Reconstructive Surgical Intervention for Malunited Distal End Radius and Ulna Fracture: A Case Report Demonstrating Improved Patient Outcomes

This case report explores the efficacy of reconstructive surgical intervention in addressing malunited fractures of the distal end of the radius and ulna. The study presents a detailed analysis of a specific case, highlighting the surgical techniques employed and their impact on patient outcomes. The report emphasizes the importance of precision in addressing malunited fractures and showcases how the intervention led to improved patient outcomes. By documenting this case, the study contributes valuable insights into the field of orthopedic surgery, providing a basis for further research and enhancing the understanding of optimal approaches to managing such complex fractures.

Vancomycin-loaded methylcellulose aerogel scaffolds for advanced bone tissue engineering

Scaffolds grafting combined with local delivery of antibiotics at the injury site may promote bone regeneration along with prevention of infections. In this work, a processing strategy combining the 3D-printing of polysaccharide-based inks with supercritical (sc)CO2 technology was employed to manufacture drug-loaded, nanostructured, and personalized-to-patient aerogels for the first time. Methylcellulose (MC) was employed as graft matrix endowed with nanohydroxyapatite (nHA) to confer bioactivity as required in bone tissue engineering (BTE). MC-nHA aerogels were obtained through the 3D-printing of hydrogel-based scaffolds followed by scCO2 drying. Aerogels were loaded with vancomycin (VAN), an antibiotic employed in the management of bone infections. Textural properties and printing fidelity of scaffolds were studied as well as VAN release, long-term bioactivity, and pre-osteoblasts mineralization. In vitro cell studies and in vivo Artemia salina tests were carried out to evaluate the potential toxicity of the antibiotic-loaded aerogels. Aerogels efficacy in inhibiting bacterial growth was assessed by antimicrobial tests with Staphylococcus aureus. Textural stability of the aerogels after 7 months of storage was also evaluated. Obtained results showed that the scaffolds promoted the intended two-in-one effect (bone repair and infection management simultaneously) in a personalized way, regulating formulation design, drug dose, and porosity.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Real time ultrasound imaging shows changes in deep neck flexor activation during exercise in individuals with mechanical neck pain

BACKGROUND

Deep neck flexor muscle atrophy and increased superficial neck muscle activation are associated with disability and pain intensity in individuals with neck pain. There is a lack of evidence to support direct assessment of deep neck flexor muscles in a non-invasive way during exercise performance to help determine the effectiveness of different neck strengthening exercises.

OBJECTIVE

Compare longus colli (LC) and sternocleidomastoid (SCM) activation between individuals with and without neck pain using real time ultrasound (RTUS) during a series of craniocervical exercises.

METHODS

This cross-sectional cohort study recruited 10 control and 10 neck pain participants to complete four deep neck flexor activation activities involving varying levels of craniocervical flexion. Dimensions of the LC and SCM were measured using RTUS at rest and during exercise. Independent t-tests assessed baseline differences and analysis of variance examined activation changes.

RESULTS

At rest, the neck pain group had significantly smaller cross-sectional area and thickness of the LC compared to the control group (p< 0.05). During exercise, the neck pain group showed significantly larger increases in LC thickness and cross-sectional area across exercise compared to the control group, with no differences in SCM activation between groups.

CONCLUSIONS

Despite atrophy, individuals with neck pain can activate their deep neck flexor muscles appropriately without activating their superficial neck flexor muscles in a supine series of craniocervical flexion exercise as measured by non-invasive ultrasound imaging.

Dynamic spinal orthoses self-reported effects in patients with back pain due to vertebral fragility fractures: A multi-center prospective cohort study

BACKGROUND

Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated.

OBJECTIVE

This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management.

METHODS

This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured.

RESULTS

The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p< 0.0001).

CONCLUSION

The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.

Molecular origin and biological effects of exercise mimetics

With the rapid development of sports science and molecular biology technology, academia refers to molecules or microorganisms that mimic or enhance the beneficial effects of exercise on the body, called "exercise mimetics." This review aims to clarify the concept and development history of exercise mimetics, and to define the concept of exercise mimetics by summarizing its characteristics and functions. Candidate molecules and drug targets for exercise mimetics are summarized, and the relationship between exercise mimetics and exercise is explained, as well as the targeting system and function of exercise mimetics. The main targeting systems for exercise mimetics are the exercise system, circulatory system, endocrine system, endocrine system, and nervous system, while the immune system is potential targeting systems. Finally, future research directions for exercise mimetics are discussed.

Evaluation and Diagnostic-Treatment Approaches of Brachial Plexus Injuries in Adults

Background

Brachial plexus injury (BPI), as one of the most devastating injuries in adults, has various negative consequences such as profound functional impairment, debilitating pain, significant mental health consequences, and economic impacts. We aimed to review the evaluation and diagnostic-treatment Approaches of BPI in adults through a review study.

Methods

An electronic literature search was completed in Google Scholar, Springer, PubMed, and Science Direct databases from 1980 to 2023. Various keywords related to the purpose such as Brachial plexus, surgical strategy, adult were used.

Results

1.2% of people with multiple traumas had BPIs. BPI is more common in young adult males. For brachial plexus palsy, preoperative evaluation of nerve root avulsion is helpful in surgical planning. . EMG is useful in confirming a diagnosis, localizing the lesion level, estimating the extent of axon loss, and determining whether the lesion is complete. There are different options available for BPI, such as coordinating care, rehabilitation and psychosocial support. In recent times, significant advancements have been made in surgical techniques for nerve repairs.

Conclusion

Although it is often not possible to prevent damage to the brachial plexus, it is possible to reduce the risk of further problems after the injury by taking some measures.

Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study

BACKGROUND

In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx.

AIM

To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results.

METHODS

From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis.

RESULTS

From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups.

CONCLUSION

LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.

