Preoperative low serum albumin increases the rate of perioperative blood transfusion in patients undergoing total joint arthroplasty: propensity score matching.

BACKGROUND: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA). METHODS: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes. RESULTS: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888-0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50-2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30-37.3 g/L, 25-30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37-1.99, P < 0.001), 5.4 (95% CI 3.08-9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively. CONCLUSION: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion. TRIAL REGISTRATION: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.

Joint and interactive associations of body mass index and genetic factors with cardiovascular disease: a prospective study in UK Biobank.

BACKGROUND: Both body mass index (BMI) and genetic factors independently contribute to cardiovascular disease (CVD). However, it is unclear whether genetic risk modifies the association between BMI and the risk of incident CVD. This study aimed to investigate whether BMI categories and genetic risk jointly and interactively contribute to incident CVD events, including hypertension (HTN), atrial fibrillation (AF), coronary heart disease (CHD), stroke, and heart failure (HF). METHODS: A total of 496,851 participants from the UK Biobank with one or more new-onset CVD events were included in the analyses. BMI was categorized as normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥ 30.0 kg/m2). Genetic risk for each outcome was defined as low (lowest tertile), intermediate (second tertile), and high (highest tertile) using polygenic risk score. The joint associations of BMI categories and genetic risk with incident CVD were investigated using Cox proportional hazard models. Additionally, additive interactions were evaluated. RESULTS: Among the 496,851 participants, 270,726 (54.5%) were female, with a mean (SD) age was 56.5 (8.1) years. Over a median follow-up (IQR) of 12.4 (11.5-13.1) years, 102,131 (22.9%) participants developed HTN, 26,301 (5.4%) developed AF, 32,222 (6.9%) developed CHD, 10,684 (2.2%) developed stroke, and 13,304 (2.7%) developed HF. Compared with the normal weight with low genetic risk, the obesity with high genetic risk had the highest risk of CVD: HTN (HR: 3.96; 95%CI: 3.84-4.09), AF (HR: 3.60; 95%CI: 3.38-3.83), CHD (HR: 2.76; 95%CI: 2.61-2.91), stroke (HR: 1.44; 95%CI: 1.31-1.57), and HF (HR: 2.47; 95%CI: 2.27-2.69). There were significant additive interactions between BMI categories and genetic risk for HTN, AF, and CHD, with relative excess risk of 0.53 (95%CI: 0.43-0.62), 0.67 (95%CI: 0.51-0.83), and 0.37 (95%CI: 0.25-0.49), respectively. CONCLUSIONS: BMI and genetic factors jointly and interactively contribute to incident CVD, especially among participants with high genetic risk. These findings have public health implications for identifying populations more likely to have cardiovascular benefit from weight loss interventions.

Sharing Our World: Impact of Group Motor Skill Learning on Joint Attention in Children with Autism Spectrum Disorder.

Impaired joint attention is a common feature of autism spectrum disorder (ASD), affecting social interaction and communication. We explored if group basketball learning could enhance joint attention in autistic children, and how this relates to brain changes, particularly white matter development integrity. Forty-nine autistic children, aged 4-12 years, were recruited from special education centers. The experimental group underwent a 12-week basketball motor skill learning, while the control group received standard care. Eye-tracking and brain scans were conducted. The 12-week basketball motor skill learning improved joint attention in the experimental group, evidenced by better eye tracking metrics and enhanced white matter integrity. Moreover, reduced time to first fixation correlated positively with decreased mean diffusivity of the left superior corona radiata and left superior fronto-occipital fasciculus in the experimental group. Basketball-based motor skill intervention effectively improved joint attention in autistic children. Improved white matter fiber integrity related to sensory perception, spatial and early attention function may underlie this effect. These findings highlight the potential of group motor skill learning within clinical rehabilitation for treating ASD.

Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images.

