies. Among the latter, autologous tenocyte injection (ATI) involves harvesting tenocytes from a healthy tendon of the patients and then isolating the tenocytes and culturing for 4-5 weeks. To date, there is still a lack of consensus about the efficacy of ATI in improving pain and function; therefore, the present review aimed to assess the role of ATI in the treatment of chronic tendinopathies. Methods: Two authors conducted a comprehensive search across PubMed Medline, Web of Science, Scopus, Cochrane Library, and Google Scholar (PROSPERO: CRD42024565211). From 174 articles, we finally included 5 articles. Results: The main effect obtained was the pain relief and, consequently, the improvement of patients' quality of life. The clinical improvement is also evident at MRI in which it is possible to see a progressive reduction with a general disappearance of the T2 signal hyperintensity between 4 months and 1 year. All the articles agree on the safety of ATI in chronic tendinopathies. Conclusions: ATI might represent a safe and valuable option in the management of chronic tendinopathies as a second line treatment in the case of resistant tendinopathies, with a minimal risk of side effects.

Utility of Weight-Bearing Computed Tomography in the Postoperative Assessment of Ankle Fractures

Background: Ankle fractures are among the most common injuries requiring surgical intervention. Standard radiographs are typically used for postoperative assessment; however, some patients continue to experience residual symptoms despite satisfactory radiographic outcomes. Weight-bearing computed tomography (WBCT), though not yet widely integrated into clinical practice, offers potential advantages in evaluating lower-limb deformities, injuries, and arthritis. This study explores the utility of WBCT for the midterm assessment following ankle fracture fixation and compares its findings with those obtained from standard radiographs. Methods: In this retrospective case study, we analyzed the correlations between the functional outcome scores approximately one year post-surgery and parameters assessed using WBCT. Pearson's correlation coefficient was used to evaluate these correlations, and a t-test was performed to assess their statistical significance, with a threshold p-value of 0.05. Additionally, Spearman's rank correlation coefficient was calculated as a supplementary descriptive measure, without significance testing. These correlations were then compared with those obtained from standard ankle radiographic views (anteroposterior, lateral, and mortise). Results: Several correlations were identified between WBCT parameters and functional scales, with certain parameters demonstrating high statistical significance (p < 0.05). Overall, the correlations observed for WBCT were stronger than those for standard radiographs. Conclusions: Although the study cohort was limited, the findings suggest that WBCT may provide additional insights beyond conventional radiography. Further research with larger patient groups is needed to establish its clinical relevance.

Hidden players in the metabolic vulnerabilities of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a complex and rapidly progressive motor neuron disorder with a fatal outcome. Despite the remarkable progress in understanding ALS pathophysiology, which has significantly contributed to clinical trial design, ALS remains a rapidly disabling and life-shortening condition. The non-motor neuron features of ALS, including nutritional status, energy expenditure, and metabolic imbalance, are increasingly gaining attention. Indeed, the bioenergetic failure and mitochondrial dysfunction of patients with ALS impact not only the high energy-demanding motor neurons but also organs and brain areas long considered irrelevant to the disease. As such, here we discuss how considering energy balance in ALS is reshaping research on this disease, opening the path to novel targetable opportunities for its treatment.

Causal associations between 26 musculoskeletal disorders and gut microbiota: a Mendelian randomization analysis with Bayesian validation

Emerging evidence suggests that gut microbiota imbalances may influence the onset of musculoskeletal disorders (MSDs), yet conclusive evidence establishing causation remains limited. This study investigates the causal relationship between gut microbiota and a range of MSDs, aiming to identify potential therapeutic targets. Using data on 211 gut microbiome taxa from a genome-wide association study (GWAS) and summary statistics for 26 MSDs from the Finnish Biobank, we employed Mendelian randomization (MR) with inverse-variance weighting (IVW) as the primary analytical approach, complemented by Bayesian model validation to ensure robust results. Our MR analyses revealed significant causal associations between gut microbiota and nine MSDs within four categories, including osteoporosis (IVW-Beta = 0.011, P = 0.025), rheumatoid arthritis (IVW-Beta = - 0.016, P < 0.001), rotator cuff syndrome (IVW-Beta = - 0.007, P = 0.022), and calcific tendonitis of the shoulder (IVW-Beta = - 0.021, P = 0.034). Bayesian validation underscored the plausibility of these relationships, supporting the potential causal role of gut microbiota in the development of these disorders. Our findings present a library of causal associations that underscore the gut microbiome's role in MSD pathogenesis, providing genetic evidence that highlights specific gut microbiota taxa as prospective therapeutic targets. This research offers novel insights into the pathogenic mechanisms underlying MSDs and points toward new directions for future investigation into microbiome-based therapies.

