Influence of Capsicum chinense concentration and salt varieties on the quality attributes of Kilishi, a sundried beef jerky.

The impact of Capsicum chinense concentration and salt varieties on cholesterol oxides, physicochemical properties, microbial profiles and organoleptic attributes of Kilishi, a sundried beef jerky, was assessed. Kilishi (KL) was prepared from sundried strips of Biceps femoris and marinated with either 2 % Sodium chloride (NaCl) + 7 % fresh Capsicum chinense (CC) (KL-1), 1 % NaCl + 1 % Potassium chloride (KCl) + 7 % CC (KL-2), 1 % NaCl + 1 % Potassium citrate (C6H5K3O7) + 7 % CC (KL-3), 1 % NaCl + 14 % CC (KL-4), 1 % KCl + 14 % CC (KL-5) or 1 % C6H5K3O7 + 14 % CC (KL-6), and stored at 29 ± 1 °C for 90 d. The partial or total replacement of NaCl lowered (P < 0.05) the Na content in KL. The KL samples treated with 14 % CC had lower (P < 0.05) 25-hydroxy cholesterol, cholesta-3,5-dien-7-one, carbonyl, pH, malondialdehyde, and lightness and greater (P < 0.05) redness and Lactobacillus counts than those treated with 7 % CC. The chemical composition, sensory scores and water activity were unaffected by the additives. The taste, flavor, and overall acceptance scores of KL decreased (P < 0.05) after 30 days of storage. The substitution of KCl and C6H5K3O7 for NaCl and the increase in CC concentration from 7 to 14 % lowered the Na content and selected cholesterol oxides, respectively, without impairing the organoleptic traits of Kilishi.

Sequential early-life viral infections modulate the microbiota and adaptive immune responses to systemic and mucosal vaccination.

Increasing evidence points to the microbial exposome as a critical factor in maturing and shaping the host immune system, thereby influencing responses to immune challenges such as infections or vaccines. To investigate the effect of early-life viral exposures on immune development and vaccine responses, we inoculated mice with six distinct viral pathogens in sequence beginning in the neonatal period, and then evaluated their immune signatures before and after intramuscular or intranasal vaccination against SARS-CoV-2. Sequential viral infection drove profound changes in all aspects of the immune system, including increasing circulating leukocytes, altering innate and adaptive immune cell lineages in tissues, and markedly influencing serum cytokine and total antibody levels. Beyond changes in the immune responses, these exposures also modulated the composition of the endogenous intestinal microbiota. Although sequentially-infected mice exhibited increased systemic immune activation and T cell responses after intramuscular and intranasal SARS-CoV-2 immunization, we observed decreased vaccine-induced antibody responses in these animals. These results suggest that early-life viral exposures are sufficient to diminish antibody responses to vaccination in mice, and highlight the potential importance of considering prior microbial exposures when investigating vaccine responses.

An ILC2-chitinase circuit restores lung homeostasis after epithelial injury.

Environmental exposures increase the risk for severe lung disease, but specific drivers of persistent epithelial injury and immune dysfunction remain unclear. Here, we identify a feedback circuit triggered by chitin, a common component of airborne particles, that affects lung health after epithelial injury. In mice, epithelial damage disrupts lung chitinase activity, leading to environmental chitin accumulation, impaired epithelial renewal, and group 2 innate lymphoid cell (ILC2) activation. ILC2s, in turn, restore homeostasis by inducing acidic mammalian chitinase (AMCase) in regenerating epithelial cells and promoting chitin degradation, epithelial differentiation, and inflammatory resolution. Mice lacking AMCase or ILC2s fail to clear chitin and exhibit increased mortality and impaired epithelial regeneration after injury. These effects are ameliorated by chitinase replacement therapy, demonstrating that chitin degradation is crucial for recovery after various forms of lung perturbation. Thus, the ILC2-chitinase response circuit may serve as a target for alleviating persistent postinjury lung epithelial and immune dysfunction.

Type I MET inhibitors cooperate with PD-1 blockade to promote rejection of hepatocellular carcinoma.