Introduction: Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aids in optimal positioning, but replicating it accurately in the operating room is challenging. Research question: This study aims to assess the feasibility of superimposing VSP onto intraoperative fluoroscopic images to aid in optimal implant placement. Material and methods: A method for intraoperative guidance using 3D/2D registration was developed and tested during SIJF as an available and potentially efficient alternative for costly and more invasive navigation systems. Preoperatively, a VSP is performed and simulated fluoroscopic images are generated from a preoperative CT scan. During surgery, the simulated image that visually best matches the intraoperative fluoroscopic image is selected. Subsequently, the VSP is superimposed onto the intraoperative fluoroscopic image using a developed script-based workflow. The surgeon then places the implants accordingly. Postoperative implant placement accuracy was evaluated. Results: Five interventions were performed on five patients, resulting in a total of 15 placed implants. Minor complications without clinical consequences occurred in one case, primarily attributable to the patient's anatomy and pathological manifestations. Mean deviations at implant apex and 3D angle were 4.7 ± 1.6 mm and 3.5 ± 1.3°, respectively. Discussion and conclusions: The developed intraoperative workflow was feasible and resulted in implants placed with low deviations from the VSP. Further research is needed to automate and validate this method in a larger cohort.

Cross-cultural Adaptation of the Avoidance of Daily Activities Photo Scale for Turkish patients with shoulder pain: Reliability and validity assessment according to the COSMIN guideline.

CONTEXT: People with chronic or long-term pain may develop various psychosocial symptoms such as fear and avoidance of behavior due to pain. Reliable and valid quality of life tools must be available in Turkish to specifically assess avoidance of behavior in people with shoulder pain. OBJECTIVES: This study aimed to translate and culturally adapt the Avoidance of Daily Activities Photo Scale for Patients with Shoulder Pain and to evaluate the psychometric properties of its Turkish version (ADAP-Tr) in patients with shoulder pain. METHODS: Translation, adaptation, and validation were performed according to the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. The internal consistency, reliability, construct validity, and discriminant validity of the ADAP-Tr were tested. The Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), and Shoulder Pain and Disability Index (SPADI) were applied for validation purposes. RESULTS: The study included a total of 162 participants with shoulder pain. The internal consistency of the ADAP-Tr showed excellent reliability with a Cronbach's α of 0.94 and a test-retest assessment of 0.88 ICC (95% CI, 0.83-0.91). The standard error of measurement was 1.85 points, and the minimal detectable change was determined 5.12 points. There was a low to high correlation among the ADAP-Tr and PCS (r = 0.481, p < .001), TSK (r = 0.448, p < .001), and SPADI (r = 0.826, p < .001) scores. CONCLUSIONS: The ADAP-Tr was shown to be a valid and strong reliability tool to use in clinical and research settings as a shoulder-specific measurement tool.

Independent and joint role of inflammatory diet and physical activity with cognitive function in aging: Evidence from a population-based survey.

OBJECTIVE: This study aims to explore the independent and joint association of physical activity (PA) and inflammatory diet with cognitive function in aging. METHOD: Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) was used. 2249 NHANES participants with valid data represented a weighted population of 50.5 million American residents aged 60 and older. This study separately analyzed the independent associations of PA (measured by global physical activity questionnaire) and inflammatory diet (measured by energy-adjusted dietary inflammatory index from 24-h dietary recall), and their joints (inactive & pro-inflammatory as reference) with cognitive function (assessed by three cognitive tests), and considered an individual of different status and non-linear effect by sub-group and restricted cubic splines (RCS) analysis, respectively. All analysis was multivariable-adjusted and sample-weighted. RESULTS: The results showed that inflammatory diet was independently associated with lower cognitive function, with a 1.08, 1.29, 2.67, 0.56 lower score in the Registry for Alzheimer's Disease word list learning test (CERAD), the Animal Fluency Test (AFT), the Digit Symbol Substitution test (DSST), Z-scores, and 51 %, 62 %, 63 %, 93 % higher odds ratio (OR) of lower performance in CERAD, AFT, DSST, and p-MCI, respectively. PA was independently associated with higher cognitive function, with a 1.41, 3.37, and 0.52 higher score in AFT, DSST, Z-scores, and 28 %, 51 %, 41 % lower ORs of lower performance in CERAD and DSST and p-MCI, respectively. Active & Anti-inflammatory was always positively associated with cognitive function, with a 1.42, 2.69, 5.47, and 1.04 higher score for CERAD, AFT, DSST, and Z-score, a 58 %, 56 %, 74 %, 76 % lower ORs of lower performance in CERAT, AFT, DSST, and p-MCI, respectively, which elicited the maximum compared to other joints. CONCLUSION: Adhering to both active PA and anti-inflammatory diet is recommended for cognitive management in older adults. Sticking to either active PA or anti-inflammatory diet also shows potential cognitive benefits, with the diet possibly playing more vital role.

