Association of age and sex at onset with Glenohumeral Osteoarthritis: A systematic review and meta-analysis.

OBJECTIVE: The aim of the present systematic review is to synthesize existing evidence (qualitative and quantitative) regarding age- and sex-specific differences with glenohumeral osteoarthritis (GH OA). DESIGN: The electronic databases PubMed, Medline and Web of Science were searched up to March 15, 2023. Articles reporting on the association of risk factors (age and sex) with GH OA were considered. We used Newcastle-Ottawa scale to assess study quality. Meta-analysis was conducted to quantitatively summarize the association of age and sex with GH OA. RESULTS: A total of 24 articles were retrieved for full-text review. Out of twenty-four articles, 8 articles reporting age-specific and 5 articles reporting sex-specific associations with GH OA were included. The odds ratio (OR) for the age [OR-3.18; 95% confidence interval (CI)-1.10-15.92] and female sex [OR-1.78; 95%CI-0.95-3.42] were increased and observed statistically significant. CONCLUSIONS: The present systematic review and meta-analysis suggests the role of increasing age as one of the significant contributors to GH OA. However, association of female sex with GH OA is least convincing. Future studies are required to understand the molecular mechanisms behind the contributory role of increasing age and female sex in the establishment of GH OA.

Sport participation among children with complicated mild traumatic brain injury.

BACKGROUND: Complicated mild traumatic brain injury (C-mTBI) represents mTBI with positive trauma-related radiographic findings, such as hematoma. It is estimated that 7.5% of all pediatric mTBIs meet these criteria. There is a paucity of research on return to sports in children with C-mTBI. OBJECTIVE: To examine children with C-mTBI, mTBI with skull fracture (mTBI-SF) only and mTBI in relation to sport participation and factors associated with repeated injury. DESIGN: Cross-sectional survey. SETTING: Level I pediatric trauma center. PARTICIPANTS: Parents of children who were 5-18 years of age at the time of injury who sustained C-mTBI or mTBI from 2010 to 2013. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sports participation characteristics before and after injury in children with C-mTBI and mTBI as a function of degree and length of recovery. Repeat mTBI after the index injury was also examined. RESULTS: Of 247 children who participated in sports preinjury (27.5% with C-mTBI and 9.7% with mTBI-SF), 95.1% returned to sports. There was no significant difference by mTBI type regarding participation in any sports (p = .811) nor with high-risk sports (p = .128). C-mTBI but not mTBI-SF (versus mTBI) was associated with lower odds of sustaining a repeat mTBI (odds ratio = 0.30, p = .045). Waiting longer (>3 months compared to <1 month) to return to contact sports was associated with lower odds of sustaining a repeat mTBI (odds ratio = 0.23, p < .05). CONCLUSIONS: Children with C-mTBI and mTBI-SF resume similar sports as children with mTBI. Those with C-mTBI and those who take longer to return to play may have lower risk of repeat mTBIs. Prospective research is needed to inform the development of evidence-based guidelines for children with C-mTBI and mTBI-SF.

Neurogenic thoracic outlet syndrome in the overhead and throwing athlete: A narrative review.

Thoracic outlet syndrome is an important cause of shoulder pain and dysfunction due to compression of neurovascular structures as they traverse the thoracic outlet. Symptoms are most commonly due to compression of the brachial plexus called neurogenic thoracic outlet syndrome (nTOS). Throwing athletes are at increased risk of nTOS because of a variety of biomechanical factors. However, because nTOS symptoms are often nonspecific, delayed diagnosis is common. Neurogenic thoracic outlet largely remains a diagnosis of exclusion with advanced imaging ruling out vascular involvement and diagnostic injections gaining favor in helping localize sites of compression. Although rehabilitation alone may improve symptoms in some athletes, many require surgical treatment for long-term relief. This generally entails decompression of the thoracic outlet by some combination of muscle release, brachial plexus neurolysis, and first rib resection. Outcomes tend to be successful in athletes with most achieving resolution of symptoms and return to athletic activity. NTOS is an important cause of shoulder pain and dysfunction in throwing athletes. The history and physical examination should focus on activities that exacerbate symptoms. Treatment of nTOS generally requires surgical intervention and allows throwing athletes to return to sport.

Subchondral versus intra-articular orthobiologic injections for the treatment of knee osteoarthritis: a review.

Recent perspectives suggest that osteoarthritis (OA) is a disease involving not only the articular cartilage but also the osteochondral unit, including the synovium, supportive cartilage and subchondral bone. Current conservative treatments for OA are symptomatic and do not prevent progression or reverse the disease process. Compelling data show that intra-articular orthobiologic injections, such as platelet-rich plasma and mesenchymal stromal cells, are effective in providing relief of OA symptoms. However, recent data suggest that injections of orthobiologics into the subchondral bone may be superior to intra-articular injections for the management of OA. This review highlights the rationale and current evidence for intra-articular and subchondral bone injections of orthobiologics for the treatment of OA.

Reconciling bubble nucleation in explosive eruptions with geospeedometers.

