Simultaneous Ipsilateral Anterior Cruciate Ligament and Proximal Hamstring Tendon Ruptures: A Case Report.

Introduction: Simultaneous anterior cruciate ligament (ACL) and ipsilateral hamstring ruptures have never been reported in the literature. The purpose of this article is to describe a treatment approach for such a case. The principles in this case can help guide treatment for any patient with concomitant ACL and hamstring pathology. Case Report: We describe the case of a 53-year-old male who presented with left ipsilateral simultaneous complete proximal hamstring tendon (HT) and ACL tears after an acute tennis injury. He was successfully treated with a staged procedure, first with a proximal HT repair and later with a delayed ACL reconstruction using a bone-patellar tendon-bone autograft. Conclusion: Ipsilateral simultaneous complete proximal HT and ACL tears can be successfully treated with acute proximal HT repair and delayed ACL reconstruction after rehabilitation from the HT repair. The synergistic relationship between the ACL and hamstring muscles in preventing anterior translation of the tibia necessitates staged reconstruction in the setting of a simultaneous injury.

Medical Students' Perspectives Regarding the Use of a Slit-Lamp Smartphone Adapter for Clinical Slit-Lamp Photography.

Background This study aimed to investigate medical students' perspectives regarding the ease and utility of smartphone slit-lamp photography. Methodology In this prospective experimental study, fourth and fifth-year medical students who were in or had finished ophthalmology rotation were included to attempt slit-lamp smartphone anterior segment photography on adult patients after a brief hands-on instruction course. Each medical student attempted to record five supervised slit-lamp videos of the anterior segment of five patients using the described adapter and their own smartphone. The time taken until photography was calculated for each attempt. After the fifth attempt, each medical student rated the ease of the use of this method of slit-lamp photography as well as their perspective regarding its utility as a potential means of medical education and telemedical consultations on a five-point Likert scale. Results A total of 33 medical students participated, with each successfully recording five slit-lamp examinations using their smartphones. The time used for the application of the adapter until the image capture ranged from 6 to 278 seconds (average = 39.51 ± 34.7 seconds) and markedly improved by the fifth attempt (30.5 ± 25.7 seconds) compared to the first attempt (67.3 ± 49.3 seconds). Learning this skill was perceived to be relatively easy (2.2 ± 1), with high potential in clinical education (4.6 ± 0.75) and teleconsultations (4.7 ± 0.65). Conclusions Smartphone slit-lamp photography is a relatively easy process. It can be quickly acquired by medical students and has the potential to enhance their medical education and telemedical consultation capabilities.

Assessing the reporting of harms in systematic reviews focused on platelet-rich plasma therapy: a cross-sectional analysis.

Aim: Our objectives are: to evaluate the completeness of harms reporting in systematic reviews (SRs) on platelet-rich plasma therapy; to assess the overall methodological quality of the SR using AMSTAR-2 tool; to assess harms reporting overlap in primary studies between SRs. Materials & methods: The authors searched five database systems for relevant literature on platelet rich plasma therapy. The authors screened and extracted in masked, duplicate fashion. Results: All SRs reported less than 50% completeness in harms reporting. The most frequently reported item was harms being stated in the abstract or title (26/103, 25.2%). AMSTAR-2 assessed 96 SRs as 'critically low', 6 SRs as 'low' and 1 'moderate'. Conclusion: Our study highlights that reporting of harms should become more standardized and transparent.

This study looked at how well the negative effects (harms) of platelet-rich plasma therapy are reported in systematic reviews (SRs). The researchers carefully reviewed and extracted data of SRs from different databases. They found that less than 50% of the SRs reported the harms associated with platelet rich plasma therapy. The researchers also used a tool called AMSTAR to assess the value of each of the SRs, and most were found to be 'critically low' reviews. In conclusion, this study highlights the importance of platelet rich plasma therapy negative effect reporting by SRs.

A Comprehensive Pan-Cancer Analysis Identifies CEP55 as a Potential Oncogene and Novel Therapeutic Target.