Blockade of the immune checkpoints programmed death-1 (PD-1) and cytotoxic lymphocyte antigen 4 has improved outcomes for patients with hepatocellular carcinoma (HCC), yet most still fail to achieve objective clinical benefit. MET plays key roles in both HCC tumorigenesis and immunosuppressive conditioning; however, inhibition of MET causes upregulation of PD-ligand 1 (PD-L1) suggesting the use of these inhibitors in the context of PD-1 blockade. We sought to investigate across the Hepa1-6, HCA-1 and diethylnitrosamine (DEN) models of HCC whether the combination of more specific type I versus more pleiotropic type II MET inhibitors would confer superior outcomes in combination with PD-1 blockade. While MET inhibition demonstrated cooperativity with αPD-1 across all three models, the type I MET inhibitor capmatinib showed optimal activity in combination and statistically significantly outperformed the combination with the type II inhibitor cabozantinib in the αPD-1 refractory DEN model. In both HCA-1 and DEN HCC, the capmatinib and αPD-1 combination enhanced CD8 T cell frequency and activation state while limiting intratumoral myeloid immune suppression. In vitro studies of antigen-specific T cell activation reveal significantly less inhibition of effector cytokine production and proliferation by capmatinib versus by type II or type III MET inhibitors. These findings suggest significant potential for clinical HCC combination studies of type I MET inhibitors and PD-1 blockade where prior trials using type II inhibitors have yielded limited benefit.

Development of a high-performance optical sensor for sensitive detection of cobalt ions in pharmaceutical, food, biological, and environmental samples.

A re-generable optical chemical sensing film was created using a modified chitosan film that incorporates immobilized 4-(thiazol-2-yldiazenyl) benzene-1,3-diol (TDBD) for the detection of Co2+ in acidic aqueous solutions. Upon exposure to Co2+, the film's color shifted from yellowish green to red by forming a complex between Co2+ and TDBD. The sensor's complex was measured at 574 nm, a wavelength where the sensing membrane exhibited minimal background interference. The film exhibited its highest responsiveness to cobalt ions at pH 5.0. Two sample volumes were analysed: 2.5 mL with a Co2+ concentration range of 8.0-140 ng/mL, and 250 mL with a concentration range of 2.4-15.2 ng/mL. Both sample sizes produced linear calibration curves, with detection limits of 2.5 and 0.7 ng/mL, respectively. The relative standard deviation was 1.35 % for six separate films in a 100 ng/mL Co2+ solution, and 0.87 % for six individual films in a 10 ng/mL solution using 2.5 and 250 ng/mL, respectively. The sensing films demonstrated good stability over 30 days and were successfully used to determine Co2+ in pharmaceutical, food, environmental, and biological samples, yielding satisfactory results compared to the ICP-AES method.

Quantitative assessment of areal bone mineral density using multi-energy localizer radiographs from photon-counting detector CT.

Objective To assess the accuracy and stability of areal bone-mineral-density (aBMD) measurements from multi-energy CT localizer radiographs acquired using photon-counting detector (PCD) CT. Approach A European Spine Phantom (ESP) with hydroxyapatite (HA 0.5, 1.0 and 1.5 g/cm2) was scanned using clinical PCD-CT and a dual-energy x-ray absorptiometry (DXA) to compare aBMD values. To assess aBMD stability and reproducibility, PCD-localizers were acquired twice a day for one week, and once per week for five weeks. Multiple phantom anteroposterior thicknesses (18, 26, 34, and 40 cm) were simulated using a synthetic gel layer and scanned across eight tube current values for both 120 kV (15-120 mA) and 140 kV (10 -80 mA), and one-way analysis of variance was performed for statistical significance (p<0.05 considered significant). Quantitative HA and water maps were reconstructed using a prototype software, and aBMD was calculated after background correction. In vivo performance of PCD-based aBMD was illustrated using a patient scan acquired at 140 kV and 40 mA, and lumbar aBMD were compared with the DXA. Main results The ESP aBMD values from PCD-localizers demonstrated excellent day-to-day stability with a coefficient-of-variation ranging from 0.42-0.53%, with Mean Absolute Percentage Errors (MAPE) of less than 5% for all three vertebral bodies. The coefficient-of-variation for weekly scans ranged from 0.17-0.60%, again with MAPE below 5% for all three vertebral bodies. Across phantom sizes and tube currents, the MAPE values varied ranging from 1.84 - 13.78% for 120 kV, and 1.38 - 9.11% for 140 kV. No significant difference was found between different tube currents. For the standard phantom size, DXA showed 11.21% MAPE whereas PCD-CT showed 3.04% MAPE. For the patient scan, deviation between PCD-based aBMD values and those obtained from DXA ranged from 0.07-9.82% for different lumbar vertebra. Significance This study highlights the accuracy and stability of PCD-CT localizers for measuring aBMD. We demonstrated aBMD accuracy across different sizes and showed that higher radiation doses did not inherently increase aBMD accuracy.