Transformer encoder with multiscale deep learning for pain classification using physiological signals

Pain, a pervasive global health concern, affects a large segment of population worldwide. Accurate pain assessment remains a challenge due to the limitations of conventional self-report scales, which often yield inconsistent results and are susceptible to bias. Recognizing this gap, our study introduces PainAttnNet, a novel deep-learning model designed for precise pain intensity classification using physiological signals. We investigate whether PainAttnNet would outperform existing models in capturing temporal dependencies. The model integrates multiscale convolutional networks, squeeze-and-excitation residual networks, and a transformer encoder block. This integration is pivotal for extracting robust features across multiple time windows, emphasizing feature interdependencies, and enhancing temporal dependency analysis. Evaluation of PainAttnNet on the BioVid heat pain dataset confirm the model's superior performance over the existing models. The results establish PainAttnNet as a promising tool for automating and refining pain assessments. Our research not only introduces a novel computational approach but also sets the stage for more individualized and accurate pain assessment and management in the future.

Advances of Blood Coagulation Factor XIII in Bone Healing

The biologic process of bone healing is complicated, involving a variety of cells, cytokines, and growth factors. As a result of bone damage, the activation of a clotting cascade leads to hematoma with a high osteogenic potential in the initial stages of healing. A major factor involved in this course of events is clotting factor XIII (FXIII), which can regulate bone defect repair in different ways during various stages of healing. Autografts and allografts often have defects in clinical practice, making the development of advanced materials that support bone regeneration a critical requirement. Few studies, however, have examined the promotion of bone healing by FXIII in combination with biomaterials, in particular, its effect on blood coagulation and osteogenesis. Therefore, we mainly summarized the role of FXIII in promoting bone regeneration by regulating the extracellular matrix and type I collagen, bone-related cells, angiogenesis, and platelets, and described the research progress of FXIII = related biomaterials on osteogenesis. This review provides a reference for investigators to explore the mechanism by which FXIII promotes bone healing and the combination of FXIII with biomaterials to achieve targeted bone tissue repair.

Deciphering variations in the endocytic uptake of a cell-penetrating peptide: the crucial role of cell culture protocols

Delivery tools, including cell-penetrating peptides (CPPs), are often inefficient due to a combination of poor endocytosis and endosomal escape. Aspects that impact the delivery of CPPs are typically characterized using tissue culture models. One problem of using cell culture is that cell culture protocols have the potential to contribute to endosomal uptake and endosomal release of CPPs. Hence, a systematic study to identify which aspects of cell culturing techniques impact the endocytic uptake of a typical CPP, the TMR-TAT peptide (peptide sequence derived from HIV1-TAT with the N-terminus labeled with tetramethylrhodamine), was conducted. Aspects of cell culturing protocols previously found to generally modulate endocytosis, such as cell density, washing steps, and cell aging, did not affect TMR-TAT endocytosis. In contrast, cell dissociation methods, media, temperature, serum starvation, and media composition all contributed to changes in uptake. To establish a range of endocytosis achievable by different cell culture protocols, TMR-TAT uptake was compared among protocols. These protocols led to changes in uptake of more than 13-fold, indicating that differences in cell culturing techniques have a cumulative effect on CPP uptake. Taken together this study highlights how different protocols can influence the amount of endocytic uptake of TMR-TAT. Additionally, parameters that can be exploited to improve CPP accumulation in endosomes were identified. The protocols identified herein have the potential to be paired with other delivery enhancing strategies to improve overall delivery efficiency of CPPs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-023-00591-1.

Recent advances in 3D bioprinted cartilage-mimicking constructs for applications in tissue engineering

Human cartilage tissue can be categorized into three types: hyaline cartilage, elastic cartilage and fibrocartilage. Each type of cartilage tissue possesses unique properties and functions, which presents a significant challenge for the regeneration and repair of damaged tissue. Bionics is a discipline in which humans study and imitate nature. A bionic strategy based on comprehensive knowledge of the anatomy and histology of human cartilage is expected to contribute to fundamental study of core elements of tissue repair. Moreover, as a novel tissue-engineered technology, 3D bioprinting has the distinctive advantage of the rapid and precise construction of targeted models. Thus, by selecting suitable materials, cells and cytokines, and by leveraging advanced printing technology and bionic concepts, it becomes possible to simultaneously realize multiple beneficial properties and achieve improved tissue repair. This article provides an overview of key elements involved in the combination of 3D bioprinting and bionic strategies, with a particular focus on recent advances in mimicking different types of cartilage tissue.

Complete tibial nerve lesion secondary to postoperative popliteal pseudoaneurysm following anterior cruciate ligament arthroscopic reconstruction: A series of two patients

Background

Complications following arthroscopic anterior cruciate ligament reconstruction (ACLR) are rare, but injuries to the popliteal artery can occur. Popliteal pseudoaneurysms are a potential complication and can cause significant morbidity if not diagnosed and treated promptly.

Cases Description

We describe the cases of two patients who developed nerve injuries following arthroscopic ACLR, with subsequent diagnosis of a popliteal pseudoaneurysm. The peroneal nerve recovered spontaneously in both cases, while the tibial nerve was reconstructed using autologous nerve grafting. Satisfying, functional recoveries were observed 24 months postoperatively.

Conclusion

Prompt diagnosis and effective treatment of popliteal pseudoaneurysms are crucial to prevent further complications. However, timely diagnosis can be challenging due to inconsistent clinical presentations and a low index of suspicion. This case report highlights the need for increased awareness of this uncommon complication and provides insights into its pathophysiological mechanisms.

Extra-capsular floating fat at the extremity: a review

Extra-capsular floating fat may present in a variety of non-articular locations at the extremity. Manifestation of floating fat or fat-fluid level(s) outside of a joint is a marker of trauma or infection. Recognizing radiologic sign(s) of extra-capsular floating fat can aid radiologists to provide an informed differential diagnosis and facilitate clinical care. This review discusses the etiology, mechanisms, and imaging appearance of extracapsular floating fat in specific anatomic and non-anatomic locations at the extremity.

Arthroscopy in India Through the Medicolegal Lens: A Comprehensive Review

Introduction

With the increasing number of Arthroscopic surgeries, comes with it, the undesirable problem of litigation associated with it. Arthroscopy does possess certain unique aspects which need to be understood from the legal point of view as well.

Materials and Methods

We obtained information on specific medico-legal cases involving arthroscopy from books and websites containing collections of medico-legal judgments in Indian legal courts, consumer dispute redressal forums at the state and national levels, and state medical councils..