Emerging research findings have shown that a centrosomal protein (CEP55) is a potential oncogene in numerous human malignancies. Nevertheless, no pan-cancer analysis has been conducted to investigate the various aspects and behavior of this oncogene in different human cancerous tissues. Numerous databases were investigated to conduct a detailed analysis of CEP55. Initially, we evaluated the expression of CEP55 in several types of cancers and attempted to find the correlation between that and the stage of the examined malignancies. Then, we conducted a survival analysis to determine the relationship between CEP55 overexpression in malignancies and the patient's survival. Furthermore, we examined the genetic alteration forms and the methylation status of this oncogene. Additionally, the interference of CEP55 expression with immune cell infiltration, the response to various chemotherapeutic agents, and the putative molecular mechanism of CEP55 in tumorigenesis were investigated. The current study found that CEP55 was upregulated in cancerous tissues versus normal controls where this upregulation was correlated with a poor prognosis in multiple forms of human cancers. Additionally, it influenced the level of different immune cell infiltration and several chemokines levels in the tumor microenvironment in addition to the response to several antitumor drugs. Herein, we provide an in-depth understanding of the oncogenic activities of CEP55, identifying it as a possible predictive marker as well as a specific target for developing anticancer therapies.

A rare case report of tenosynovial chondromatosis of the semimembranosus-medial collateral ligament bursa.

BACKGROUND: Synovial chondromatosis is an uncommon metaplastic process of the synovial lining that results in the formation of cartilaginous nodules within joints or their associated bursae or tendon sheaths. Radiologic evidence of mineralized bodies within these structures is typically pathognomonic for this condition. Extraarticular chondromatosis is rarer than intraarticular chondromatosis, and the knee is affected less frequently than the smaller joints of the hands and feet. To our knowledge, no reports describing this condition in the semimembranosus-medial collateral ligament (SM-MCL) bursa have been published. CASE PRESENTATION: We describe a case of tenosynovial chondromatosis in a 37-year-old woman. The case was atypical for both the location within the SM-MCL bursa and the paucity of radiodense or hypointense changes to support a clinical suspicion of chondroid metaplasia on radiographs and T2-weighted MRI, respectively. Recreational weightlifting and swimming by the patient were impaired by chronic pain, and restricted range of motion of the ipsilateral knee persisted despite extensive skilled physical therapy and injections of both corticosteroids and platelet-rich plasma. Thirteen months after a diagnostic and therapeutic knee arthroscopy, open surgical excision of the SM-MCL bursal body was performed, and knee pain and range of motion improved by the 6-week postoperative reevaluation. Pathologic evaluation of the excised tissue was consistent with tenosynovial chondromatosis. CONCLUSIONS: Synovial chondromatosis should be considered in the differential diagnosis for recalcitrant bursitis, even in the absence of classic imaging findings.

Integration of Chemoinformatics and Multi-Omics Analysis Defines ECT2 as a Potential Target for Cancer Drug Therapy.

Epithelial cell transforming 2 (ECT2) is a potential oncogene and a number of recent studies have correlated it with the progression of several human cancers. Despite this elevated attention for ECT2 in oncology-related reports, there is no collective study to combine and integrate the expression and oncogenic behavior of ECT2 in a panel of human cancers. The current study started with a differential expression analysis of ECT2 in cancerous versus normal tissue. Following that, the study asked for the correlation between ECT2 upregulation and tumor stage, grade, and metastasis, along with its effect on patient survival. Moreover, the methylation and phosphorylation status of ECT2 in tumor versus normal tissue was assessed, in addition to the investigation of the ECT2 effect on the immune cell infiltration in the tumor microenvironment. The current study revealed that ECT2 was upregulated as mRNA and protein levels in a list of human tumors, a feature that allowed for the increased filtration of myeloid-derived suppressor cells (MDSC) and decreased the level of natural killer T (NKT) cells, which ultimately led to a poor prognosis survival. Lastly, we screened for several drugs that could inhibit ECT2 and act as antitumor agents. Collectively, this study nominated ECT2 as a prognostic and immunological biomarker, with reported inhibitors that represent potential antitumor drugs.

A Hybrid Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents-a Multi-center Pilot Program.