Lipoxin A4 modulates the PKA/CREB and NF-κB signaling pathway to mitigate chondrocyte catabolism and apoptosis in temporomandibular joint osteoarthritis.

Temporomandibular joint osteoarthritis (TMJ-OA) is characterized by the degradation of the extracellular matrix (ECM) in cartilage and the apoptosis of chondrocytes, which is caused by inflammation and disruptions of chondrocyte metabolism and inflammation. Lipoxin A4 (LXA4), a specialized pro-resolving mediator, has been shown to inhibit inflammation and regulate the balance between ECM synthesis and degradation. However, the therapeutic effects of LXA4 on TMJ-OA and its underlying mechanisms remain unclear. Interleukin-1 beta (IL-1ß)-induced chondrocyte and surgically induced TMJ-OA rat models were established in this study. The viability of chondrocytes treated with LXA4 was evaluated with the cell counting kit-8 (CCK-8) assay, while protein levels were assessed by western blot analysis, and the apoptosis rate was evaluated with terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labelling (TUNEL) staining. Histological analysis was conducted to evaluate the impact of LXA4 on cartilage degradation in TMJ-OA rat models. In vitro, the qRT-PCR and western blot analysis demonstrated that LXA4 facilitated the upregulation of collagen proteins (Collagen II) and decreased expression of matrix metalloproteinases (MMP-3, and MMP-13) associated with extracellular matrix (ECM) modulation. LXA4 enhanced the TMJ-OA chondrocyte viability and decreased apoptotic rate. In vivo, histology and immunohistochemistry (IHC) analysis revealed that intraperitoneal injection of LXA4 contributed to the amelioration of chondrocyte injuries and deceleration of TMJ-OA. Transcriptomic sequencing revealed that cAMP was up-regulated and NF-κB signaling pathway was down-regulated in LXA4 treated group. LXA4 inhibited the phosphorylation of P65 and inhibitor of nuclear factor kappa B (IκBα) proteins while enhancing the phosphorylation PKA and CREB. This study demonstrates the potential of LXA4 as a therapeutic agent for suppressing chondrocyte catabolism and apoptosis by increasing PKA/CREB activity and decreasing NF-κB signaling.

Radiosynoviorthesis with [90Y] Yttrium citrate in refractory synovitis of the knee: Experience of 2 reference hospitals.

INTRODUCTION: To describe the therapeutic efficacy of radiosynoviorthesis with [90Y]Yttrium citrate (90Y), in patients with chronic knee synovitis refractory to systemic treatments and/or infiltrations, correlating the results with the different etiologies and degenerative changes that they showed, in order to optimize the indication of the technique. MATERIAL AND METHODS: Observational retrospective study with 32 patients (22 men and 10 women) and 34 knees, with refractory chronic knee synovitis, who underwent radiosynoviorthesis between January 2013 and December 2022. Its efficacy was described and analyzed by the subjective improvement referred by the patients and its relationship with the existing etiologies and radiological degenerative changes, expressed by the Kellgren-Lawrence (K-L) scale. RESULTS: A statistically significant subjective improvement was observed in 70.6% of the cases (p < 0.001). There were 92.3% of cases with absent, doubtful or mild degenerative changes (K-L 0-2) who improved, while only 50% with moderate or severe changes (K-L 3-4) improved, showing statistically significant differences (p = 0.03). Among patients with chronic inflammatory origin of synovitis (spondyloarthropathies and rheumatoid arthritis), 80% improved, while in those with osteoarthritis (degenerative) origin, only 25% improved with statistically significant differences (p = 0.006). CONCLUSIONS: Radiosynoviorthesis with 90Y is an effective treatment in patients with knee refractory chronic synovitis, especially in the presence of mil degenerative joint changes and chronic inflammatory origin. We must ensure the appropiate selection of patients according to these criteria.