Results

We assimilated and analysed all this information, combined it with our experience in the field of medical law, and have provided practical, enforceable ways to decrease the medicolegal risk for arthroscopy surgeons.

Conclusion

This review provides a comprehensive overview of pressing issues in relation to the medicolegal aspects of arthroscopic surgery.

Synergistic effect of FGF-2 and TGF-β1 on the mineralization of human umbilical cord perivascular cells

OBJECTIVE

Human umbilical cord perivascular cells (HUCPVCs) are derived from the human umbilical cord perivascular tissue and are expected to replace mesenchymal stromal cells in the future. We investigated the synergistic effects of fibroblast growth factor 2 (FGF-2) and transforming growth factor-beta 1 (TGF-β1) on HUCPVC mineralization.

DESIGN

We prepared HUCPVCs with (FGF(+)HUCPVCs) or without FGF-2 (FGF(-)HUCPVCs) in the presence of activated vitamin D3, a bone morphogenic protein inhibitor, and TGF-β1. We examined the cell proliferative capacity, expression of various hard tissue-forming cell gene markers, and mineralization induction ability and identified the crystalline phases of the mineralized nodules.

RESULTS

FGF(+)HUCPVCs exhibited higher intracellular alkaline phosphatase (ALP) gene expression and ALP activity, and their cell proliferation rate was higher than that of FGF(-)HUCPVCs. The expression levels of osteoblast marker genes increased in FGF(+)HUCPVCs, whereas those of elastic fiber and muscle cell markers increased in FGF(-)HUCPVCs. The expression of genes related to matrix vesicle-mediated mineralization was increased in FGF(+)HUCPVCs. While FGF(-)HUCPVCs displayed myofibroblast-like properties and could not induce mineralization, FGF(+)HUCPVCs demonstrated the ability to produce mineralized nodules. The resulting mineralized nodules consisted of hydroxyapatite as the major phase and minor amounts of octacalcium phosphate. The mineralized nodules exhibited the morphological characteristics of bone hydroxyapatite, composed of fibrous hydroxyapatite nanorods and polycrystalline sheets.

CONCLUSION

We found that FGF-2 synergizes with TGF-β1 and is a key factor in the differentiation of HUCPVCs into osteoblast-like cells. Thus, HUCPVCs can potentially serve as a new stem cell source for future bone regeneration and dental treatments.

Avulsion fracture is associated with more pain after anatomic repair procedure for ATFL injury at the talar side

PURPOSE

To evaluate the clinical outcomes of anatomic repair procedure for chronic anterior talofibular ligament (ATFL) injury at the talar side, and to compare the outcomes between patients with and without concomitant avulsion fractures. It was hypothesized that anatomic repair procedure could produce similarly satisfactory outcomes for those two groups.

METHODS

Thirty-nine consecutive patients with chronic ATFL injuries at the talar side who underwent anatomic repair procedure at the department of sports medicine at Peking University Third Hospital between 2013 and 2018, were retrospectively evaluated. The pain visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Tegner score, and Foot & Ankle Outcome Score (FAOS) were recorded as the primary outcomes. Time to return to sports (RTS), surgical satisfaction, deficiency of ankle range of motion (ROM), recurrent sprain, and postoperative complications were recorded as the secondary outcomes. Outcomes were compared between patients with (Group A, 16 cases) and without (Group B, 23 cases) concomitant avulsion fractures.

RESULTS

The mean follow-up time was 79.4 ± 17.0 and 76.6 ± 18.5 months for Group A and B, respectively. VAS, AOFAS, Tegner, FAOS, and all subscale scores of FAOS were significantly improved in both groups at the final follow up. Patients in group A had inferior postoperative VAS, AOFAS, FAOS, and pain score of FAOS compared to group B (1.1 ± 1.1 vs. 0.4 ± 0.5, 89.1 ± 10.1 vs. 95.2 ± 5.2, 87.2 ± 7.2 vs. 91.5 ± 4.1, and 88.4 ± 11.3 vs. 96.7 ± 3.5, respectively).The mean time to RTS, rate of satisfaction and recurrent sprain had no significant differences between group A and B (6.1 ± 2.8, 93.8%, and 18.8% vs. 5.2 ± 2.2, 100.0%, and 13.0%, respectively), and the rate of ROM deficiency was significantly higher in group A (37.5 vs. 8.7%). Avulsion fracture was identified as an independent risk factor for inferior pain score of FAOS.

CONCLUSION

Anatomic repair procedure for chronic ATFL injuries at the talar side produces favourable results for patients with and without avulsion fractures at 5 to 10 years follow-up, however, avulsion fracture is associated with more pain.

LEVEL OF EVIDENCE

III.

Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study

BACKGROUND

Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning.

AIM

To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation.

DESIGN

Prospective cohort design.

SETTING

Acute and postoperative rehabilitation hospital settings.

POPULATION

Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included.

METHODS

Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination.

RESULTS

SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge.

CONCLUSIONS

Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture.

CLINICAL REHABILITATION IMPACT

These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.

Postural Analysis Using Rasterstereography and Inertial Measurement Units in Volleyball Players: Different Roles as Indicators of Injury Predisposition

Background and Objectives: Acute and chronic injuries are frequent in volleyball. Biomechanics of sport-specific tasks can influence the risk of injury, which is also related to specific court positions. We investigated posture at raster-stereography, balance, and dynamic tasks using inertial motion units to find differences between roles, which can be predictive of a higher risk of injury. Materials and Methods: We cross-sectionally evaluated amateur volleyball athletes. Participants were divided into roles as outside hitters, setters, middle blockers, and opposite hitters. We excluded the "libero" position from our analysis. Results: Sixteen players were included in the analysis. A statistically significant difference was found in left lower limb stiffness among the outside hitter and setter groups. Conclusions: Differences in stiffness might be related to the different training and the different abilities among the two groups. Raster-stereography is extending its indications and should be implemented for non-invasive postural analysis. The use of inertial motion units provides objective measurements of variables that could go unrecognized within a clinical evaluation; its use should be considered in injury preventive programs.