Opportunistic Bone Mineral Density Measurement Using Photon-Counting Detector CT Spectral Localizer Images: A Prospective Study.

Background: Spectral localizer images from photon-counting detector (PCD) CT can be used for bone mineral density (BMD) evaluation given their 2D-projectional nature and material decomposition capability. As all CT examinations include localizer images, this approach could allow opportunistic osteoporosis screening in patients undergoing clinically indicated imaging by PCD CT. Objective: To assess the utility of PCD-CT spectral localizer images for opportunistic derivation of area BMD (aBMD) values and T-scores, using dual-energy X-ray absorptiometry (DXA) as the reference standard. Methods: This prospective study included patients ≥18 years old scheduled for clinically indicated lumbar spine CT between October 2023 and February 2024 and who underwent DXA within the 13 prior months or were scheduled for DXA within the subsequent 13 months. Participants underwent lumbar spine CT by PCD CT including spectral localizer images. Lumbar spine aBMD was extracted from clinical DXA reports. ROIs were placed on lumbar vertebral bodies and background soft tissues to extract areal densities from spectral localizer images using material decomposition; areal densities were used to derive lumbar spine aBMD values. The aBMD values were used to derive T-scores, which were classified as representing normal (≥-1) or abnormal (<-1) bone mass. DXA-derived and PCD-CT derived measurements were compared. Results: The study included 51 participants (mean age: 62 years [range, 28-83 years]; 31 female, 20 male). Mean DXA-derived T-score was 0.39±1.64; mean PCD-CT derived T-score was 0.28±1.77 (p=.29). Lin's concordance correlation coefficient between DXA-derived and PCD-CT T-scores was 0.90. The difference between DXA-derived and PCD-CT derived T-scores showed a small correlation with patient age (r=-0.13), absolute interval between DXA and PCD CT (r=.15), and BMI (r=0.28); this difference in scores did not show a significant difference between male and female patients (0.08 vs 0.13, respectively; p=.81). PCD-CT T-scores had sensitivity of 97%, specificity of 71%, PPV of 90%, and NPV of 91% for detecting abnormal bone mass using DXA-derived T-scores as the reference standard. Conclusion: PCD-CT spectral localizers showed clinical utility for deriving aBMD values and, consequently, T-scores. Clinical Impact: The T-score derived from PCD-CT spectral localizers may serve as an opportunistic screening tool for low bone mass and osteoporosis.

Effect of Eruca sativa on Spermatogenesis in Rats Exposed to Cigarette Smoke.

Smoking is among the significant adverse factors to reproductive health and accounts for damage to spermatogenesis and maturation of spermatozoa. The proposed research contributes to understanding the potential of Eruca sativa to prevent the cytotoxic effect of tobacco smoke on different aspects of male reproductive health, including sperm: sperm morphology, sperm count, testes' weight, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testosterone, and lipid profile in passive smokers. The experiment on how Eruca sativa leaves affect sperm morphology and concentration is performed by grinding leaves to make the aqueous juice. The research participants were grouped into four groups: a control group, Eruca sativa-treated, cigarette-treated, and a group receiving both Eruca sativa and cigarette exposure. The rats were weighed and euthanized surgically, and the testes were harvested and weighed after four weeks of treatment. The sperm count was determined using epididymal sperm, and sperm morphology was determined using vas deferens sperm. The collected cardiac blood was used for lipid profile assessment and hormone-level determination. The findings of this study are significant. Tobacco exposure led to a notable increase in abnormal sperm and a decrease in sex hormone levels. In contrast, the Eruca sativa group showed a highly significant difference in sperm morphology and counts compared to the cigarette group, with a p< 0.001. Although there was a slight decrease in the lipid profile concentration, it was insignificant. Importantly, the co-administration of Eruca sativa and cigarette smoke resulted in a significant reduction in abnormal sperm count, increased sperm count, higher sex hormone concentration, and lipid profile. The Eruca sativa juice used in this study had a protective effect that could be used to reverse or prevent the effects mentioned above of passive smoking.

