Combined anterior and posterior vs isolated posterior facet fixation for subtalar arthrodesis: A proportional meta-analysis and systematic review of the literature.

INTRODUCTION: Subtalar arthrodesis (SA) is a common procedure to treat end-stage subtalar osteoarthritis. We set out in order to determine whether a combined direct fixation of both anterior and posterior facets during SA might influence union and complications compared to isolated fixation of the posterior facet. Our hypothesis was that a combined fixation increases the union rate and reduces the complication rate. METHODS: In this PRISMA-compliant PROSPERO-registered systematic review, we included studies reporting data after SA stabilized with screws in adults. The characteristics of the cohort, study design, surgical details, nonunion and complication rate at the longest follow-up were recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were compared: an ANT/POST group (screws positioned both in the anterior and posterior facet) and an ONLY POST group (isolated posterior facet fixation). RESULTS: Eighteen series (685 feet: ANT/POST = 96, ONLY POST = 589) were selected. The median follow-up was 28 months (IQR, 12-42). The pooled proportion showed a similar nonunion rate (6% vs 10%; p = 0.46) and complication rate (14% vs 19%, p = 0.47) in the ANT/POST group as compared to the ONLY POST group. The pooled proportion of reoperation was not different either (ANT/POST: 7% vs ONLY POST: 10%, p = 0.37). Kernel regression suggested a correlation between the proportion of open/arthroscopic procedures and the nonunion rate (p = 0.025) with a median nonunion rate at 10.9% and 5.9% for open and arthroscopic procedures, respectively. Mean CMS was 40.4 points (poor quality). CONCLUSION: This proportional meta-analysis suggested that a combined direct fixation of anterior and posterior facets during subtalar arthrodesis does not significantly influence the risk of nonunion nor affects the risk of complication and reoperation as compared to isolated posterior facet fixation. LEVEL OF EVIDENCE: IV; review of Level I-IV studies.

Trends in the Use of Weightbearing Computed Tomography.

Background: This review aimed to critically appraise the most recent orthopedic literature around cone beam weightbearing computed tomography (WBCT), summarizing what evidence has been provided so far and identifying the main research trends in the area. Methods: This scoping review was performed on studies published between January 2013 and December 2023 on the Pubmed database. All studies (both clinical and nonclinical) in which WBCT had been used were critically analyzed to extract the aim (or aims) of the study, and the main findings related to the role of this imaging modality in the diagnostic pathway. Results: Out of 1759 studies, 129 were selected. One hundred five manuscripts (81%) dealt with elective orthopedic conditions. The majority of the analyses (88 studies; 84%) were performed on foot and ankle conditions, while 13 (12%) studies looked at knee pathologies. There was a progressive increase in the number of studies published over the years. Progressive Collapsing Foot Deformity (22 studies; 25%) and Hallux Valgus (19 studies; 21%) were frequent subjects. Twenty-four (19%) manuscripts dealt with traumatic conditions. A particular interest in syndesmotic injuries was documented (12 studies; 60%). Conclusions: In this review, we documented an increasing interest in clinical applications of weightbearing CT in the orthopedic field between 2013 and 2023. The majority of the analyses focused on conditions related to the foot and the ankle; however, we found several works investigating the value of WBCT on other joints (in particular, the knee).

Median age of patients undergoing total ankle replacement has not significantly changed between 1999 and 2023: A systematic review of prospective studies.

INTRODUCTION: Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. METHODS: This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, number of cohorts in each study, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. RESULTS: Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6397 ankles, 6317 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 32 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p = 0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p = 0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p = 0.12). CONCLUSION: According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time. LEVEL OF EVIDENCE: Level II - systematic review including Level I and Level II studies.

Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial.

BACKGROUND: Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results. OBJECTIVES: To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively. METHODS: Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group. RESULTS: There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals. CONCLUSION: RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identification number NCT02760212.

Best practices, errors, and perspectives of half a century of plant translocation in Italy.