Magma from Plinian volcanic eruptions contains an extraordinarily large numbers of bubbles. Nucleation of those bubbles occurs because pressure decreases as magma rises to the surface. As a consequence, dissolved magmatic volatiles, such as water, become supersaturated and cause bubbles to nucleate. At the same time, diffusion of volatiles into existing bubbles reduces supersaturation, resulting in a dynamical feedback between rates of nucleation due to magma decompression and volatile diffusion. Because nucleation rate increases with supersaturation, bubble number density (BND) provides a proxy record of decompression rate, and hence the intensity of eruption dynamics. Using numerical modeling of bubble nucleation, we reconcile a long-standing discrepancy in decompression rate estimated from BND and independent geospeedometers. We demonstrate that BND provides a record of the time-averaged decompression rate that is consistent with independent geospeedometers, if bubble nucleation is heterogeneous and facilitated by magnetite crystals.

Explosive-effusive volcanic eruption transitions caused by sintering.

Silicic volcanic activity has long been framed as either violently explosive or gently effusive. However, recent observations demonstrate that explosive and effusive behavior can occur simultaneously. Here, we propose that rhyolitic magma feeding subaerial eruptions generally fragments during ascent through the upper crust and that effusive eruptions result from conduit blockage and sintering of the pyroclastic products of deeper cryptic fragmentation. Our proposal is supported by (i) rhyolitic lavas are volatile depleted; (ii) textural evidence supports a pyroclastic origin for effusive products; (iii) numerical models show that small ash particles ≲10-5 m can diffusively degas, stick, and sinter to low porosity, in the time available between fragmentation and the surface; and (iv) inferred ascent rates from both explosive and apparently effusive eruptions can overlap. Our model reconciles previously paradoxical observations and offers a new framework in which to evaluate physical, numerical, and geochemical models of Earth's most violent volcanic eruptions.

Comparison of Varying Corticosteroid Type, Dose, and Volume for the Treatment of Pain in Small- and Intermediate-Size Joint Injections: A Narrative Review.

OBJECTIVE: To systematically evaluate the scientific literature examining the effect of corticosteroid type, dose, and volume of small- and intermediate-size joint injections on pain and function. TYPE: Narrative review. LITERATURE SURVEY: Medline (PubMed), Cochrane Central Register of Controlled Trial, and SportDiscus databases were searched. METHODOLOGY: Inclusion criteria included prospective studies evaluating pain- and/or function-related improvements following a corticosteroid injection of a small- or intermediate-size joint. SYNTHESIS: A total of 28 articles were included, all studying patients with osteoarthritis and/or rheumatoid arthritis. Eleven studies were randomized-controlled trials comparing corticosteroid injections to a control treatment and three were randomized trials comparing corticosteroid dose or type; the rest were prospective case series without a control. Most studies used 10 to 20 mg of methylprednisolone or triamcinolone for small joints and 20 to 40 mg for intermediate joints; wrist joints were the only joint studied that directly compared doses-20 mg was noninferior to 40 mg. Triamcinolone hexacetonide was found to be superior to methylprednisolone in the interphalangeal finger joints in a single randomized-controlled trial; no other studies compared steroid types in any joint. No studies evaluated the effect of volume on clinical outcomes. CONCLUSIONS: Very few studies directly examine the effect of corticosteroid type, corticosteroid dose, or injectate volume on clinical outcomes for small- or intermediate-size joint arthralgia. Future studies are needed to better elucidate the most effective treatment protocols. LEVEL OF EVIDENCE: IV.

Factors Associated With Degree and Length of Recovery in Children With Mild and Complicated Mild Traumatic Brain Injury.

BACKGROUND: A complicated mild traumatic brain injury (C-mTBI) is an mTBI with some form of intracranial abnormality identified radiographically. The lack of knowledge in recovery patterns and no clear guidelines on return to activity in children with C-mTBI provide unique challenges to physicians. OBJECTIVE: To examine recovery patterns among three cohorts: mTBI, mTBI with skull fracture only (mTBI-SF), and C-mTBI via a cross-sectional survey. METHODS: Caregivers of children with mTBI (from hospital database queries 2010-2013) were mailed a questionnaire on preinjury health, postinjury recovery, and activity patterns before and after injury. We examined degree (0-10 with 10 being complete recovery) and length (in months) of recovery in children with mTBI, and associations of potential risk factors to these variables. RESULTS: Of the 1777 surveyed, a total of 285 complete responses were analyzed for this study. Data included 175 (61.4%) children with mTBI, 33 (11.6%) children with mTBI-SF, and 77 (27.0%) children with C-mTBI. Older age and C-mTBI (vs mTBI) were significantly associated with a lower degree and longer period of recovery (P < .05). Predicted probabilities of complete recovery for children with mTBI, those with mTBI-SF, and those with C-mTBI were 65.5%, 52.7%, and 40.0%, respectively. Predicted probabilities of not yet completely recovered after more than a year since injury for these groups were 11.3%, 24.4%, and 37.6%, respectively. CONCLUSION: These results demonstrate significant differences in children with different forms of mTBI, and argue for further investigation of treatment plans individualized for each form of mTBI.