Nanostructured graphene oxide enriched with metallic nanoparticles as a biointerface to enhance cell adhesion through mechanosensory modifications

Nanostructuring is a process involving surface manipulation at the nanometric level, which improves the mechanical and biological properties of biomaterials. Specifically, it affects the mechanotransductive perception of the microenvironment of cells. Mechanical force conversion into an electrical or chemical signal contributes to the induction of a specific cellular response. The relationship between the cells and growth surface induces a biointerface-modifying cytophysiology and consequently a therapeutic effect. In this study, we present the fabrication of graphene oxide (GO)-based nanofilms decorated with metallic nanoparticles (NPs) as potential coatings for biomaterials. Our investigation showed the effect of decorating GO with metallic NPs for the modification of the physicochemical properties of nanostructures in the form of nanoflakes and nanofilms. A comprehensive biocompatibility screening panel revealed no disturbance in the metabolic activity of human fibroblasts (HFFF2) and bone marrow stroma cells (HS-5) cultivated on the GO nanofilms decorated with gold and copper NPs, whereas a significant cytotoxic effect of the GO nanocomplex decorated with silver NPs was demonstrated. The GO nanofilm decorated with gold NPs beneficially managed early cell adhesion as a result of the transient upregulation of α1β5 integrin expression, acceleration of cellspreading, and formation of elongated filopodia. Additionally, the cells, sensing the substrate derived from the nanocomplex enriched with gold NPs, showed reduced elasticity and altered levels of vimentin expression. In the future, GO nanocomplexes decorated with gold NPs can be incorporated in the structure of architecturally designed biomimetic biomaterials as biocompatible nanostructuring agents with proadhesive properties.

Myrislignan targets extracellular signal-regulated kinase (ERK) and modulates mitochondrial function to dampen osteoclastogenesis and ovariectomy-induced osteoporosis

BACKGROUND

Activated osteoclasts cause excessive bone resorption, and disrupt bone homeostasis, leading to osteoporosis. The extracellular signal-regulated kinase (ERK) signaling is the classical pathway related to osteoclast differentiation, and mitochondrial reactive oxygen species are closely associated with the differentiation of osteoclasts. Myrislignan (MRL), a natural product derived from nutmeg, has multiple pharmacological activities; however, its therapeutic effect on osteoporosis is unclear. Here, we investigated whether MRL could inhibit osteoclastogenesis and bone mass loss in an ovariectomy mouse model by suppressing mitochondrial function and ERK signaling.

METHODS

Tartrate-resistant and phosphatase (TRAP) and bone resorption assays were performed to observe the effect of MRL on osteoclastogenesis of bone marrow macrophages. MitoSOX RED and tetramethyl rhodamine methyl ester (TMRM) staining was performed to evaluate the inhibitory effect of MRL on mitochondria. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay was performed to detect whether MRL suppressed the expression of osteoclast-specific genes. The impact of MRL on the protein involved in the mitogen-activated protein kinase (MAPK) and nuclear factor-κB pathways was evaluated using western blotting. In addition, a specific ERK agonist LM22B-10, was used to revalidate the inhibitory effect of MRL on ERK. Finally, we established an ovariectomy mouse model to assess the therapeutic effect of MRL on osteoporosis in vivo.

RESULTS

MRL inhibited osteoclast differentiation and the associated bone resorption, by significantly decreasing osteoclastic gene expression. Mechanistically, MRL inhibited the phosphorylation of ERK by suppressing the mitochondrial function, thereby downregulating the nuclear factor of activated T cells 1 (NFATc1) signaling. LM22B-10 treatment further verified the targeted inhibition effect of MRL on ERK. Microscopic computed tomographic and histologic analyses of the tibial tissue sections indicated that ovariectomized mice had lower bone mass and higher expression of ERK compared with normal controls. However, MRL treatment significantly reversed these effects, indicating the anti-osteoporosis effect of MRL.

CONCLUSION

We report for the first time that MRL inhibits ERK signaling by suppressing mitochondrial function, thereby ameliorating ovariectomy-induced osteoporosis. Our findings can provide a basis for the development of a novel therapeutic strategy for osteoporosis.

Anti-inflammatory reprogramming of microglia cells by metabolic modulators to counteract neurodegeneration; a new role for Ranolazine

Microglia chronic activation is a hallmark of several neurodegenerative diseases, including the retinal ones, possibly contributing to their etiopathogenesis. However, some microglia sub-populations have anti-inflammatory and neuroprotective functions, thus making arduous deciphering the role of these cells in neurodegeneration. Since it has been proposed that functionally different microglia subsets also rely on different metabolic routes, we hypothesized that modulating microglia metabolism might be a tool to enhance their anti-inflammatory features. This would have a preventive and therapeutic potential in counteracting neurodegenerative diseases. For this purpose, we tested various molecules known to act on cell metabolism, and we revealed the anti-inflammatory effect of the FDA-approved piperazine derivative Ranolazine on microglia cells, while confirming the one of the flavonoids Quercetin and Naringenin, both in vitro and in vivo. We also demonstrated the synergistic anti-inflammatory effect of Quercetin and Idebenone, and the ability of Ranolazine, Quercetin and Naringenin to counteract the neurotoxic effect of LPS-activated microglia on 661W neuronal cells. Overall, these data suggest that using the selected molecules -also in combination therapies- might represent a valuable approach to reduce inflammation and neurodegeneration while avoiding long term side effects of corticosteroids.

A scoping review of music-based interventions for swallowing difficulties: implications for treating older adults with presbyphagia

Objectives

Presbyphagia refers to age-related changes in the swallowing mechanism (e.g., reduced skeletal muscle strength that decreases bolus control). If left untreated, these changes can lead to dysphagia, which refers to impaired swallowing (e.g., coughing or choking when eating). Given that swallowing difficulties are common among older adults that they make up the fastest growing age group globally, the need for interventions to address presbyphagia is gaining urgency. To begin to address this need, we conducted a scoping review to analyze music therapy research aimed at enhancing swallowing function. The objective was to identify key intervention characteristics and propose clinical implications for treating presbyphagia using music therapy.

