A Novel Technique Using the Dorsal Capsule of the Distal Radioulnar Joint for Extensor Carpi Ulnaris Tendon Subsheath Reconstruction.

Background Ulnar-sided wrist pain is a common problem encountered by hand surgeons. Symptomatic recurrent subluxation of the extensor carpi ulnaris (ECU) tendon has become increasingly recognized as one of the pathological conditions leading to ulnar-sided wrist pain. Surgical reconstruction of the subsheath is usually needed. ECU tendon subsheath reconstruction with the periosteal flap was first described by Schlesinger in 1907. Since then, various other techniques have been widely used. We describe a technique of ECU subsheath reconstruction using the dorsal capsule of the distal radioulnar joint (DRUJ). Description of Technique Two hand surgeons performed the surgeries with the same steps taken each time. A detailed description of our surgical technique, with the dorsal capsule of the DRUJ used to reconstruct the ECU tendon subsheath, is illustrated. Patient and Methods Patients who presented with symptomatic ECU instability despite conservative treatment or who have failed primary subsheath repair were offered this surgical option. Patients were followed up postoperatively for an average duration of 6.7 months in our outpatient clinics for assessment of wrist function. The surgical outcomes were reviewed and graded with the Modified Mayo Wrist Score (MMWS). Results All but one of the seven patients had an overall improvement in their range of movement of the wrist, grip strength, and pain scores. Four patients had excellent outcomes on the MMWS, one of whom had an asymptomatic recurrence seen on dynamic ultrasound. Two patients required subsequent surgeries: one had an excellent outcome and the other had a poor outcome on the MMWS. Conclusion We present our first seven cases of ECU subsheath reconstruction with the dorsal capsule of the DRUJ. Our results in the short term have been satisfactory. The technique does not disrupt the integrity of the extensor retinaculum, which is essential for optimal extensor tendon function, and can also be considered as an option to salvage failed procedures.

Corrigendum: Advances and potential of omics studies for understanding the development of food allergy.

[This corrects the article DOI: 10.3389/falgy.2023.1149008.].

The alpha-1A adrenergic receptor regulates mitochondrial oxidative metabolism in the mouse heart.

AIMS: The sympathetic nervous system regulates numerous critical aspects of mitochondrial function in the heart through activation of adrenergic receptors (ARs) on cardiomyocytes. Mounting evidence suggests that α1-ARs, particularly the α1A subtype, are cardioprotective and may mitigate the deleterious effects of chronic ß-AR activation by shared ligands. The mechanisms underlying these adaptive effects remain unclear. Here, we tested the hypothesis that α1A-ARs adaptively regulate cardiomyocyte oxidative metabolism in both the uninjured and infarcted heart. METHODS: We used high resolution respirometry, fatty acid oxidation (FAO) enzyme assays, substrate-specific electron transport chain (ETC) enzyme assays, transmission electron microscopy (TEM) and proteomics to characterize mitochondrial function comprehensively in the uninjured hearts of wild type and α1A-AR knockout mice and defined the effects of chronic ß-AR activation and myocardial infarction on selected mitochondrial functions. RESULTS: We found that isolated cardiac mitochondria from α1A-KO mice had deficits in fatty acid-dependent respiration, FAO, and ETC enzyme activity. TEM revealed abnormalities of mitochondrial morphology characteristic of these functional deficits. The selective α1A-AR agonist A61603 enhanced fatty-acid dependent respiration, fatty acid oxidation, and ETC enzyme activity in isolated cardiac mitochondria. The ß-AR agonist isoproterenol enhanced oxidative stress in vitro and this adverse effect was mitigated by A61603. A61603 enhanced ETC Complex I activity and protected contractile function following myocardial infarction. CONCLUSIONS: Collectively, these novel findings position α1A-ARs as critical regulators of cardiomyocyte metabolism in the basal state and suggest that metabolic mechanisms may underlie the protective effects of α1A-AR activation in the failing heart.

An All-Arthroscopic Technique of Repairing Foveal Tears of the Triangular Fibrocartilage Complex Using a Bone Anchor-Repair Made Simple.