Purpose of Review: The increased use of musculoskeletal ultrasound (MSKUS) in clinical practice warrants achieving competency earlier in physiatrists' careers. Physical Medicine and Rehabilitation (PM&R) residency programs have started incorporating formal MSKUS training in their curricula; however, significant heterogeneity remains in MSKUS education. Recent Findings: Numerous barriers contribute to the lack of consensus for MSKUS training during residency, but the COVID-19 pandemic severely disrupted in-person learning. As an adjunct or alternative to in-person learning, teleguided technology is being utilized. Summary: This curriculum demonstrates the role of a hybrid MSKUS training with interinstitutional collaboration. Twenty PM&R learners, from two institutions, were divided into a fundamental or advanced track. Virtual didactic sessions alternated weekly with hands-on ultrasonographic scanning sessions. Following a 12-month longitudinal curriculum, an end-of-year practical examination was used for competency assessment, in addition to a survey assessing resident perceptions and feedback. To our knowledge, this is the first collaborative and hybrid MSKUS curriculum for PM&R learners that can be easily reproduced at most training institutions and circumvent some of the barriers amplified by the COVID-19 pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s40141-023-00380-z.

Fistula of acromioclavicular cyst treated with a staged reverse total shoulder arthroplasty: a case report.

BACKGROUND: Acromioclavicular (AC) joint cysts are relatively rare. There are two distinct etiologies of AC cysts. Type 1 is isolated to the AC joint, while type 2, is related to a tear or rupture of the rotator cuff (RC). The disease is usually a rare result of advanced AC joint arthritis or RC-tear arthropathy. Patients may present with signs and symptoms of RC impingement and tear. Conservative management may be used initially in asymptomatic individuals who are also not concerned with cosmesis. Aspiration and steroid injection of the cyst has been reported as one method of non-surgical management of these lesions, however, there is a high rate of recurrence. CASE PRESENTATION: We report a case of A 72-year-old right-handed female with past medical history of type two diabetes mellitus, chronic smoking, and a prior right RC repair with distal clavicle resection who presented with an AC joint cyst complicated by a draining fistula as a result of cyst aspiration and steroid injection. Due to the persistent drainage of the cyst and concern for infection, the patient was treated with a staged reverse shoulder arthroplasty given the setting of an irreparable rotator cuff tear and end-stage cuff-tear arthropathy. CONCLUSION: This case demonstrates an important complication of persistent draining fistula resulting from AC joint cyst aspiration and steroid injection in the setting of advanced RC-tear arthropathy. In immunocompromised patients, staged reverse shoulder arthroplasty should be considered for treatment of these draining fistulas especially when the concern for periprosthetic infection is high.

In vitro and in vivo impacts of nifedipine and diltiazem on praziquantel chemotherapy in murine Schistosoma mansoni.

AIM: This study was planned to evaluate the in vitro and in vivo antischistosomal effects of the widely used antihypertensive drugs, nifedipine (NIF) and diltiazem (DTZ), and their combinations with praziquantel (PZQ) on early and late Schistosoma (S.) mansoni infections 21- and 45- days old stages. METHODS: In the In vitro study, Calcium channel blockers (CCBs), NIF and DTZ were added to schistosomula and adult worm cultures in different concentrations 10, 20 and 30 mg/ml. The mortality percentage was calculated 1, 12 and 24 h after incubation. In vivo, NIF and DTZ either alone or combined with PZQ were used to treat male albino mice. The parasitological and total immunoglobulin (Ig) G and IgM anti-soluble egg antigen (SEA) were assessed to demonstrate the disease severity. RESULTS: In the In vitro study, 10 mg/ml NIF induced 100% mortality percentage of both schistosomula and adult worms after 24 h incubation, while DTZ induced similar mortality percentage at 30 mg/ml concentration. In vivo results showed that early or late combination of 30 mg/kg of NIF, but not DTZ, significantly (P <0.05) enhanced the reductive efficacy of PZQ based on the parasitological data. The maximal reduction (P <0.05) of anti-SEA IgM and IgG levels was developed during NIF-PZQ administration 21- (1.12 ± 0.06 and 1.09 ± 0.04, respectively) or 45- (1.00 ± 0.03 and 0.8 ± 0.06, respectively) days post infection (PI), compared to either PZQ or NIF individual treatments. The decreased concentration of anti-SEA antibodies was correlated with the diminished granulomatous diameter and disease severity. CONCLUSION: Nifedipine improved PZQ chemotherapy targeting either early or late S. mansoni infection in mice compared to the PZQ mono-therapy. Administering NIF can be considered as a promising drug candidate for schistosomiasis chemotherapy.