Periprosthetic Joint Infection: What's New?

Total joint arthroplasty (TJA) ranks among the most commonly performed orthopedic surgeries, with its annual incidence on the rise globally. Periprosthetic joint infection (PJI) remains a leading cause of arthroplasty failure. This review aims to summarize recent literature updates on the epidemiology, diagnosis, and management of PJI.

Early Improvements with Guselkumab Associate with Sustained Control of Psoriatic Arthritis: Post hoc Analyses of Two Phase 3 Trials.

INTRODUCTION: Patterns of treatment response can inform clinical decision-making. This study assessed the course and impact of achieving minimal clinically important improvement (MCII) in clinical measures and patient-reported outcomes (PROs) with guselkumab in patients with active psoriatic arthritis (PsA). METHODS: Post hoc analyses evaluated 1120 patients with PsA receiving guselkumab every 4 or 8 weeks (Q4W/Q8W) or placebo from DISCOVER-1 (31% tumor necrosis factor inhibitor-experienced) and DISCOVER-2 (biologic-naïve). Achievement of MCII in clinical Disease Activity Index for PsA (cDAPSA), patient global assessment (PtGA) of arthritis, PtGA of psoriasis, patient-reported pain, Functional Assessment of Chronic Illness Therapy-Fatigue, Health Assessment Questionnaire-Disability Index, 36-item Short-Form Health Survey Physical Component Summary score, PtGA Arthritis + Psoriasis, and PsA Disease Activity Score (PASDAS) was compared between the guselkumab and placebo groups using Cox regression. Logistic regression adjusting for baseline factors evaluated associations between early (W4/W8) MCII achievement and stringent response (≥%50/%70 improvement in American College of Rheumatology response criteria, cDAPSA low disease activity [LDA], PASDAS LDA, and minimal disease activity) at W24/W52 among guselkumab-randomized patients. RESULTS: Among patients with highly active PsA (baseline cDAPSA = 44.1-45.0, PASDAS = 6.4-6.5), times to MCII were significantly faster for guselkumab vs. placebo (hazard ratios 1.3-2.5; P < 0.05). Across measures, at first timepoint assessed, MCII rates were significantly higher with guselkumab (Q4W/Q8W 28-68%/29-65%) vs. placebo (19-47%; both P < 0.05). Early (W4/W8) MCII with guselkumab associated with higher odds of achieving stringent responses at W24/W52 (odds ratios 1.4-17.2/1.4-5.4). CONCLUSIONS: In a mixed PsA population, significant proportions of patients treated with guselkumab achieved early (W4/W8) MCII across clinical and PRO measures, which associated with a higher likelihood of attaining clinically relevant improvements and low levels of disease activity at W24/W52. TRIAL REGISTRATION: DISCOVER-1 (NCT03162796). DISCOVER-2 (NCT03158285).

Risk factors for deep vein thrombosis of the lower extremity after total hip arthroplasty.