Evaluating the relationship between inflammatory markers and preoperative delirium in elderly hip fracture patients: A retrospective observational study

Preoperative delirium is common and associated with poor clinical outcomes in elderly hip fracture patients. Although inflammatory markers have shown potential in predicting postoperative delirium, their relevance to preoperative delirium remains unclear. This study aimed to investigate the relationship between inflammatory markers and preoperative delirium to improve risk prediction and management strategies. We retrospectively studied 548 elderly hip fracture patients aged 70 years or older. The primary outcome was preoperative delirium diagnosed using the Confusion Assessment Method (CAM). Explanatory variables included inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune-inflammation index [SII], inflammatory burden index [IBI], and systemic inflammation response index [SIRI]). About 7.66% of patients developed preoperative delirium in the study. These patients were more likely to be older, have comorbid cardiovascular disease, and be transferred to an internal medicine ward for further treatment (P < .001). Multivariate analysis further revealed that older age (OR = 1.11, 95% CI = 1.04-1.18) and comorbid cardiovascular disease (OR = 2.94, 95% CI = 1.51-5.67) were independently associated with the occurrence of preoperative delirium. No significant differences were observed between groups for inflammatory markers: NLR (P = .70), PLR (P = .09), IBI (P = .09), SII (P = .21), or SIRI (P = .80). Older age and cardiovascular comorbidities were independent risk factors for preoperative delirium. No significant associations were found with inflammatory markers. Future research should explore additional biomarkers to refine risk stratification in this population.

Diagnosis and Treatment of Hypophosphatasia

Hypophosphatasia (HPP) is a rare inherited metabolic disorder characterized by deficient activity of tissue-nonspecific alkaline phosphatase (TNAP) caused by variants in the ALPL gene. Disease manifestations encompass skeletal hypomineralization with rickets and lung hypoplasia, vitamin B6-dependent seizures, craniosynostosis, and premature loss of deciduous teeth. The clinical presentation can comprise failure to thrive with muscular hypotonia, delayed motor development, and gait disturbances later in childhood. In adults, pseudofractures are a characteristic indicator of severely compromised enzyme activity, but non-canonical symptoms like generalized musculoskeletal pain, weakness, and fatigue, frequently accompanied by neuropsychiatric and gastrointestinal issues are increasingly recognized as key findings in patients with HPP. The diagnosis is based on clinical manifestations in combination with persistently low alkaline phosphatase (ALP) activity, elevated levels of ALP substrates, specifically inorganic pyrophosphate (PPi), pyridoxal 5'-phosphate (PLP) or urine phosphoethanolamine (PEA), and genetic confirmation of a causative ALPL variant. Considering the wide range of manifestations, treatment must be multimodal and tailored to individual needs. The multidisciplinary team for comprehensive management of HPP patients should include expertise to ensure disease state metabolic and musculoskeletal treatment, dental care, neurological and neurosurgical surveillance, pain management, physical therapy, and psychological care. Asfotase alfa as first-in-class enzyme replacement therapy (ERT) for HPP has been shown to improve survival, rickets, and functional outcomes in severely affected children, but further research is needed to refine how enzyme replacement can also address emerging manifestations of the disease. Prospectively, further elucidating the pathophysiology behind the diverse clinical manifestations of HPP is instrumental for improving diagnostic concepts, establishing novel means for substituting enzyme activity, and developing integrative, multimodal care.

Detection, identification and removing of artifacts from sEMG signals: Current studies and future challenges

Surface electromyography (sEMG), a non-invasive technique, offers the ability to identify insights into the activities of muscles in the form of electrical pulses. During the process of recording, the sEMG signals frequently become contaminated by a multitude of different artifacts, the origin of which may be attributed to numerous sources. These artifacts affect the reliability and accuracy of the pure sEMG activity, and subsequently reduce the quality of analysis and interpretation. This can lead to a misinterpretation of sEMG signals, incorrect diagnostic, or a false decision in the case of human-machine interfaces (HMI), etc. Currently, several approaches have been developed to remove or reduce the effect of artifacts on the sEMG activity. In this paper, a comprehensive review of the current studies dealing with identification, detection, and removal of artifacts from sEMG signals is proposed. In addition, this study presents different features used to characterize the artifacts from that of the clean sEMG recordings. Finally, in order to improve the quality of denoising methods, the associated challenges of detection and artifact removal approaches are discussed to be addressed carefully in the future works.