Effect of mobile phone text message and call reminders in the completeness of pentavalent vaccines in Kano state, Nigeria.

PURPOSE: This study assessed the effect of mobile phone text message and call reminders in the completeness of the pentavalent vaccine administered against diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenza. DESIGN AND METHODS: The population for this quasi-experimental study were recent mothers of children not more than three weeks old selected from six local government areas of Kano State, Northern Nigeria. Three local government areas were each allocated to the intervention (reminder) and control groups of the study. Mobile phone reminders (SMS and follow-up calls) were sent to mothers in the reminder group three days to and on the due date of their child's schedule for the 1st, 2nd and 3rd doses of the pentavalent vaccine. All statistical data were entered into the Statistical Package for Social Sciences (SPSS) version 23.0 and analysed using descriptive and inferential statistics. RESULTS: A total of 541 mothers (271 in the intervention group and 270 in the control group) participated in the study. Completion rates for the three doses of the pentavalent vaccine were observed to be higher for children in the reminder group (n = 161, 59.4%) compared to those in the control group (n = 92, 34.1%). CONCLUSION: Mobile phone reminders were effective and improved the rate of completeness of the pentavalent vaccine in the studied population. In line with the findings of the study, it is recommended that future studies should focus on identifying the best approach to remind parents either through SMS, phone calls, or voice messages or a combination of any of the approaches. PRACTICE IMPLICATION: Nurses and other health care providers will have empirical evidence on the use of mobile phone technology to improve the health and wellbeing of children by protecting them from vaccine-preventable diseases.

The Transverse Infrapatellar View: A New Ultrasound Technique to Measure Distal Femoral Cartilage Thickness.

OBJECTIVES: To examine the reliability and face validity of ultrasound (US) measurements of distal femoral cartilage thickness (CT) using the infrapatellar view (IPV) with knee extension compared to the traditional suprapatellar view (SPV) with knee hyperflexion in young asymptomatic participants and patients with painful knee osteoarthritis (KOA). METHODS: The IPV was obtained in an extended knee position by placing the US transducer on the patellar tendon at a 60° angle tilted toward the distal femoral condyle in 19 young adults (control group) and 70 patients with KOA. The CT was measured at the medial femoral condyle, the intercondylar notch, and the lateral femoral condyle. RESULTS: The inter-rater intraclass correlation coefficient was higher for IPV-based CT measurement (range, 0.856-0.858) compared to SPV-based CT measurement (range, 0.315-0.523) among the patients with symptomatic KOA. The IPV-based CT differed significantly between the control group and the KOA group at the intercondylar notch (P < .001) and lateral femoral condyle (P = .006). The SPV-based CT differed significantly between the control group and the KOA group only at the lateral femoral condyle region (P = .014). CONCLUSIONS: An infrapatellar US evaluation of the distal femoral CT can be a reliable alternative method to a suprapatellar US evaluation for patients with KOA.

Comparative Performance of Spectral Reflectance Indices and Multivariate Modeling for Assessing Agronomic Parameters in Advanced Spring Wheat Lines Under Two Contrasting Irrigation Regimes.