OBJECTIVE: To investigate the risk factors for deep vein thrombosis (DVT) following total hip arthroplasty (THA). METHODS: Patients who underwent THA in the Department of Joint Surgery at the Sixth Affiliated Hospital of Xinjiang Medical University from September 2020 to December 2022 were retrospectively selected based on inclusion criteria. They were divided into the DVT group (n = 65) and the non-DVT group (n = 397) according to the occurrence of postoperative DVT. The following variables were reviewed for both groups: age, sex, Body Mass Index (BMI), affected limb, previous history (smoking and drinking), diabetes, hypertension, operation time, total cholesterol, triglycerides, fibrinogen, hemoglobin, albumin, platelets, D-dimer, International Normalized Ratio (INR), and fibrin degradation products. Univariate analysis was conducted on these factors, and those with statistical significance were further analyzed using a binary logistic regression model to assess their correlation with DVT after THA. RESULTS: A total of 462 patients were included in the study, with the DVT group representing approximately 14% and the non-DVT group approximately 86%. The DVT group had an average age of 67.27 ± 4.10 years, while the non-DVT group had an average age of 66.72 ± 8.69 years. Univariate analysis revealed significant differences in diabetes mellitus, preoperative fibrinogen, preoperative D-dimer, preoperative INR, and preoperative and postoperative fibrin degradation products between the DVT and non-DVT groups. Binary logistic regression analysis identified diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR (p < 0.05) as risk factors for DVT after THA. CONCLUSION: This study found that diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR are independent risk factors for DVT following THA. Surgeons should thoroughly assess these risk factors, implement timely and effective interventions, and guide patients to engage in functional exercises as early as possible to reduce the incidence of DVT, thereby improving the outcomes of THA and improving patient quality of life.

Reliability and agreement of manual and automated morphological radiographic hip measurements.

Objective: To determine the reliability and agreement of manual and automated morphological measurements, and agreement in morphological diagnoses. Methods: Thirty pelvic radiographs were randomly selected from the World COACH consortium. Manual and automated measurements of acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg center edge angle (WCEA), lateral center edge angle (LCEA), extrusion index (EI), neck-shaft angle (NSA), and triangular index ratio (TIR) were performed. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to test reliability. Agreement in diagnosing acetabular dysplasia, pincer and cam morphology by manual and automated measurements was assessed using percentage agreement. Visualizations of all measurements were scored by a radiologist. Results: The Bland-Altman plots showed no to small mean differences between automated and manual measurements for all measurements except for ADR. Intraobserver ICCs of manual measurements ranged from 0.26 (95%-CI 0-0.57) for TIR to 0.95 (95%-CI 0.87-0.98) for LCEA. Interobserver ICCs of manual measurements ranged from 0.43 (95%-CI 0.10-0.68) for AA to 0.95 (95%-CI 0.86-0.98) for LCEA. Intermethod ICCs ranged from 0.46 (95%-CI 0.12-0.70) for AA to 0.89 (95%-CI 0.78-0.94) for LCEA. Radiographic diagnostic agreement ranged from 47% to 100% for the manual observers and 63%-96% for the automated method as assessed by the radiologist. Conclusion: The automated algorithm performed equally well compared to manual measurement by trained observers, attesting to its reliability and efficiency in rapidly computing morphological measurements. This validated method can aid clinical practice and accelerate hip osteoarthritis research.

Global research trends of antibiotic-loaded bone cement: A bibliometric and visualized study.