Methods

This review followed the methodological frameworks outlined by Arksey and O'Malley and Levac et al. and used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews for analysis and reporting. Four electronic databases (i.e., ProQuest, PubMed, RISS, Web of Science) were searched for quantitative and qualitative studies in English or Korean that used music-based interventions to address swallowing function in older adults. Content analysis was conducted to identify and compare the main features of music interventions for swallowing difficulties among older adults.

Results

Ten articles were identified and analyzed. It was found that three core components-respiration, vocalization, and singing-were employed to enhance swallowing function in populations with neurological impairments, dementia, or head and neck cancer. Notably, actions closely linked to swallowing function, such as laryngeal elevation and oral movements, were utilized therapeutically to speak or sing. Based on these characteristics, clinical implications are proposed to address presbyphagia.

Conclusion

Singing entails a systematic and focused incorporation of stepwise activities that can be used to address swallowing disorders. In this context, critical clinical implications that music therapists should consider when treating individuals with presbyphagia include warmup breathing, vocalizing targeting laryngeal control, and singing targeting oral motor control. This review can contribute to the expansion of music therapy with older adults and the advancement of music therapy techniques.

Current Concepts about Calcaneal Fracture Management: A Review of Metanalysis and Systematic Reviews

Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures.

Stem cell therapy in sports medicine: current applications, challenges and future perspectives

Stem cells have demonstrated significant potential for tissue repair and regeneration, making them a promising therapeutic avenue in sports medicine. This review aims to provide a comprehensive overview of the current state of research on the application of stem cells in sports medicine. We will discuss the types of stem cells used, their mechanisms of action, and the clinical outcomes of stem cell therapy in different sports-related injuries. Furthermore, we will delve into the challenges and ethical considerations associated with stem cell therapy, as well as future directions and potential applications of stem cells in sports medicine.

Biceps brachii muscle cross-sectional area measured by ultrasonography is independently associated with one-month mortality: A prospective observational study

PURPOSE

Studies examining mortality in palliative care units are limited. We aimed to investigate the mortality and associated factors including ultrasonographic muscle parameters in hospitalized palliative patients with a subgroup analysis of older patients.

METHODS

A prospective-observational study. We recorded the demographics, number of diseases, diagnoses, and the Charlson comorbidity index (CCI), palliative performance scale (PPS), and nutritional risk screening-2002 (NRS-2002) scores. We noted the nutritional parameters and mortality. We measured the subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris and biceps brachii using ultrasonography.

RESULTS

We enrolled 100 patients (mean age: 73.2 ± 16.4 years, 53%: female). One-month mortality was 42%. The non-survivors had significantly higher malignancy, increased CCI and NRS-2002 scores, lower required energy intake, calorie sufficiency rate, and biceps brachii SFT, MT, and CSA than the survivors. The independent mortality predictors were malignancy and biceps brachii CSA while the PPS score and malignancy were significantly associated with mortality in the older subgroup.

CONCLUSION

The malignancy and biceps brachii CSA might have prognostic value in predicting mortality in palliative patients. This was the first study investigating the mortality-associated factors including ultrasonographic muscle measurements of both the lower and upper limbs in a palliative care center.

Rare Reconstruction of Four Metatarsals Using Kirschner Wires After a Severe Crushing Injury: Surgical Decision Making and Prognosis

Metatarsal fractures are one of the most common injuries after foot trauma. It is debilitating, as the metatarsals are one of the most crucial bones for any weight-bearing movement. This report demonstrates the beneficial outcome of using Kirschner wires (K-wires) in a trauma setting and the complicated healing process. A 56-year-old gentleman was brought into the emergency department after a reinforced cement pipe fell onto the patient's steel-toe boots, striking his left foot immediately proximal to the steel portion of the boot. The patient had sustained displaced comminuted fractures of the left second, third, fourth, and fifth metatarsals with an extensive open wound (Gustilo type II open fracture). Open reduction with internal fixation (ORIF) was performed using K-wires to restore and preserve the anatomical and functional integrity of the foot. Following the surgery, the patient developed a hammer toe of the left fifth metatarsophalangeal (MTP) joint two months after the ORIF; we performed resection arthroplasty to relieve discomfort and further aid the recovery process. Following the resection arthroplasty, eschar had formed at the surgical site, extending from the lateral aspect of the left foot to the plantar surface, for which we had performed a skin graft after excisional debridement of the necrotic tissue. After one year of close follow-ups with rigorous physical therapy exercises, the patient had a fair recovery process and is now able to ambulate without any assistive devices. As such, using K-wires remains a viable option for reducing misaligned metatarsal fractures and providing fairly good outcomes even in the setting of severe foot trauma.

Eccentric Exercises on the Board with 17-Degree Decline Are Equally Effective as Eccentric Exercises on the Standard 25-Degree Decline Board in the Treatment of Patellar Tendinopathy

Background and Objectives: Patellar tendinopathy is one of the most significant problems in jumping and running athletes. Eccentric quadriceps exercise has been introduced into the therapy of patients with patellar tendinopathy in order to avoid weakening the tendon during rehabilitation. The use of decline boards with a decline angle of 25° has been the cornerstone of therapy over the last two decades. Biomechanical studies have suggested that an equal or potentially better outcome could be achieved with lower angles of decline (up to 16°). Materials and Methods: In this present research, we compared the effects of two various decline board angles on the clinical outcome of patients treated for patellar tendinopathy by performing eccentric quadriceps exercises. Patients were randomly allocated into two groups: patients practicing on the standard board with a 25° decline, and patients practicing on the 17° decline (n = 35 per group). Results: After 6 weeks of exercise, we found a significant improvement in all the clinical scores (VISA-P score, KOOS score, Lysholm Knee Questionnaire/Tegner Activity Scale, and VAS scale) of treated patients. However, there was no significant difference between the patients who performed eccentric quadriceps exercises on the standard 25° decline board and those exercising on the 17° decline board. A smaller additional degree of improvement was visible at the end of the follow-up period (at 12 weeks), but, again, no statistical difference could be detected between the investigated groups. We conclude that both treatment options provide similar short-term and midterm benefits regarding improvements in pain and clinical scores. The improvement in clinical scores does not depend on age, sex, BMI, or the professional sport of the patient. Conclusions: Our findings encourage changes in the decline angle of the board in the case of a patient's discomfort in order to achieve better compliance without affecting the recovery.