Traumatic foveal tears of the triangular fibrocartilage complex lead to ulnar-sided wrist pain and instability, resulting in painful motion and loss of grip strength with a severe impact on the overall function of the upper limb. Surgical repair is nothing new and has traversed through the realm of open repair to arthroscopic assisted to all arthroscopic repair techniques over the many decades, with arthroscopic repairs showing better visualization, lesser trauma, and equally favorable patient outcomes. Techniques had varied from using trans osseous tunnels to bone anchors, with or without the usage of special jigs. Here, we describe a simple and fast 3 portal arthroscopic technique of repairing the torn foveal insertion of the triangular fibrocartilage complex using a bone anchor inserted under arthroscopic and fluoroscopic guidance into the fovea. Both the dorsal and volar limbs of the triangular fibrocartilage complex are repaired arthroscopically, resulting in a strong anatomic repair resulting in a stable and pain-free wrist.

All-Arthroscopic Foveal Triangular Fibrocartilage Complex Tendon Reconstruction.

Background In symptomatic chronic injury of ulnar-sided tear of the triangular fibrocartilage complex, reconstruction techniques involving foveal reconstruction with palmaris longus tendon graft using the method described by Bain have been described with good outcomes. Description of Technique With increasing popularity of wrist arthroscopy to address various wrist pathologies, we present our technique of arthroscopic foveal reconstruction. We also include a step-by-step description of the procedure with illustrations, with aims to aid surgeons in executing it Conclusion Unlike other arthroscopic techniques described, this involves single osseous ulnar tunnel and performed completely arthroscopically, allowing an end result similar to Bain's open technique.

Soft robotic apparel to avert freezing of gait in Parkinson's disease.

Freezing of gait (FoG) is a profoundly disruptive gait disturbance in Parkinson's disease, causing unintended stops while walking. Therapies for FoG reveal modest and transient effects, resulting in a lack of effective treatments. Here we show proof of concept that FoG can be averted using soft robotic apparel that augments hip flexion. The wearable garment uses cable-driven actuators and sensors, generating assistive moments in concert with biological muscles. In this n-of-1 trial with five repeated measurements spanning 6 months, a 73-year-old male with Parkinson's disease and substantial FoG demonstrated a robust response to robotic apparel. With assistance, FoG was instantaneously eliminated during indoor walking (0% versus 39 ± 16% time spent freezing when unassisted), accompanied by 49 ± 11 m (+55%) farther walking compared to unassisted walking, faster speeds (+0.18 m s-1) and improved gait quality (-25% in gait variability). FoG-targeting effects were repeatable across multiple days, provoking conditions and environment contexts, demonstrating potential for community use. This study demonstrated that FoG was averted using soft robotic apparel in an individual with Parkinson's disease, serving as an impetus for technological advancements in response to this serious yet unmet need.

Individualized Learning-Based Ground Reaction Force Estimation in People Post-Stroke Using Pressure Insoles.

Stroke is a leading cause of gait disability that leads to a loss of independence and overall quality of life. The field of clinical biomechanics aims to study how best to provide rehabilitation given an individual's impairments. However, there remains a disconnect between assessment tools used in biomechanical analysis and in clinics. In particular, 3-dimensional ground reaction forces (3D GRFs) are used to quantify key gait characteristics, but require lab-based equipment, such as force plates. Recent efforts have shown that wearable sensors, such as pressure insoles, can estimate GRFs in real-world environments. However, there is limited understanding of how these methods perform in people post-stroke, where gait is highly heterogeneous. Here, we evaluate three subject-specific machine learning approaches to estimate 3D GRFs with pressure insoles in people post-stroke across varying speeds. We find that a Convolutional Neural Network-based approach achieves the lowest estimation errors of 0.75 ± 0.24, 1.13 ± 0.54, and 4.79 ± 3.04 % bodyweight for the medio-lateral, antero-posterior, and vertical GRF components, respectively. Estimated force components were additionally strongly correlated with the ground truth measurements ( ). Finally, we show high estimation accuracy for three clinically relevant point metrics on the paretic limb. These results suggest the potential for an individualized machine learning approach to translate to real-world clinical applications.

Serial SARS-CoV-2 Antibody Titers in Vaccinated Dialysis Patients: Prevalence of Unrecognized Infection and Duration of Seroresponse.