Objective: Antibiotic-loaded bone cement (ALBC) plays an indispensable role in the treatment of infectious diseases of bone and joint. Here, we intended to analyze the research status, hot spots and frontiers in the field of ALBC, and to provide reference for future research ideas. Methods: The related English literature in the field of ALBC in the Web of Science Core Collection database was retrieved from January 1, 2009 to July 11, 2023. VOSviewer was used to extract the information of research constituents or bibliometric items such as authors, institutions, countries, and journals. CiteSpace was used to perform cluster analysis and frontier analysis of key words in ALBC research field. Results: A total of 1091 literatures related to ALBC research were retrieved, and the annual number of publications showed a steady upward trend in the past 15 years. The high-yield countries and regions are mainly represented by the United States, China (including Taiwan, China) and several European countries, such as Germany, England, Spain, Italy, the Netherlands, etc. The top three institutions with the highest number of publications were Shanghai Jiao Tong University, Chang Gung University and Chang Gung Memorial Hospital in China. Four of the top 10 influential scholars come from Germany, namely Konstantinos Anagnostakos, Volker Alt, Andrej Trampuz, and Bernd Fink. The top 10 high-yield journals had an average of 25 articles per journal and an average of 618.9 citations. The top 3 high-yield journals were Journal of Arthroplasty (57 articles, 1213 citations), Clinical Orthopaedics and Related Research (35 articles, 1119 times cited), and Journal of Orthopaedic Research (29 papers, 488 times cited). The keywords with high frequency were infection (266 times), vancomycin (239 times), bone-cement (219 times), gentamicin (216 times), antibiotics (168 times), osteomyelitis (163 times), etc. The clustering knowledge map of high-frequency keywords could be divided into 4 categories: (1) elution, release, mechanical and antibacterial properties of ALBC; (2) Application of ALBC in revision of prosthetic joint infections (PJIs); (3) Antibiotic types and application forms of ALBC; (4) Application of ALBC in the treatment of osteomyelitis. The keywords with the strongest citation bursts analysis revealed a core ("replacement/arthroplasty") and two stages of development in the field of ALBC research. The first stage (2009-2018) focused more on ALBC drug delivery, release, and infection prevention, while the second stage (2018-2023) mainly focused on ALBC drug elution, mechanical properties, and PJIs revision. Starting from 2018, the keyword with the strongest citation bursts had shifted from "acrylic bone cement" to "periprosthetic joint infection". Conclusion: ALBC research is steadily on the rise. Arthroplasty related applications continue to be the core of ALBC research. The research hotspot and trend are mainly the application in the prevention and treatment of bone and joint infectious diseases and the elution, release, mechanical and antibacterial properties of ALBC.

Glenoid morphology variation between patients with hypermobile shoulder joints and controls: Identification of hyperlaxity-related morphologic bone changes.

Objective: Our study aims to quantitatively determine the concavity of the glenoid articular surface in patients with hypermobile shoulders compared to those without. Method: We examined medical records of shoulder CTs from 2017 to 2022, selecting 50 patients with clinical signs of joint hypermobility for our case group and 54 for our control group. Two blinded readers independently assessed the glenoid morphology, calculating the glenoid concavity angle (GCA) and evaluating the articular surface shape as concave, flat, or convex. They also recorded the presence and severity of glenoid dysplasia. We compared these assessments between groups. Results: The mean GCA was significantly lower in the hypermobile group (2.3 ± 3.7° and 2.3 ± 3.8°) versus controls (6.6 ± 3.3° and 5.3 ± 3.8°) (P < 0.05). Interobserver reproducibility was high (ICC=0.76). A stark difference in glenoid morphology was noted between groups (P < 0.001), with a majority of hypermobile patients having a flat or convex glenoid. GCAs decreased with increasing shoulder laxity and dysplasia. GCA showed 77-81 % sensitivity and 55-82 % specificity for detecting shoulder hyperlaxity with a 4° cutoff. Conclusion: There is a significant association between GCA and shoulder hyperlaxity, demonstrating diagnostic efficacy and substantial interobserver agreement. Clinical Relevance: GCA values lower than 4° warrant further clinical investigation for shoulder hyperlaxity and associated conditions, which is crucial for patient treatment planning.

Novel presentation of rigid flat foot flexor hallucis longus passing through the subtalar joint: A comprehensive case report.

This case report presents a novel cause of rigid flatfoot caused by the entrapment of the Flexor Hallucis Longus (FHL) tendon within the subtalar joint. A 19-year-old male with chronic right ankle and foot pain diagnosed with rigid flatfoot deformity. MRI identified the FHL tendon entrapped within the subtalar joint, a condition to our knowledge never previously reported. This report highlights the importance of thorough clinical evaluation and advanced imaging techniques in diagnosing rare causes of rigid flatfoot and suggests that surgical options may still be valid for such rare presentations.

Isolated proximal tibiofibular dislocation: Don't miss it.