Conservation translocations are becoming common conservation practice, so there is an increasing need to understand the drivers of plant translocation performance through reviews of cases at global and regional levels. The establishment of the Italian Database of Plant Translocation (IDPlanT) provides the opportunity to review the techniques used in 186 plant translocation cases performed in the last 50 years in the heart of the Mediterranean Biodiversity Hotspot. We described techniques and information available in IDPlanT and used these data to identify drivers of translocation outcomes. We tested the effect of 15 variables on survival of translocated propagules as of the last monitoring date with binomial logistic mixed-effect models. Eleven variables significantly affected survival of transplants: life form, site protection, material source, number of source populations, propagation methods, propagule life stage, planting methods, habitat suitability assessment, site preparation, aftercare, and costs. The integration of vegetation studies in the selection of suitable planting sites significantly increased the success of translocation efforts. Although posttranslocation watering had a generally positive effect on translocation outcome, other aftercare techniques did not always increase transplant survival. Finally, we found that how funds were spent appeared to be more important than the actual amount spent. Plant translocations in Italy and in the Mediterranean area should account for the complexity of speciation, gene flow, and plant migrations that has led to local adaptations and has important implications for the choice and constitution of source material.

Mejores prácticas, errores y perspectivas tras medio siglo de reubicaciones botánicas en Italia Resumen Las reubicaciones son una práctica cada vez más común en la conservación, por lo que hay una necesidad creciente por entender los factores del desempeño de las reubicaciones botánicas por medio de la revisión de casos regionales y globales. La creación de la Italian Database of Plant Translocation (IDPlanT) proporciona una oportunidad para revisar las técnicas usadas para los casos de reubicación de 186 plantas realizados durante los últimos cincuenta años en el centro del punto caliente de biodiversidad mediterránea. Describimos las técnicas y la información disponible en IDPlanT y usamos estos datos para identificar los factores involucrados en los resultados de las reubicaciones. Usamos modelos logísticos binomiales de efectos mixtos para analizar el efecto de 15 variables sobre la supervivencia de los propágulos reubicados a partir de la última fecha de monitoreo. Once de las variables afectaron de manera significativa la supervivencia de las plantas: forma de vida, protección del sitio, fuente de materiales, cantidad de poblaciones originarias, método de propagación, etapa de vida del propágulo, método de siembra, evaluación de idoneidad del hábitat, preparación del sitio, cuidados posteriores y costos. La integración de los estudios botánicos a la selección de los sitios idóneos para plantar aumentó el éxito de los esfuerzos de reubicación. Aunque el riego posterior a la reubicación tuvo un efecto positivo general sobre el resultado, las otras técnicas de cuidado posterior no siempre incrementaron la supervivencia de la planta reubicada. Por último, descubrimos que parece ser más importante cómo se utilizan los fondos que la cantidad actual empleada. Las reubicaciones botánicas en Italia y en el área del Mediterráneo deben considerar lo complejo de la especiación, el flujo génico y la migración botánica que han derivado en adaptaciones locales y que han tenido implicaciones importantes para la elección y constitución del material de origen.

Role of fibular autograft in ankle arthrodesis fixed using cannulated screws: a proportional meta-analysis and systematic review.