Reliability of the Athletic Shoulder test in asymptomatic and symptomatic overhead racquet athletes

OBJECTIVES

Assessing intra- and inter-rater reliability of the Athletic Shoulder (ASH) test using a force plate in asymptomatic and symptomatic overhead racquet athletes.

DESIGN

Within-session, intra- and inter-rater reliability.

SETTING

Physiotherapy practice in Belgium.

PARTICIPANTS

Forty-two overhead racquet athletes (21 asymptomatic, 21 symptomatic with shoulder complaints), all playing tennis, badminton, and/or padel for at least 4 h weekly.

MAIN OUTCOME MEASURES

Intra- and inter-rater reliability (intraclass correlation coefficients), standard errors of measurement, minimum detectable change, and agreement (Bland-Altman plots).

RESULTS

The ASH test demonstrated excellent intra-rater reliability among asymptomatic (ICC 0.93-0.98) and symptomatic athletes (ICC 0.91-0.98) in all positions (I,Y,T). Inter-rater reliability ranged from good to excellent (asymptomatic: ICC 0.80-0.95, symptomatic: ICC 0.79-0.91).

CONCLUSIONS

The ASH test demonstrated excellent reliability for single-rater use, supporting its utility for assessing isometric strength in overhead racquet athletes, with or without shoulder complaints. In the asymptomatic group, excellent inter-rater reliability was observed in the Y and T positions. In the symptomatic group, only the non-dominant T position showed excellent inter-rater reliability, making consistent use of a single rater preferable in this population. Future applications may aid injury rehabilitation and return-to-play protocols in sports medicine.

An Evaluation of Orthotics on In-Toeing or Out-Toeing Gait

Background and Objectives: In-toeing and out-toeing gait are rotational deformities commonly observed in children with neuromuscular conditions. These gait abnormalities often result from internal tibial torsion, increased femoral anteversion, and metatarsus adductus. This study was conducted to create a comprehensive evaluation of the effectiveness of lower extremity orthotics as a non-operative treatment option, given their regular use in clinical settings. The aim of this literature review was to understand the efficacy of various orthotic devices in correcting rotational deformities in the transverse plane, thereby improving ambulation stability and 3D joint motion. Materials and Methods: Literature published after 1 January 1990 was reviewed, utilizing databases such as CENTRAL (Wiley), CINAHL (EBSCO), Medline (OVID), Scopus (Elsevier), and Web of Science (Clarivate). In totality, 13 studies were included, evaluating 365 participants with neuromuscular conditions using various orthotic devices. Results: Among these studies, two were randomized control trials (Level 1), nine were quasi-experimental studies (Level 2), and two were case studies (Level 4). Quality assessment determined that 69% of the included studies had a low risk of bias, while 31% demonstrated a moderate risk. Compression garments and rotational systems showcased the greatest change in proximal lower extremity rotation at 19.73° ± 1.57 and 24.13° ± 8.49, respectively. The most significant difference in foot progression angle is through the use of rotational systems, 19° ± 26.87. Conclusions: In a short-term treatment, children with neuromuscular disorders exhibiting in-toeing or out-toeing gait may benefit from different types of orthoses. Compression garments may aid joint alignment and enhance proprioception, rotational systems correct alignment with precise adjustability, AFOs that achieve effective stabilization can deliver benefits in the transverse plane, and foot orthotics may be appropriate for mild gait abnormality management.

The rational design, biofunctionalization and biological properties of orthopedic porous titanium implants: a review

Porous titanium implants are becoming an important tool in orthopedic clinical applications. This review provides a comprehensive survey of recent advances in porous titanium implants for orthopedic use. First, the review briefly describes the characteristics of bone and the design requirements of orthopedic implants. Subsequently, the pore size and structural design of porous titanium alloy materials are presented, then we introduce the application of porous titanium alloy implants in orthopedic clinical practice, including spine surgery, joint surgery, and the treatment of bone tumors. Following that, we describe the surface modifications applied to porous titanium implants to obtain better biological functions. Finally, we discuss incorporating environmental responsive mechanisms into porous titanium alloy materials to achieve additional functionalities.