Proven anti-virulence therapies in combating methicillin- and vancomycin-resistant Staphylococcus aureus infections.

Introduction: Despite years of efforts to develop new antibiotics for eradicating multidrug-resistant (MDR) and multi-virulent Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Staphylococcus aureus (VRSA) infections, treatment failures and poor prognoses in most cases have been common. Therefore, there is an urgent need for new therapeutic approaches targeting virulence arrays. Our aim is to discover new anti-virulence therapies targeting MRSA and VRSA virulence arrays. Methodology: We employed phenotypic, molecular docking, and genetic studies to screen for anti-virulence activities among selected promising compounds: Coumarin, Simvastatin, and Ibuprofen. Results: We found that nearly all detected MRSA and VRSA strains exhibited MDR and multi-virulent profiles. The molecular docking results aligned with the phenotypic and genetic assessments of virulence production. Biofilm and hemolysin productions were inhibited, and all virulence genes were downregulated upon treatment with sub-minimum inhibitory concentration (sub-MIC) of these promising compounds. Ibuprofen was the most active compound, exhibiting the highest inhibition and downregulation of virulence gene products. Moreover, in vivo and histopathological studies confirmed these results. Interestingly, we observed a significant decrease in wound area and improvements in re-epithelialization and tissue organization in the Ibuprofen and antimicrobial treated group compared with the group treated with antimicrobial alone. These findings support the idea that a combination of Ibuprofen and antimicrobial drugs may offer a promising new therapy for MRSA and VRSA infections. Conclusion: We hope that our findings can be implemented in clinical practice to assist physicians in making the most suitable treatment decisions.

Anterior Endocrowns as An Alternative to Core Crown restorations: A Systematic Review.

Restoring extensively damaged endodontically treated teeth presents a challenging task due to the state of biomechanical deterioration affecting long-term prognosis. Therefore, the study aims to assess and compare the biomechanical performance of endocrowns and post core-crown restorations in anterior endodontically treated teeth with severe coronal structure loss. Following PRISMA guidelines, a systematic search was conducted using PubMed, Scopus, Web of Science, and Google Scholar for articles published from January 2014 to March 2024. Two independent reviewers screened and selected studies based on the predefined inclusion and exclusion criteria. The included studies were analyzed using the QUIN tool for risk of bias assessment in in-vitro studies. Additionally, the biomechanical outcomes were collected for qualitative comparative analysis. Twelve studies were included in this systematic review. In most studies, Endocrowns demonstrated comparable fatigue resistance under load to failure to post core-crown restorations. Endocrowns without ferrule exhibited a higher rate of debonding but had significantly more repairable failures. Conversely, post core-crown restorations demonstrated higher fracture resistance with the presence of ferrule, but were associated with more catastrophic failure patterns. Additionally, endocrowns generated lower stress levels in both the restorative material and the luting material compared to post core-crown restorations. Among the tested materials, lithium disilicate ceramics provided the best biomechanical properties. Overall, the studies included provided sufficient information for most evaluation criteria of the QUIN risk of bias assessment tool. Endocrowns are a viable and conservative approach for restoring endodontically treated anterior teeth, offering comparable biomechanical performance to traditional post core-crown restorations and less catastrophic failures. The findings of this systematic review suggest that endocrown restorations, especially with lithium disilicate ceramics and proper ferrule design, can improve fracture resistance and longevity of rehabilitated teeth, enhancing patient outcomes for severely damaged anterior endodontically treated teeth.

Influence of Connector Design on Displacement and Micromotion in Tooth-Implant Fixed Partial Dentures Using Different Lengths and Diameters: A Three-Dimensional Finite Element Study.