Ankle arthrodesis is commonly performed to treat end-stage ankle osteoarthritis. The aim of this study was to determine whether the use of fibular autograft might increase the fusion rate and decrease the complication rate in ankle arthrodesis (AA) fixed using cannulated screws. To perform this PRISMA-compliant proportional meta-analysis, multiple databases were searched for studies in which patients undergone AA (using exclusively cannulated screws and augmented with fibular bone graft) were followed. The characteristics of the cohort, the study design, surgical details, the nonunion and complication rate at the longest follow-up were extracted and recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were built: arthrodeses fixed with screws combined with cancellous autograft (G1) and arthrodeses fixed with screws combined with cancellous autograft and augmented with a lateral fibular onlay (G2). A third group (arthrodeses fixed with screws and no graft, G3) was extracted from previous literature for a further comparison. Overall, we included 306 ankles (296 patients) from ten series (ten studies). In G1 and G2 there were 118 ankles (111 patients) and 188 ankles (185 patients), respectively. In patients where cancellous autograft was used, a further augmentation with a fibular lateral strut autograft did not change significantly the nonunion (4% [95% CI 1-9] in G1 vs. 2% [95% CI 0-5) in G2, p = 0.99) nor the complication rate (18% [95% CI 0-36] in G1 vs. 13% [95% CI 6-21) in G2, p = 0.71). Upon comparison with 667 ankles (659 patients, G3) in which arthrodeses had been performed without grafting, the nonunion and complication rates did not differ significantly either (pooled estimates: 3% [95% CI 1-3) in G1 + G2 vs. 3% [95% CI 2-4] in G3, p = 0.73 for nonunion; 15% [8-23] in G1 + G2 vs. 13% [95% CI 9-17] in G3, p = 0.93 for complications). In ankle arthrodesis fixed with cannulated screws combined with cancellous autograft at the fusion site, a construct augmentation with a distal fibular onlay strut graft positioned laterally at the ankle joint does not reduce the risk of nonunion or complication. In general, the use of bone graft does not influence significantly the nonunion nor the complication rate as compared to non-grafted screw-fixed ankle arthrodeses.Kindly check and confirm the corresponding author mail id is correctly identified.It's all correct.

Dune plants as a sink for beach litter: The species-specific role and edge effect on litter entrapment by plants.

Anthropogenic litter accumulates along coasts worldwide. In addition to the flowing litter load, wind, sea currents, geomorphology and vegetation determine the distribution of litter trapped on the sandy coasts. Although some studies highlighted the role of dune plants in trapping marine litter, little is known about their efficiency as sinks and about the small-scale spatial distribution of litter across the dune area. Here, we explore these gaps by analysing six plant species widespread in Mediterranean coastal habitats, namely Echinophora spinosa, Limbarda crithmoides, Anthemis maritima, Pancratium maritimum, Thinopyrum junceum, and Salsola kali. The present study analyses for the first time the capture of litter by dune vegetation at a multi-species level, considering their morphological structure. Data on plastic accumulation on dune plants were compared with unvegetated control plots located at embryo-dune and foredune belts. We found that dunal plants mainly entrapped macrolitter (> 0.5 cm). Particularly, E. spinosa, L. crithmoides, A. maritima and P. maritimum mostly accumulated litter in the embryo dune while T. junceum and S. kali entrapped more in the foredune area. Moreover, beach litter was mainly blocked at the edge of the plant patches rather than in the core, highlighting the 'Plant-edge litter effect'. As A. maritima and S. kali entrapped respectively more litter in embryo and foredune habitats, these species could be used to monitor and recollect litter. In this light, our findings provide further insight into the role of dune plants in the beach litter dynamics, suppling useful information for beach clean-up actions.

Hyperpolarized 129 Xe imaging of the brain: Achievements and future challenges.

Hyperpolarized (HP) xenon-129 (129 Xe) brain MRI is a promising imaging modality currently under extensive development. HP 129 Xe is nontoxic, capable of dissolving in pulmonary blood, and is extremely sensitive to the local environment. After dissolution in the pulmonary blood, HP 129 Xe travels with the blood flow to the brain and can be used for functional imaging such as perfusion imaging, hemodynamic response detection, and blood-brain barrier permeability assessment. HP 129 Xe MRI imaging of the brain has been performed in animals, healthy human subjects, and in patients with Alzheimer's disease and stroke. In this review, the overall progress in the field of HP 129 Xe brain imaging is discussed, along with various imaging approaches and pulse sequences used to optimize HP 129 Xe brain MRI. In addition, current challenges and limitations of HP 129 Xe brain imaging are discussed, as well as possible methods for their mitigation. Finally, potential pathways for further development are also discussed. HP 129 Xe MRI of the brain has the potential to become a valuable novel perfusion imaging technique and has the potential to be used in the clinical setting in the future.