Proximal tibiofibular joint (PTFJ) dislocation is a rare but significant traumatic knee injury that often goes undetected due to its subtle presentation and the rarity of the condition. It accounts for less than 1% of all knee injuries, making it an uncommon diagnosis in clinical practice. Despite its rarity, the implications of missing this injury can be profound, leading to chronic pain, instability, and potential nerve damage if not appropriately managed.Effective management, from closed reduction to open reduction, requires awareness from both clinicians and radiologists. In this case report, we present the clinical presentation, radiological investigations, treatment, and outcome of a 38-year-old woman who presented with a painful left knee following a domestic accident. The diagnosis of anterolateral tibiofibular dislocation was confirmed through careful clinical and radiological assessment. This case underscores the critical importance of early recognition and appropriate management of this uncommon knee injury to prevent long-term complications and ensure optimal patient outcomes. By detailing this case, we aim to raise awareness among clinicians about the need for vigilance in diagnosing PTFJ dislocations and to highlight the key steps in the diagnostic and therapeutic process. This case report contributes to the growing body of literature on PTFJ dislocations, emphasizing the clinical and radiological cues that should prompt consideration of this diagnosis.

Estimating genus-specific effects of non-native honey bees and urbanization on wild bee communities: A case study in Maryland, United States.

Non-native species have the potential to detrimentally affect native species through resource competition, disease transmission, and other forms of antagonism. The western honey bee (Apis mellifera) is one such species that has been widely introduced beyond its native range for hundreds of years. There are strong concerns in the United States, and other countries, about the strain that high-density, managed honey bee populations could pose to already imperiled wild bee communities. While there is some experimental evidence of honey bees competing with wild bees for resources, few studies have connected landscape-scale honey bee apiary density with down-stream consequences for wild bee communities. Here, using a dataset from Maryland, US and joint species distribution models, we provide the largest scale, most phylogenetically resolved assessment of non-native honey bee density effects on wild bee abundance to date. As beekeeping in Maryland primarily consists of urban beekeeping, we also assessed the relative impact of developed land on wild bee communities. Six of the 33 wild bee genera we assessed showed a high probability (> 90 %) of a negative association with apiary density and/or developed land. These bees were primarily late-season, specialist genera (several long-horned genera represented) or small, ground nesting, season-long foragers (including several sweat bee genera). Conversely, developed land was associated with an increase in relative abundance for some genera including invasive Anthidium and other urban garden-associated genera. We discuss several avenues to ameliorate potentially detrimental effects of beekeeping and urbanization on the most imperiled wild bee groups. We additionally offer methodological insights based on sampling efficiency of different methods (hand netting, pan trapping, vane trapping), highlighting large variation in effect sizes across genera. The magnitude of sampling effect was very high, relative to the observed ecological effects, demonstrating the importance of integrated sampling, particularly for multi-species or community level assessments.

Trace elements and heavy metal(loid)s triggering ecological risks in a heavily polluted river-reservoir system of central Mexico: Probabilistic approaches.

The contamination of trace elements and heavy metal(loid)s in water bodies has emerged as a global environmental concern due to their high toxicity at low concentrations to both biota and humans. This study aimed to evaluate the ecological risk associated with the occurrence and spatial distribution of Mn, Fe, Co, Cd, Ni, Zn, Sb, As, Tl, Cu, Pb, U, and V in the heavily polluted waters of an important river-reservoir system (Atoyac River Basin) in central Mexico, using two-level tired probabilistic approaches: Risk Quotient based on Species Sensitivity Distribution (RQSSD) and Joint Probability Curves (JPCs). The concentrations of these elements varied widely, ranging from 0.055 µg L-1 to 9200 µg L-1 and from 0.056 µg L-1 to 660 µg L-1, in both total and dissolved fractions, respectively. Although geogenic and anthropogenic sources contribute to the presence of these elements in waters, the discharge of untreated or poorly treated industrial wastewater is the main source of contamination. In this regard, the RQSSD results indicated high ecological risk for Mn, Fe, Co, Ni, Zn, and Sb, and medium or low ecological risk for As, Tl, U, and V at almost all sampling sites. The highest RQSSD values were found downstream of a large industrial corridor for Co, Zn, Tl, Pb, and V, with Tl, Pb, and V escalating to higher risk levels, highlighting the negative impact of industrial contamination on biota. The JPC results for these elements are consistent with the RQSSD approach, indicating an ecological risk to species from Mn, Fe, Co, Ni, Zn, and Sb in waters of the Atoyac River Basin. Therefore, the results of this study offer a thorough assessment of pollution risk, providing valuable insights for legislators on managing and mitigating exposure.