The incorporation of nondestructive and cost-effective tools in genetic drought studies in combination with reliable indirect screening criteria that exhibit high heritability and genetic correlations will be critical for addressing the water deficit challenges of the agricultural sector under arid conditions and ensuring the success of genotype development. In this study, the proximal spectral reflectance data were exploited to assess three destructive agronomic parameters [dry weight (DW) and water content (WC) of the aboveground biomass and grain yield (GY)] in 30 recombinant F7 and F8 inbred lines (RILs) growing under full (FL) and limited (LM) irrigation regimes. The utility of different groups of spectral reflectance indices (SRIs) as an indirect assessment tool was tested based on heritability and genetic correlations. The performance of the SRIs and different models of partial least squares regression (PLSR) and stepwise multiple linear regression (SMLR) in estimating the destructive parameters was considered. Generally, all groups of SRIs, as well as different models of PLSR and SMLR, generated better estimations for destructive parameters under LM and combined FL+LM than under FL. Even though most of the SRIs exhibited a low association with destructive parameters under FL, they exhibited moderate to high genetic correlations and also had high heritability. The SRIs based on near-infrared (NIR)/visible (VIS) and NIR/NIR, especially those developed in this study, spectral band intervals extracted within VIS, red edge, and NIR spectral range, or individual effective wavelengths relevant to green, red, red edge, and middle NIR spectral region, were found to be more effective in estimating the destructive parameters under all conditions. Five models of SMLR and PLSR for each condition explained most of the variation in the three destructive parameters among genotypes. These models explained 42% to 46%, 19% to 30%, and 39% to 46% of the variation in DW, WC, and GY among genotypes under FL, 69% to 72%, 59% to 61%, and 77% to 81% under LM, and 71% to 75%, 61% to 71%, and 74% to 78% under FL+LM, respectively. Overall, these results confirmed that application of hyperspectral reflectance sensing in breeding programs is not only important for evaluating a sufficient number of genotypes in an expeditious and cost-effective manner but also could be exploited to develop indirect breeding traits that aid in accelerating the development of genotypes for application under adverse environmental conditions.

The Prevalence of Asymptomatic Cervical and Lumbar Facet Arthropathy: A Computed Tomography Study.

STUDY DESIGN: Case control study. PURPOSE: To determine the prevalence and degree of asymptomatic cervical and lumbar facet joint arthritis. We retrospectively reviewed 500 computed tomography (CT) scans of cervical facet joints obtained from 50 subjects. Moreover, 500 lumbar facet joints obtained from an additional 50 subjects were reviewed. OVERVIEW OF LITERATURE: Numerous reports in the literature indicate that joint arthritis is a major source of axial neck and low back pain. However, the diagnostic value of this condition, based on degenerative changes seen on radiological studies, remains controversial because significant imaging findings may not correlate with corresponding symptoms. The CT scan is a sensitive method for facet joint evaluation and may reveal degenerative abnormalities. Previous studies have described the prevalence of facet arthropathy in symptomatic patients, according to radiological findings; however, no study to date has assessed its prevalence in asymptomatic patients. METHODS: We retrospectively reviewed the neck and abdominal CT scans of patients had been examined for non-spinal pathologies (i.e., thyroid disease, rule out cancer, ascites). Electronic medical records were reviewed to exclude patients with histories of either neck or back pain. Arthritis severity was graded using a previously published four-point CT scale. RESULTS: The prevalence of asymptomatic cervical facet arthritis (grade 1-3) was 33% (grade 1, 19%; grade 2, 11%; and grade 3, 3%). Among asymptomatic patients, 37% had scalable lumbar facet join arthritis (grade 1, 24%; grade 2, 9%; and grade 3, 4%). There was a statistically significant difference (chi-square test, p<0.0001) in the number of older individuals with arthritic degeneration at the cervical and lumbar levels compared with that of younger individuals. The C6-C7 and L5-S1 levels were the most likely to show arthritic changes. CONCLUSIONS: Arthritic changes to the cervical and lumbar facet joints are prevalent among patients, and in some cases are asymptomatic. These findings were more common in older patients and at lower spinal levels.

Evolution and Progression of Spondylodiskitis: A Case Presentation.

Pyogenic infection of the spinal column is a relatively rare condition. Spondylodiskitis is characterized by infection of the intervertebral disk and the adjacent vertebrae. Diagnosis is often delayed because the symptoms are often nonspecific and also because of the high incidence of nonspecific low back pain in the general population. We report the case of a 42-year-old woman who developed low back pain secondary to spondylodiskitis. Her diagnosis was delayed because of a lack of supporting findings on initial magnetic resonance imaging. The case highlights the clinical scenario in which maintaining a high index of suspicion may lead to follow-up imaging and an accurate diagnosis. LEVEL OF EVIDENCE: V.

Currently Recommended TON Injectate Volumes Concomitantly Block the GON: Clinical Implications for Managing Cervicogenic Headache.