Assessment of shoulder joint and muscle characteristics side-asymmetry in professional padel players

Padel is a worldwide racket sport that is growing each year. The unilateral upper limb repetitive movements of this sport may lead to shoulder structural and functional adaptations, which may alter muscle mechanics, however evidence is limited. We aimed to investigate if there is morphological, mechanical and functional shoulder symmetry between upper limbs of professional padel players. Fourthteen (7♂ and 7♀) professional Brazilian padel players were evaluated at supraspinatus muscle thickness (MT), stiffness, shoulder rotation range of motion (ROM), shoulder internal and external rotation peak torques and their ratios (ER/IR) and fatigue index torque. Subsequently, were compared all variables between dominant and non-dominant sides (α = 0.05). Total work, IR and ER absolute and normalised torque were higher in the dominant limb (p < 0.05). Moreover, 78% and 64% of the athletes presented reduced ER/IR peak torque ratio values in the dominant and non-dominant upper limb, respectively. No differences in supraspinatus MT, stiffness and shoulder ROM were found. Our study found that Brazilian professional padel players have asymmetrical shoulder ER/IR peak torques ratio. Therefore, it's recommended for padel players to strengthen the ER of the dominant shoulder and both IR and ER of the non-dominant shoulder to address side-asymmetry and reduced ER peak torques.

Oral Health and Oral Health-Related Quality of Life in Professional Soccer Players in Southern Italy: A Cross-Sectional Study

OBJECTIVES

To evaluate the oral health of professional footballers and to investigate possible determinants of oral health as well as the self-reported impacts on well-being, quality of life (QoL), and performance.

METHODS

This cross-sectional study was carried out on professional soccer players of the Calabria region, Italy. The outcome measures were the following: DMFT (decayed, missing and filled permanent teeth), DMFS (decayed, missing and filled permanent teeth surfaces), BEWE (basic erosive wear examination), CPI (community periodontal index), CPITN (community periodontal index of treatment needs), Oral Health Impact Profile-14 (OHIP-14).

RESULTS

One hundred and sixty footballers were recruited from seven clubs. The median age of the players was 25 years (19-39) years. The mean DMFT was 2.8 ± 2.9, and the multiple logistic regression analyses showed a positive association with frequent intake of drinks rich in sugar (OR = 3.69, 95% CI = 1.59-8.56) and sports drinks (OR = 3.73, 95% CI = 1.09-12.75). Dental erosions were present in 48.1% of footballers and periodontal diseases in 50%, with a positive association with frequent intake of energy drinks (OR = 2.86, 95% CI = 1.09-7.51). The OHIP-14 showed that 30.6% of participants reported having had pain in their teeth/mouth/dentures occasionally.

CONCLUSIONS

Results from the present study showed that the oral health of professional soccer players in Southern Italy was poor, especially regarding caries, erosion, and periodontal diseases. Moreover, OHIP-14 showed an impact on oral health in soccer players' QoL, revealing that poor oral health negatively affected professional well-being and performance. Results suggest the need for prevention interventions for professional athletes.

Are palpation-guided interventional procedures on the adductor longus muscle safe? A cadaveric and sonographic investigation

PURPOSE

The main objective was to study the anatomy of the adductor longus by ultrasound and cadaveric dissection, correlate the findings with the different approaches described, and evaluate the feasibility of defining a "safe window" for interventional musculoskeletal procedures.

METHODS

The anatomical study was performed on six cadaveric pieces, while ultrasound evaluations were performed on both lower limbs of 26 subjects (n = 52). Ultrasound variables included the number of saphenous veins, the location of the saphenous vein in relation to the proximal myotendinous junction, the number of vessels within or superficial to the adductor longus, and the distance between the dermis and the inferior border of the adductor longus to the anterior branch of the obturator nerve.

RESULTS

Key anatomic risk factors identified in cadavers included the great saphenous vein, the anterior branch of the obturator nerve, and the vascular network traversing the adductor longus. Ultrasound findings revealed that 91.4% of cases had at least one vessel at the proximal myotendinous junction in the cross-sectional area, almost 60% showed two to five vessels within the thickness of the muscle, and the anterior branch of the obturator nerve was located at a mean depth of 3.63-3.93 cm.

CONCLUSIONS

It was not possible to define a "safe" approach area without the risk of damaging any neurovascular bundle due to the high anatomical variability both in number and in the route of these along the adductor longus. Therefore, the use of ultrasound to guide any interventional musculoskeletal procedure is highly recommended.

SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up

INTRODUCTION

Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up.

METHODS

All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination.

RESULTS

Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°).

CONCLUSIONS

The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe.

LEVEL OF EVIDENCE

Level IV, Retrospective case series.