Association of free fatty acid in first trimester with the risk of gestational diabetes mellitus: a nested case-control study.

BACKGROUND: Accumulating evidence shows that free fatty acids (FFA) are associated with gestational diabetes mellitus (GDM). However, most of the studies focus on a few specific types of FFA, such as α-linolenic acid (C18:3n3) and Arachidonic acid (C20:4n6) or a total level of FFA. OBJECTIVE: This study aimed to test the association between a variety of FFAs during the first trimester and the risk of GDM. METHODS: The participants came from the Zhoushan Pregnant Women Cohort (ZWPC). A 1:2 nested case-control study was conducted: fifty mothers with GDM were matched with 100 mothers without GDM by age, pre-pregnancy body mass index (BMI), month of oral glucose tolerance test (OGTT) and parity. Thirty-seven FFAs (including 17 saturated fatty acids (SFA), 8 monounsaturated fatty acids (MUFA), 10 polyunsaturated fatty acids (PUFA) and 2 trans fatty acids (TFA)) in maternal plasma during the first trimester were tested by Gas Chromatography-Mass Spectrometry (GC-MS). Conditional logistic regression models were performed to assess the associations of FFA with the risk of GDM. RESULTS: Nine FFAs were respectively associated with an increased risk of GDM (P < 0.05), and four FFAs were respectively associated with a decreased risk of GDM (P < 0.05). SFA risk score was associated with a greater risk of GDM (OR = 1.34, 95% CI: 1.12-1.60), as well as UFA risk score (OR = 1.26, 95% CI: 1.11-1.44), MUFA risk score (OR = 1.70, 95%CI: 1.27-2.26), PUFA risk score (OR = 1.32, 95%CI: 1.09-1.59) and TFA risk score (OR = 2.51, 95%CI: 1.23-5.13). Moreover, joint effects between different types of FFA risk scores on GDM were detected. For instance, compared with those with low risk scores of SFA and UFA, women with high risk scores of SFA and UFA had the highest risk of GDM (OR = 8.53, 95%CI: 2.41-30.24), while the Odds ratio in those with a low risk score of SFA and high risk score of UFA and those with a high risk score of SFA and low risk score of UFA was 6.37 (95%CI:1.33- 30.53) and 4.25 (95%CI: 0.97-18.70), respectively. CONCLUSION: Maternal FFAs during the first trimester were positively associated with the risk of GDM. Additionally, there were joint effects between FFAs on GDM risk. CONDENSATION: Elevated FFA levels in the first trimester increased the risk of GDM.

Dimension reduction, cell clustering, and cell-cell communication inference for single-cell transcriptomics with DcjComm.

Advances in single-cell transcriptomics provide an unprecedented opportunity to explore complex biological processes. However, computational methods for analyzing single-cell transcriptomics still have room for improvement especially in dimension reduction, cell clustering, and cell-cell communication inference. Herein, we propose a versatile method, named DcjComm, for comprehensive analysis of single-cell transcriptomics. DcjComm detects functional modules to explore expression patterns and performs dimension reduction and clustering to discover cellular identities by the non-negative matrix factorization-based joint learning model. DcjComm then infers cell-cell communication by integrating ligand-receptor pairs, transcription factors, and target genes. DcjComm demonstrates superior performance compared to state-of-the-art methods.