Aging impairs mouse skeletal muscle macrophage polarization and muscle-specific abundance during recovery from disuse.

Impaired recovery of aged muscle following a disuse event is an unresolved issue facing the older adult population. Although investigations in young animals have suggested that rapid regrowth of skeletal muscle following a disuse event entails a coordinated involvement of skeletal muscle macrophages, this phenomenon has not yet been thoroughly tested as an explanation for impaired muscle recovery in aging. To examine this hypothesis, young (4-5 mo) and old (24-26 mo) male mice were examined as controls following 2 wk of hindlimb unloading (HU) and following 4 (RL4) and 7 (RL7) days of reloading after HU. Muscles were harvested to assess muscle weight, myofiber-specifc cross-sectional area, and skeletal muscle macrophages via immunofluorescence. Flow cytometry was used on gastrocnemius and soleus muscle (at RL4) single-cell suspensions to immunophenotype skeletal muscle macrophages. Our data demonstrated impaired muscle regrowth in aged compared with young mice following disuse, which was characterized by divergent muscle macrophage polarization patterns and muscle-specifc macrophage abundance. During reloading, young mice exhibited the classical increase in M1-like (MHC II+CD206-) macrophages that preceeded the increase in percentage of M2-like macrophages (MHC II-CD206+); however, old mice did not demonstrate this pattern. Also, at RL4, the soleus demonstrated reduced macrophage abundance with aging. Together, these data suggest that dysregulated macrophage phenotype patterns in aged muscle during recovery from disuse may be related to impaired muscle growth. Further investigation is needed to determine whether the dysregulated macrophage response in the old during regrowth from disuse is related to a reduced ability to recruit or activate specific immune cells.

Planting the Seeds of Change: Growing Lifestyle Medicine Interest Groups With the Donald A. Pegg Award.

The practice of Lifestyle medicine (LM) focuses on helping patients make healthy choices to prevent and treat disease. While such interventions are considered first-line treatment for many diseases, many medical schools have not yet been able to include lifestyle medicine classes in the core curriculum but most are able to offer a parallel curriculum that does not interfere with the schedule of core classes. Lifestyle Medicine Interest Groups (LMIGs) are being created around the country and around the globe. Many students and faculty members are interested in starting and sustaining a LMIG at their schools, but some do not have enough funding or they lack the framework that provides structure to their efforts. To address this situation, the American College of Lifestyle Medicine (ACLM) has encouraged the development of LMIGs, which are student-run organizations that provide a parallel curriculum in LM. To support and strengthen this effort, the ACLM initiated the Donald A. Pegg award to fund four allied health students in founding and augmenting their institution's LMIGs. The 2016 inaugural winners were James Gardner, P. Elainee Poling, Alyssa Abreu, and Jessie M. Hipple. Their LMIG activities have included events such as nutrition and cooking classes, exercise prescription seminars, group fitness sessions, and patient lifestyle counseling in various clinical settings. Pearls of wisdom for building successful LMIGs include cultivating strong faculty mentorship, marketing the personal benefits to students who attend activities, and collaborating with other student groups.

Deformation-assisted fluid percolation in rock salt.

Deep geological storage sites for nuclear waste are commonly located in rock salt to ensure hydrological isolation from groundwater. The low permeability of static rock salt is due to a percolation threshold. However, deformation may be able to overcome this threshold and allow fluid flow. We confirm the percolation threshold in static experiments on synthetic salt samples with x-ray microtomography. We then analyze wells penetrating salt deposits in the Gulf of Mexico. The observed hydrocarbon distributions in rock salt require that percolation occurred at porosities considerably below the static threshold due to deformation-assisted percolation. Therefore, the design of nuclear waste repositories in salt should guard against deformation-driven fluid percolation. In general, static percolation thresholds may not always limit fluid flow in deforming environments.

Testing wetland features to increase amphibian reproductive success and species richness for mitigation and restoration.

Aquatic habitat features can directly influence the abundance, species richness, and quality of juvenile amphibians recruited into adult populations. We examined the influences of within-wetland slope, vegetation, and stocked mosquito fish (Gambusia affinis) on amphibian metamorph production and species richness during the first two years post-construction at 18 experimental wetlands in northeast Missouri (U.S.A.) grasslands. We used an information theoretic approach (AICc) to rank regression models representing total amphibian metamorph production, individual amphibian species metamorph production, and larval amphibian species richness. Total amphibian metamorph production was greatest at shallow-sloped, fish-free wetlands during the first year, but shallow-sloped wetlands with high vegetation cover were best the second year. Species richness was negatively associated with fish and positively associated with vegetation in both survey years. Leopard frog (Rana blairi/sphenocephala complex) metamorph quality, based on average metamorph size, was influenced by slope and the number of cohorts in the wetland. However, the tested variables had little influence on the size of American toads (Bufo americanus) or boreal chorus frogs (Pseudacris maculata). Our results indicate that wetlands designed to act as functional reproductive habitat for amphibians should incorporate shallows, high amounts of planted or naturally established vegetation cover, and should be fish-free.