Rationale & Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are likely underdiagnosed, but the degree of underdiagnosis among patients receiving maintenance dialysis is unknown. The durability of the immune response after the third vaccine dose in this population also remains uncertain. This descriptive study tracked antibody levels to (1) assess the rate of undiagnosed infections and (2) characterize seroresponse durability after the third dose. Study Design: Retrospective observational study. Setting & Participants: SARS-CoV-2-vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies [anti-spike immunoglobulin (Ig) G] titers were assessed monthly after vaccination. Exposures: Two and 3 doses of SARS-CoV-2 vaccine. Outcomes: Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over time. Analytical Approach: Undiagnosed SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥100 BAU/mL, not associated with receipt of vaccine or diagnosed SARS-CoV-2 infection (by polymerase chain reaction test or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time. Results: Among 2,703 patients without previous coronavirus disease 2019 (COVID-19) who received an initial 2-dose vaccine series, 271 had diagnosed SARS-CoV-2 infections (3.4 per 10,000 patient-days) and 129 had undiagnosed SARS-CoV-2 infections (1.6 per 10,000 patient-days). Among 1,894 patients without previous COVID-19 who received a third vaccine dose, 316 had diagnosed SARS-CoV-2 infections (7.0 per 10,000 patient-days) and 173 had undiagnosed SARS-CoV-2 infections (3.8 per 10,000 patient-days). In both cohorts, anti-spike IgG levels declined over time. Of the initial 2-dose cohort, 66% had a titer of ≥500 BAU/mL in the first month, with 24% maintaining a titer of ≥500 BAU/mL at 6 months. Of the third dose cohort, 95% had a titer of ≥500 BAU/mL in the first month after the third dose, with 77% maintaining a titer of ≥500 BAU/mL at 6 months. Limitations: The assays used had upper limits. Conclusions: Among patients receiving maintenance dialysis, about 1 in every 3 SARS-CoV-2 infections was undiagnosed. Given this population's vulnerability to COVID-19, ongoing infection control measures are needed. A 3-dose primary mRNA vaccine series optimizes seroresponse rate and durability. Plain-Language Summary: Patients receiving maintenance dialysis have been particularly vulnerable to COVID-19. Using serially measured antibodies, we found that a substantial proportion (about one-third) of SARS-CoV-2 infections among this population had been missed, both among those who had completed a 2-dose vaccine series and among those who had received a third vaccine dose. Such missed infections likely had only mild or minimal symptoms, but this failure to recognize all infections is concerning. Furthermore, vaccines have been effective among patients receiving dialysis, but our study additionally shows that the immune response wanes over time, even after a third dose. There is therefore a role for ongoing vigilance against this highly transmissible infection.

Recent Mechanistic Studies in Allergic Diseases.

Allergic diseases, such as food allergies, asthma, and allergic rhinitis, continue to present a significant challenge for a broad cross-section of the population, despite recent advancements in their treatment and prevention [...].

Elemental analysis of vertebrae discerns diadromous movements of threatened non-marine elasmobranchs.

River sharks (Glyphis spp.) and some sawfishes (Pristidae) inhabit riverine environments, although their long-term habitat use patterns are poorly known. We investigated the diadromous movements of the northern river shark (Glyphis garricki), speartooth shark (Glyphis glyphis), narrow sawfish (Anoxypristis cuspidata), and largetooth sawfish (Pristis pristis) using in situ laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) on vertebrae to recover elemental ratios over each individual's lifetime. We also measured elemental ratios for the bull shark (Carcharhinus leucas) and a range of inshore and offshore stenohaline marine species to assist in interpretation of results. Barium (Ba) was found to be an effective indicator of freshwater use, whereas lithium (Li) and strontium (Sr) were effective indicators of marine water use. The relationships between Ba and Li and Ba and Sr were negatively correlated, whereas the relationship between Li and Sr was positively correlated. Both river shark species had elemental signatures indicative of prolonged use of upper-estuarine environments, whereas adults appear to mainly use lower-estuarine environments rather than marine environments. Decreases in Li:Ba and Sr:Ba at the end of the prenatal growth zone of P. pristis samples indicated that parturition likely occurs in fresh water. There was limited evidence of prolonged riverine habitat use for A. cuspidata. The results of this study support elemental-environment relationships observed in teleost otoliths and indicate that in situ LA-ICP-MS elemental characterization is applicable to a wide range of elasmobranch species as a discriminator for use and movement across salinity gradients. A greater understanding of processes that lead to element incorporation in vertebrae, and relative concentrations in vertebrae with respect to the ambient environment, will improve the applicability of elemental analysis to understand movements across the life history of elasmobranchs into the future.