Crosslinking strategies in modulating methylcellulose hydrogel properties

Methylcellulose (MC) hydrogels are ideal materials for the design of thermo-responsive platforms capable of exploiting the environment temperature as a driving force to activate their smart transition. However, MC hydrogels usually show reduced stability in an aqueous environment and low mechanical properties, limiting their applications' breadth. A possible approach intended to overcome these limitations is chemical crosslinking, which represents a simple yet effective strategy to modify the MC hydrogels' properties (e.g., physicochemical, mechanical, and biological). In this regard, understanding the selected crosslinking method's role in modulating the MC hydrogels' properties is a key factor in their design. This review offers a perspective on the main MC chemical crosslinking approaches reported in the literature. Three main categories can be distinguished: (i) small molecule crosslinkers, (ii) crosslinking by high-energy radiation, and (iii) crosslinking via MC chemical modification. The advantages and limitations of each approach are elucidated, and special consideration is paid to the thermo-responsive properties after crosslinking towards the development of MC hydrogels with enhanced physical stability and mechanical performance, preserving the thermo-responsive behavior.

3D printed pH-responsive tablets containing N-acetylglucosamine-loaded methylcellulose hydrogel for colon drug delivery applications

The pH-responsive drug release approach in combination with three-dimensional (3D) printing for colon-specific oral drug administration can address the limitations of current treatments such as orally administered solid tablets. Such existing treatments fail to effectively deliver the right drug dosage to the colon. In order to achieve targeted drug release profiles, this work aimed at designing and producing 3D printed tablet shells using Eudragit® FS100 and polylactic acid (PLA) where the core was filled with 100 µl of N-acetylglucosamine (GlcNAc)-loaded methyl cellulose (MC) hydrogel. To meet the requirements of such tablets, the effects of polymer blending ratios and MC concentrations on physical, thermal, and material properties of various components of the tablets and most importantly in vitro drug release kinetics were investigated. The tablets with 80/20 wt% of Eudragit® FS100/PLA and the drug-loaded hydrogel with 30 mg/ml GlcNAc and 3% w/v MC showed the most promising results having the best printability, processability, and drug release kinetics besides being non-cytotoxic. Manufacturing of these tablets will be the first milestone in shifting from the conventional "one size fits all" approach to personalized medicine where different dosages and various combinations of drugs can be effectively delivered to the inflammation site.

Performance Analysis in Padel: A Systematic Review

The aim of the study was to carry out a systematic review of the most recent research on performance analysis in padel. An electronic search was made in four sport science databases: Web of Science, Pubmed, Scopus and Google Scholar. Systematic review principles were used to identify and select studies following inclusion and exclusion criteria. From a total of 261 articles identified in the initial search, 27 articles were included in analysis, all dating from after 2018. The articles were classified according to four study variables: temporal aspects, game actions, on-court movements and match score studies, ordered in turn according to the year of publication. The results show differences in the four study variables according to the gender or the level of players, the side or the zone of play and the duration of the match. In conclusion, the results define the relevant aspects of the game with the aim of being used at a technical, tactical and physical level, as well as contributing to the development of scientific knowledge in padel, allowing future research to address less studied topics and carry out more complete and specific studies and interventions for a greater understanding of the needs of padel.

The increased anterior talofibular ligament-posterior talofibular ligament angle on MRI may help evaluate chronic ankle instability

PURPOSE

This study intended to compare the difference between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) angle with chronic ankle instability (CAI) patients and healthy volunteers, and to confirm whether using the ATFL-PTFL angle could be a reliable assessment method for CAI, so as to improve the accuracy and specificity of clinical diagnosis.

METHODS

This retrospective study included 240 participants: 120 CAI patients and 120 healthy volunteers between 2015 and 2021. The ATFL-PTFL angle of the ankle region was gaged in the cross-sectional supine position on MRI between two groups. After participants undergoing a comprehensive MRI scanning, ATFL-PTFL angles were regarded as the main indicator of patients with the injured ATFLs and healthy volunteers to compare, and were measured by an experienced musculoskeletal radiologist. Moreover, other qualitative and quantitative indicators referring to anatomical and morphological characteristics of the AFTL were included in this study with MRI, such as the length, width, thickness, shape, continuity, and signal intensity of the ATFL, which can be used as secondary indicators.

RESULTS

In the CAI group, the ATFL-PTFL angle was 90.8° ± 5.7°, which was significantly different from the non-CAI group where the ATFL-PTFL angle for 80.0° ± 3.7° (p < 0.001). As for the ATFL-MRI characteristics, the length (p = 0.003), width (p < 0.001), and thickness (p < 0.001) in the CAI group were also significantly different from the non-CAI group. Over 90% of the cases, patients of the CAI group had injured ATFL with an irregular shape, non-continuous, and high or mixed signal intensity.

CONCLUSION

Compared with healthy people, the ATFL-PTFL angle of most CAI patients is larger, which can be used as a secondary index to diagnose CAI. However, the MRI characteristic changes of ATFL may not relate to the increased ATFL-PTFL angle.

Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study

OBJECTIVE

To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90).

METHODS

Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups.

RESULTS

A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05).

CONCLUSIONS

For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial

BACKGROUND

Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains.

METHODS

Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3).

RESULTS

After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported.

CONCLUSIONS

Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.

Effects of eyeshades in sleep quality and pain after surgery in school-age children with supracondylar humeral fractures

Objective

This study aimed to explore the effects of eye masks on the sleep quality and pain of children over 5 years old with humeral supracondylar fracture after surgery.

Methods

Fifty children with humeral supracondylar fracture who underwent closed reduction and percutaneous pinning (CRPP) in the Pediatric orthopaedic Department of a provincial hospital in China from February 2020 to December 2021 were selected. The children were randomly divided into the experimental group (n = 25) and the control group (n = 25). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights after surgery. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children's Pain Behaviour Scale was used to evaluate the pain of the children.