BACKGROUND: Headache (HA) is a significant cause of morbidity globally. Despite many available treatment options, HAs that are refractory to conservative management can be challenging to treat. Third occipital nerve (TON) and greater occipital nerve (GON) irritation are potential etiologic agents of primary and cervicogenic HAs that can be targeted using minimally invasive treatment options such as nerve blocks or radiofrequency ablation. However, a substantial number of patients that undergo radiofrequency ablation do not experience pain relief despite a positive diagnostic medial branch block (MBB). OBJECTIVE: In this study, we investigate the underlying cause for the high rate of false positives associated with MBBs by evaluating injectate spread in cadaveric subjects. STUDY DESIGN: Cadaveric study. SETTING: Academic medical center. METHODS: After obtaining exemption status from our Institutional Review Board, TON injections were performed on 5 preserved cadavers, a total of 10 TONs, using anatomic landmarks, partial dissection, and palpation to guide needle placement. Cadaveric dissections were performed to evaluate the location, vertical spread, and grossly observed injectate coating of the TON and GON for each quantity of methylene blue injectate, 0.3 mL and 0.5 mL, administered. RESULTS: The average distance between the TON and GON at their respective foraminal exit points was 1.81 cm. The average vertical spread for 0.3 mL and 0.5 mL of methylene blue injectate was 2.02 + 0.35 cm and 3.26 + 0.48 cm when performing a TON block. When using 0.3 mL injectate, both the TON and GON were simultaneously coated 60% of the time. After increasing the injectate volume to 0.5 mL, both the TON and GON were simultaneously coated 100% of the time. LIMITATIONS: The cadaveric design of this study presents limitations when translating cadaveric findings to the clinical setting. Also, the small sample size limits its power and generalizability. Lastly, the potential for researcher bias exists as the investigators were not blinded. CONCLUSIONS: This study demonstrates that currently recommended injectate volumes for TON blocks may result in concomitant coating of the GON. Conventional radiofrequency ablation (RFA) of these nerves may not lesion both the TON and GON given its restrictive circumferential lesioning diameter of 5 - 7 mm. As such, interventionalists should consider performing radiofrequency ablation to both the TON and GON after a positive TON block. KEY WORDS: Chronic pain, cervicogenic headache, third occipital nerve, greater occipital nerve, injectate spread, radiofrequency ablation.

Spontaneous Iliopsoas Tendon Rupture: An Uncommon Cause of Hip Pain in Elderly Patients.

Iliopsoas tendon rupture is a relatively rare cause of hip pain. It has been described in children, in adults with pathologic avulsion secondary to metastatic disease, and in older individuals with multiple chronic illnesses. We are reporting a case of apparently spontaneous iliopsoas tendon rupture that occurred in an elderly patient presenting with severe debilitating hip pain whose etiology initially was unrecognized. Magnetic resonance imaging of the hip confirmed the diagnosis. This case highlights the importance of considering iliopsoas tear in the differential diagnosis of unexplained acute onset hip pain and illustrates that geriatric patients with this condition can be treated conservatively with satisfactory functional outcome.

Implantation of a skin graft tube to create a saphenoperitoneal shunt for refractory ascites.

PURPOSE: We evaluated the effectiveness of placing a skin tube in the subcutaneous plane to manage refractory ascites by draining the ascitic fluid from the peritoneal cavity into the long saphenous vein. METHODS: Twenty patients with refractory ascites underwent this technique which was performed in two stages. In the first stage, a thin piece of partial thickness skin graft was rolled into a tube and implanted in the subcutaneous plane of the lower abdomen and the upper thigh near and parallel to the upper segment of the long saphenous vein. In the second stage, which was done 3 months later, we anastomosed the upper end of the skin tube to the peritoneal cavity and the lower end of the skin tube to the long saphenous vein. The follow-up period was 4 years. RESULTS: There was no mortality. The complications consisted of hematoma formation in two patients, wound infection in three, and ascitic fluid leakage from the upper anastomosis in three. All these complications were managed conservatively. CONCLUSION: These findings show that creating a saphenoperitoneal shunt with a skin graft tube interposition is a novel, safe, and cost-effective technique of resolving the problem of refractory ascites.