The literature presents insufficient data evaluating the displacement and micromotion effects resulting from the combined use of tooth-implant connections in fixed partial dentures. Analyzing the biomechanical behavior of tooth-implant fixed partial denture (FPD) prothesis is vital for achieving an optimum design and successful clinical implementation. The objective of this study was to determine the relative significance of connector design on the displacement and micromotion of tooth-implant-supported fixed dental prostheses under occlusal vertical loading. A unilateral Kennedy class I mandibular model was created using a 3D reconstruction from CT scan data. Eight simulated designs of tooth-implant fixed partial dentures (FPDs) were split into two groups: Group A with rigid connectors and Group B with non-rigid connectors. The models were subjected to a uniform vertical load of 100 N. Displacement, strain, and stress were computed using finite element analysis. The materials were defined as isotropic, homogeneous, and exhibiting linear elastic properties. This study focused on assessing the maximum displacement in various components, including the bridge, mandible, dentin, cementum, periodontal ligament (PDL), and implant. Displacement values were predominantly higher in Group B (non-rigid) compared to Group A (rigid) in all measured components of the tooth-implant FPDs. Accordingly, a statistically significant difference was observed between the two groups at the FPD bridge (p value = 0.021 *), mandible (p value = 0.021 *), dentin (p value = 0.043 *), cementum (p value = 0.043 *), and PDL (p value = 0.043 *). Meanwhile, there was an insignificant increase in displacement values recorded in the distal implant (p value = 0.083). This study highlighted the importance of connector design in the overall stability and performance of the prosthesis. Notably, the 4.7 mm × 10 mm implant in Group B showed a displacement nearly 92 times higher than its rigid counterpart in Group A. Overall, the 5.7 mm × 10 mm combination of implant length and diameter showcased the best performance in both groups. The findings demonstrate that wider implants with a proportional length offer greater resistance to displacement forces. In addition, the use of rigid connection design provides superior biomechanical performance in tooth-implant fixed partial dentures and reduces the risk of micromotion with its associated complications such as ligament overstretching and implant overload, achieving predictable prognosis and enhancing the stability of the protheses.

Monoclonal Gammopathy of Clinical Significance (MGCS) and Related Disorders: A Review and the Role of Imaging.

The term monoclonal gammopathy of clinical significance (MGCS) refers to a group of symptomatic monoclonal gammopathies that do not meet the diagnostic criteria for malignant plasma cell disorders, such as multiple myeloma or Waldenström macroglobulinemia. These symptoms are attributable to the paraneoplastic effects of monoclonal immunoglobulins that occur through diverse mechanisms. The presence of symptoms distinguishes MGCS from monoclonal gammopathy of undetermined significance, which lacks significant symptomatic presentation. The presentations of MGCS are manifold, adding to the diagnostic challenge. Clinical suspicion is key for accurate and timely diagnosis. Radiologic imaging can provide pivotal information to guide the diagnosis. In this review, we discuss MGCS from a radiology perspective and highlight pertinent imaging features associated with the disorders.

Cytokine Storm-Induced Thyroid Dysfunction in COVID-19: Insights into Pathogenesis and Therapeutic Approaches.

Angiotensin-converting enzyme 2 receptors (ACE2R) are requisite to enter the host cells for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). ACE2R is constitutive and functions as a type I transmembrane metallo-carboxypeptidase in the renin-angiotensin system (RAS). On thyroid follicular cells, ACE2R allows SARS-CoV-2 to invade the thyroid gland, impose cytopathic effects and produce endocrine abnormalities, including stiff back, neck pain, muscle ache, lethargy, and enlarged, inflamed thyroid gland in COVID-19 patients. Further damage is perpetuated by the sudden bursts of pro-inflammatory cytokines, which is suggestive of a life-threatening syndrome known as a "cytokine storm". IL-1ß, IL-6, IFN-γ, and TNF-α are identified as the key orchestrators of the cytokine storm. These inflammatory mediators upregulate transcriptional turnover of nuclear factor-kappa B (NF-κB), Janus kinase/signal transducer and activator of transcription (JAK/STAT), and mitogen-activated protein kinase (MAPK), paving the pathway for cytokine storm-induced thyroid dysfunctions including euthyroid sick syndrome, autoimmune thyroid diseases, and thyrotoxicosis in COVID-19 patients. Targeted therapies with corticosteroids (dexamethasone), JAK inhibitor (baricitinib), nucleotide analogue (remdesivir) and N-acetyl-cysteine have demonstrated effectiveness in terms of attenuating the severity and frequency of cytokine storm-induced thyroid dysfunctions, morbidity and mortality in severe COVID-19 patients. Here, we review the pathogenesis of cytokine storms and the mechanisms and pathways that establish the connection between thyroid disorder and COVID-19. Moreover, cross-talk interactions of signalling pathways and therapeutic strategies to address COVID-19-associated thyroid diseases are also discussed herein.