Results

After three nights of receiving the eye mask intervention, the children in the experimental group had significantly lower sleep quality scores than those in the control group; the difference was statistically significant (p < 0.05), and the children in the experimental group had higher sleep quality. The experimental group's pain scores were significantly lower than the control group's, and the difference was statistically significant (p < 0.05), and the children in the experimental group experienced less post-operative pain.

Conclusions

Eye masks are a simple, safe and economical intervention, that is beneficial for improving the sleep quality and reducing pain in children over 5 years old with humeral supracondylar fracture after closed reduction and percutaneous pinning. It can be used as a reference and basis for clinical pain relief and sleep quality after surgery for supracondylar fractures of the humerus in children.

Influence of resistance training on muscle architecture in older adults: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Resistance training (RT) consists of planned exercise programs to increase muscle strength capacity through neural and structural adaptations, such as changes in the geometric arrangement of muscle fibers. This study aimed to analyze the influence of RT on muscle architecture in older people.

METHODS

This PROSPERO-registered systematic review and meta-analysis (identification number CRD42022340477) followed the PRISMA guidelines. Four electronic databases were searched for eligible randomized controlled trials (RCTs) that observed older individuals submitted to RT programs that reported muscle architecture outcomes.

RESULTS

Seventeen RCTs met the eligibility criteria with a total of 488 participants. The main results of the meta-analysis showed that RT interventions had a significant effect on the thickness of the medial gastrocnemius (SMD = 0.12; 95% CI: - 0.07 to 0.17; p < 0.00001; I2 = 0%).

CONCLUSION

Based on available evidence, studies included in this review showed improvement in maximum isometric force, pennation angle, fascicle length, thickness, and muscle activation after RT interventions. In turn, the meta-analysis suggested a potential for improving the thickness of the medial gastrocnemius after the intervention. However, any clinical implications drawn from the analyses should be interpreted with caution, as these findings are substantially limited due to a low number of included studies and a potential heterogeneity between studies.

[Ligamentous elbow injuries-When is surgical treatment still indicated?]

The elbow joint is a hinge-type synovial joint and is the second most frequently dislocated joint in adults and the most frequently dislocated joint in children. To find the right treatment options a precise understanding of the injury pattern, anatomy, biomechanics and pathology (simple vs. complex dislocation) is essential for a good reconstruction of the function and to prevent chronic instability and pain. The differentiation between acute and chronic instability gives another variation in the treatment plan. According to the latest literature there are clear indications for surgery of a complex elbow dislocation, whereas for simple dislocations conservative treatment is preferentially recommended; however, when is the surgical treatment of a ligamentous elbow dislocation (still) indicated?

Musculoskeletal injury prevalence in professional padel players. A retrospective study of the 2021 season

OBJECTIVES

To investigate the influence of the gender, ranking and playing position on the musculoskeletal injuries in professional padel players.

DESIGN

An epidemiological, observational, descriptive, retrospective cross-sectional study.

PARTICIPANTS

44 injuries were reported by 36 players (20 men/16 women) who participated in the World Padel Tour 2021.

SETTING

Online questionnaire.

MAIN OUTCOME MEASURE

Descriptive statistics and injury prevalence were calculated. Spearman/Pearson correlations between sample characteristics and injury variables were calculated. The chi-square test was used to analyse the association between injury and descriptive variables. A Mann-Whitney U test was performed to compare the group differences with regard to days of absence.

RESULTS

The results showed different injury prevalence (x1000 matches) in male (10.50) and female players (15.10). A higher injury incidence in top-ranked players, both in male (44.40%) and female (58.33%) was identified, but the low-ranked players reported more severe injuries (>28 days) (p < 0.05). Top-ranked players suffered more muscle injuries (p < 0.01) and low-ranked players suffered more tendon injuries (p < 0.01). Gender, ranking and playing position did not influence the days of absence (p > 0.05).

CONCLUSIONS

This study confirms that gender and ranking position had an impact on the injury prevalence in professional padel players.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Neuroinflammatory Pathways in the ALS-FTD Continuum: A Focus on Genetic Variants

Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal dementia (FDT) are progressive neurodegenerative disorders that, in several cases, overlap in clinical presentation, and genetic and pathological disease mechanisms. About 10-15% of ALS cases and up to 40% of FTD are familial, usually with dominant traits. ALS and FTD, in several cases, share common gene mutations, such as in C9ORF72, TARDBP, SQSTM-1, FUS, VCP, CHCHD10, and TBK-1. Also, several mechanisms are involved in ALS and FTD pathogenesis, such as protein misfolding, oxidative stress, and impaired axonal transport. In addition, neuroinflammation and neuroinflammatory cells, such as astrocytes, oligodendrocytes, microglia, and lymphocytes and, overall, the cellular microenvironment, have been proposed as pivotal players in the pathogenesis the ALS-FTD spectrum disorders. This review overviews the current evidence regarding neuroinflammatory markers in the ALS/FTD continuum, focusing on the neuroinflammatory pathways involved in the genetic cases, moving from post-mortem reports to in vivo biofluid and neuroimaging data. We further discuss the potential link between genetic and autoimmune disorders and potential therapeutic implications.

Hesperidin Ameliorates Sarcopenia through the Regulation of Inflammaging and the AKT/mTOR/FoxO3a Signaling Pathway in 22-26-Month-Old Mice

Faced with a globally aging society, the maintenance of health and quality of life in older people is very important. The age-related loss of muscle mass and strength, known as sarcopenia, severely reduces quality of life and increases the risks of various diseases. In this study, we investigated the inhibitory effect of hesperidin (HES) on inflammaging, with the intention of evaluating its potential use as a treatment for sarcopenia. We studied 22-26-month-old mice, corresponding to humans aged ≥70 years, with aging-related sarcopenia, and young mice aged 3-6 months. The daily administration of HES for 8 weeks resulted in greater muscle mass and strength and increased the fiber size of the old mice. HES also restored the immune homeostasis that had been disrupted by aging, such as the imbalance in M1/M2 macrophage ratio. In addition, we found that HES ameliorated the sarcopenia by regulating AKT/mammalian target of rapamycin/forkhead box 3a signaling through an increase in insulin-like growth factor (IGF)-1 expression in the old mice. Therefore, HES represents a promising candidate inhibitor of sarcopenia in older people, and its effects are achieved through the maintenance of immune homeostasis.