The Role of High-Resolution Ultrasound in the Diagnosis of Nerve Trauma New Perspective: A Preliminary Systematic Review and Meta-Analysis of the Recent Evidence

SUMMARY

Precise localization of peripheral nerve injuries and evaluation of their prognosis based on clinical and electrodiagnostic examinations are particularly challenging in the acute phase. High-resolution ultrasound (HRUS) may offer a viable and cost-effective imaging option for assessing the morphology of nerve injuries. Consequently, a systematic review and meta-analysis of studies on the use of ultrasound for diagnosing traumatic nerve injuries were conducted. A total of 15 studies were included, reporting the most recent findings on using HRUS in the diagnosis of traumatic nerve injury. These studies assessed the diagnostic test accuracy of ultrasound for the detection of traumatic nerve injury in 272 participants, with the cross-sectional area at the site of traumatic nerve injury also reported in 1,249 participants. The pooled sensitivity and specificity of the included studies were 92% confidence interval (CI) (0.89-0.95) and 86% CI (0.82-0.89), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 13.76 CI (1.41-134.34), 0.08 CI (0.03-0.18), and 286.23 CI (21.22-3,860.40), respectively. In the summary of the receiver operating characteristic curve, the area under the curve was 0.986, and the Q* index was 0.949. Based on the current literature, HRUS has shown promising results in addition to its availability and feasibility. HRUS can serve as a valuable complement to clinical and electrodiagnostic examinations for diagnosing traumatic peripheral nerve injuries. Further research is recommended to better understand the ultrasound characteristics of these injuries.

Public perceptions of meniscus tears: Evaluating knowledge gaps and the role of education

Background

Meniscus tears are common, occurring acutely during sports or as degenerative tears with aging. Limited information exists about the public's understanding of these injuries and their management.

Hypothesis/Purpose

This study aimed to evaluate the public's baseline understanding of meniscus tear management and assess the effectiveness of an educational intervention to improve their understanding.

Study design

Level III, Cross-Sectional Study.

Methods

A 33-question survey on meniscus anatomy, injury risk, diagnosis, treatment, and surgical expectations was distributed online to adults aged 18+ over 5 months from the beginning of July. An educational video and handout were provided to improve baseline knowledge. Data analysis included descriptive statistics, ANOVA, McNemar's test, and a paired t-test to measure pre- and post-intervention changes.

Results

Baseline surveys from 245 participants showed 66.9% were women, 69.4% were aged 18-29, and 63.7% were white. 46.1% held a bachelor's degree, and 90.2% had limited knowledge of meniscus tears. 76% believed surgery was necessary, 84% thought degenerative tears were repairable, and 65% didn't understand the link to osteoarthritis. Most expected over 3 months for recovery. Higher scores were associated with male gender, healthcare experience, and prior knowledge (p < 0.05). Post-intervention, correct responses rose from 45.3% to 75% (p < 0.001) among 118 participants.

Conclusion

Significant misconceptions about meniscus tears were identified. An educational intervention notably improved knowledge of meniscus anatomy, its link to osteoarthritis, and treatment options. This underscores the importance of education in aligning patient expectations with current medical practices to enhance care quality.

Radiology resident competency in diagnosing non-traumatic musculoskeletal conditions: A simulation-based assessment using WIDI SIM

PURPOSE

To evaluate radiology resident performance in diagnosing four non-traumatic musculoskeletal (MSK) pathologies that have historically yielded low scores on the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM).

MATERIALS AND METHODS

This multi-institutional, retrospective study analyzed WIDI SIM data collected from 2015 to 2021. A total of 351 radiology residents (R1-R4) interpreted 65 de-identified imaging cases, four of which focused on septic arthritis/osteomyelitis of the shoulder, septic arthritis/osteomyelitis of the hip, acetabular neoplasm, and Legg-Calve-Perthes disease. Each case was scored using a standardized 10-point rubric (0-2 = critical error, 3-6 = problematic omissions, 7-10 = effective report). Scores were further categorized into observational (missed findings) and interpretive (incorrect conclusion despite correct identification) errors. The Kruskal-Wallis test with Dunn's multiple comparisons was used to assess performance differences across postgraduate years.

RESULTS

Among these four MSK pathologies, only hip osteomyelitis demonstrated a statistically significant difference across training levels (p = 0.0063), although no specific pairwise comparisons were significant. Average scores remained relatively low across all cases, with observational errors surpassing interpretive errors in frequency.

CONCLUSION

Radiology residents struggled to accurately diagnose non-traumatic MSK pathologies in a simulated on-call setting, predominantly due to missed imaging findings. Implementation of enhanced training strategies, such as targeted case review, high-yield simulations, and systematic visual search protocols, may improve MSK diagnostic competency and reduce the risk of clinically significant oversights.