Are positional screws superior to lag screws in fixation of medial malleolar fractures? A randomized controlled trial.

PURPOSE: There is no consensus about the best fixation method for medial malleolar fractures. This study was conducted to compare the clinical and radiological results of positional (fully threaded) screws and lag (partially threaded) screws when used to fix medial malleolar fractures. METHODS: This prospective, randomized clinical trial included 68 patients with closed isolated medial malleolar fractures. Each study arm included 34 patients who were randomly treated with either fully threaded screws (FT group) or partially threaded screws (PT group). Patients were evaluated radiologically for union and clinically using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score. RESULTS: After a 12-month follow-up, the mean AOFAS ankle hindfoot score was 92.1 ± 3.5 in the FT group and 91.8 ± 5.4 in the PT group. Union was achieved in the FT group after a mean of 6.2 ± 1.3 weeks and after a mean of 6.5 ± 1.5 weeks in the PT group. CONCLUSION: Both fully threaded and partially threaded screws yielded good comparable clinical and radiological outcomes when used to fix isolated medial malleolar fractures.

Comparative Study Between Single-limb Versus One-and-a-Half Hip Spica Cast in Fracture Femur in Young Children.

INTRODUCTION: Femoral fractures account for ∼1% to 2% of all pediatric bone injuries and are a common occurrence in children. The conservative approach, employing either a single or one-and-a-half spica casts, has been traditionally favored, yielding satisfactory outcomes in select cases. This study aims to compare both procedures regarding functional and radiologic outcomes, complications, and parents' satisfaction. METHODS: In this randomized controlled trial, we enrolled 84 pediatric patients, aged between 2 and 6 years, presenting with femoral fractures. Participants were randomly allocated into 2 groups; one receiving single-limb spica cast fixation (n=42) and the other receiving one-and-a-half spica cast fixation (n=42). We assessed postprocedural functional and radiologic outcomes. Other evaluations focused on parental ease in maintaining hygiene for the casted child, the child's mobility capabilities including standing and crawling, and the incidence of skin complications. RESULTS: No significant variance was observed between the 2 groups concerning the time to bone union, and the overall complication rates. Parental satisfaction was notably higher in the single-limb spica group, particularly regarding the ease of maintaining hygiene for the casted child and the child's mobility while encased in the cast (P<0.001). Furthermore, a significant correlation was identified between the one-and-a-half spica application and the increased occurrence of skin pressure ulcers (P<0.001). CONCLUSION: Both single-limb and one-and-a-half spica cast applications demonstrated comparable results in functional and radiologic outcomes, as well as in complication rates. However, parents favored the single-limb method due to its facilitation of a more manageable lifestyle for both the child and their parents. These considerations suggest that the single-limb hip spica cast fixation may be preferable in managing pediatric femoral fractures. LEVEL OF EVIDENCE: Level II.

Femoral Lengthening in Children with Congenital Femoral Deficiency: A Systematic Review.

BACKGROUND: Congenital femoral deficiency (CFD) presents a significant challenge in pediatric orthopaedics, characterized by a spectrum of congenital anomalies ranging from mild femoral shortening to complete absence of the proximal femur and hip joint. This review aims at reviewing the latest concepts of femoral limb lengthening modalities in treating CFD, to explore the efficacy, complications, and long-term outcomes of various surgical techniques. METHODS: A comprehensive search of the literature was performed for clinical studies involving lengthening in patients with proximal focal femoral deficiency (PFFD) in several databases. RESULTS: We analyze the evolution of limb lengthening procedures, from the Wagner and Ilizarov methods to the latest advancements in distraction osteogenesis, and assess their role in addressing the functional needs of patients. We also analyze the possible risk factors for the occurrence of complications with each method and alternatives to avoid them. CONCLUSION: The review highlights the importance of individualized treatment plans, considering factors such as the degree of femoral deficiency and the potential for achieving a functional limb length; however, it requires a multidisciplinary approach and careful preoperative planning to optimize patient outcomes. The review underlines the need for ongoing research to refine surgical techniques and to compare them and improve the quality of life for individuals with PFFD. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.