The positive impact on translational research of Fondazione italiana di ricerca per la Sclerosi Laterale Amiotrofica (AriSLA), a non-profit foundation focused on amyotrophic lateral sclerosis. Convergence of ex-ante evaluation and ex-post outcomes when goals are set upfront

Charities investing on rare disease research greatly contribute to generate ground-breaking knowledge with the clear goal of finding a cure for their condition of interest. Although the amount of their investments may be relatively small compared to major funders, the advocacy groups' clear mission promotes innovative research and aggregates highly motivated and mission-oriented scientists. Here, we illustrate the case of Fondazione italiana di ricerca per la Sclerosi Laterale Amiotrofica (AriSLA), the main Italian funding agency entirely dedicated to amyotrophic lateral sclerosis research. An international benchmark analysis of publications derived from AriSLA-funded projects indicated that their mean relative citation ratio values (iCite dashboard, National Institutes of Health, U.S.) were very high, suggesting a strong influence on the referring international scientific community. An interesting trend of research toward translation based on the "triangle of biomedicine" and paper citations (iCite) was also observed. Qualitative analysis on researchers' accomplishments was convergent with the bibliometric data, indicating a high level of performance of several working groups, lines of research that speak of progression toward clinical translation, and one study that has progressed from the investigation of cellular mechanisms to a Phase 2 international clinical trial. The key elements of the success of the AriSLA investment lie in: (i) the clear definition of the objectives (research with potential impact on patients, no matter how far), (ii) a rigorous peer-review process entrusted to an international panel of experts, (iii) diversification of the portfolio with ad hoc selection criteria, which also contributed to bringing new experts and younger scientists to the field, and (iv) a close interaction of AriSLA stakeholders with scientists, who developed a strong sense of belonging. Periodic review of the portfolio of investments is a vital practice for funding agencies. Sharing information between funding agencies about their own policies and research assessment methods and outcomes help guide the international debate on funding strategies and research directions to be undertaken, particularly in the field of rare diseases, where synergy is a relevant enabling factor.

Silencing of FGF6 hampers aerobic glycolysis and angiogenesis in bladder cancer by regulating PI3K/Akt and MAPK signaling pathways

Metabolic abnormalities and uncontrolled angiogenesis are two vital features of malignant tumors. Although fibroblast growth factor 6 (FGF6) is known to promote the proliferation and migration of bladder cancer (BC) cells, its influences on aerobic glycolysis and angiogenesis in BC remain unclear. Gene expression at messenger RNA and protein levels were examined by reverse transcription-quantitative polymerase chain reaction and Western blot analyses, respectively. Lactate production and glucose uptake in BC cells were evaluated by performing aerobic glycolysis assays. A vasculogenic mimicry assay was executed for assessing the angiogenesis of BC cells. The viability, migration, and angiogenesis of human umbilical vein endothelial cells (HUVECs) cocultured with supernatants of BC cells were detected using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, wound healing assay, and tube formation assay. It was found that FGF6 displayed a high level in BC cell lines. Silencing of FGF6 reduced the levels of lactate production, glucose uptake, and the expression of angiogenic factors and glycolytic enzymes in BC cells, which also inhibited the viability and migration of HUVECs. In addition, FGF6 depletion or aerobic glycolysis inhibitor 2-deoxy-d-glucose treatment decreased the total branching length and intersection number of both BC cells and HUVECs. Moreover, glucose or lactate treatment reversed FGF6-induced suppression of cell viability, migration, tube formation, and vasculogenic mimicry. The activation of the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) and mitogen-activated protein kinase (MAPK) signaling pathways was blocked by silenced FGF6. Furthermore, PI3K/Akt inhibitor (LY2940002) and p38-MAPK inhibitor (SB203580) inhibited the levels of aerobic glycolysis-related proteins. In conclusion, FGF6 knockdown suppressed aerobic glycolysis, thereby inhibiting angiogenesis in BC via regulation of the PI3K/Akt and MAPK signaling pathways.

Fabricating the cartilage: recent achievements

This review aims to describe the most recent achievements and provide an insight into cartilage engineering and strategies to restore the cartilage defects. Here, we discuss cell types, biomaterials, and biochemical factors applied to form cartilage tissue equivalents and update the status of fabrication techniques, which are used at all stages of engineering the cartilage. The actualized concept to improve the cartilage tissue restoration is based on applying personalized products fabricated using a full cycle platform: a bioprinter, a bioink consisted of ECM-embedded autologous cell aggregates, and a bioreactor. Moreover, in situ platforms can help to skip some steps and enable adjusting the newly formed tissue in the place during the operation. Only some achievements described have passed first stages of clinical translation; nevertheless, the number of their preclinical and clinical trials is expected to grow in the nearest future.

Recent Progress in the Characterization, Synthesis, Delivery Procedures, Treatment Strategies, and Precision of Antimicrobial Peptides

Infectious diseases are constantly evolving to bypass antibiotics or create resistance against them. There is a piercing alarm for the need to improve the design of new effective antimicrobial agents such as antimicrobial peptides which are less prone to resistance and possess high sensitivity. This would guard public health in combating and overcoming stubborn pathogens and mitigate incurable diseases; however, the emergence of antimicrobial peptides' shortcomings ranging from untimely degradation by enzymes to difficulty in the design against specific targets is a major bottleneck in achieving these objectives. This review is aimed at highlighting the recent progress in antimicrobial peptide development in the area of nanotechnology-based delivery, selectivity indices, synthesis and characterization, their doping and coating, and the shortfall of these approaches. This review will raise awareness of antimicrobial peptides as prospective therapeutic agents in the medical and pharmaceutical industries, such as the sensitive treatment of diseases and their utilization. The knowledge from this development would guide the future design of these novel peptides and allow the development of highly specific, sensitive, and accurate antimicrobial peptides to initiate treatment regimens in patients to enable them to have accommodating lifestyles.