Arthroscopy-Assisted Scapholunate Reconstruction With Internal Brace Augmentation.

Various surgical techniques exist to repair or reconstruct complete scapholunate (SL) interosseous ligament tears, including capsulodesis, static or dynamic tenodesis, ligament reconstruction with tendon graft, bone-retinaculum-bone reconstruction, and the reduction and association of the scaphoid and lunate (RASL) procedure. The choice of surgical technique depends on arthroscopic assessment using the Geissler classification and European Wrist Arthroscopy Society staging of SL injury. This article describes arthroscopy-assisted extracapsular SL reconstruction using free tendon graft and internal brace augmentation for the treatment of unrepairable complete SL interosseous ligament tears.

Challenges for Studying and Isolating Extracellular Vesicles from Cell-Conditioned Media.

Extracellular vesicles (EV) are small (100-1000 nm) particles that cells release into the extracellular space that have become increasingly famous for their potential in regenerative medicine and for their alterations in diseases such as cancer to promote disease progression, in particular for their potential for intercellular communication. However, studying EV can be challenging due to the broad diversity of both the EV themselves as well as the methods used to study them. This chapter aims to help investigators new to the EV field by describing challenges with studying EV, methods for enriching EV, and a simple EV enrichment protocol using differential ultracentrifugation.

Advances and potential of omics studies for understanding the development of food allergy.

The prevalence of food allergy continues to rise globally, carrying with it substantial safety, economic, and emotional burdens. Although preventative strategies do exist, the heterogeneity of allergy trajectories and clinical phenotypes has made it difficult to identify patients who would benefit from these strategies. Therefore, further studies investigating the molecular mechanisms that differentiate these trajectories are needed. Large-scale omics studies have identified key insights into the molecular mechanisms for many different diseases, however the application of these technologies to uncover the drivers of food allergy development is in its infancy. Here we review the use of omics approaches in food allergy and highlight key gaps in knowledge for applying these technologies for the characterization of food allergy development.

The role of biologics in pediatric food allergy and eosinophilic gastrointestinal disorders.

Continuing insight into the molecular mechanisms of atopic disorders has enabled the development of biologics to precisely target these diseases. Food allergy (FA) and eosinophilic gastrointestinal disorders (EGIDs) are driven by similar inflammatory molecular mechanisms and exist along the same atopic disease spectrum. Therefore, many of the same biologics are being investigated to target key drivers of mechanisms shared across the disease states. The enormous potential of biologics for the treatment of FA and EGIDs is highlighted by the significant increases in the number of ongoing clinical trials (more than 30) evaluating their use in these disease states, as well as by the recent US Food and Drug Administration approval of dupilumab for the treatment of eosinophilic esophagitis. Here we discuss past and current research into the use of biologics in FA and EGIDs and their potential role in improving treatment options in the future, with the need to have biologics widely clinically available.

Serial SARS-CoV-2 antibody titers in vaccinated dialysis patients: prevalence of unrecognized infection and duration of seroresponse.

Rationale & Objective: SARS-CoV-2 infections are likely underdiagnosed, but the degree of underdiagnosis among maintenance dialysis patients is unknown. Durability of the immune response after third vaccine doses in this population also remains uncertain. This study tracked antibody levels to 1) assess the rate of undiagnosed infections and 2) characterize seroresponse durability after third doses. Study Design: Retrospective observational study. Setting & Participants: SARS-CoV-2 vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies (anti-spike IgG) titers were assessed monthly following vaccination. Exposures: Two and three doses of SARS-CoV-2 vaccine. Outcomes: Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over time. Analytical Approach: "Undiagnosed" SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥ 100 BAU/mL, not associated with receipt of vaccine or "diagnosed" SARS-CoV-2 infection (by PCR or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time. Results: Among 2660 patients without prior COVID-19 who received an initial two-dose vaccine series, 371 (76%) SARS-CoV-2 infections were diagnosed and 115 (24%) were undiagnosed. Among 1717 patients without prior COVID-19 who received a third vaccine dose, 155 (80%) SARS-CoV-2 infections were diagnosed and 39 (20%) were undiagnosed. In both cohorts, anti-spike IgG levels declined over time. Of the initial two-dose cohort, 66% had a titer ≥ 500 BAU/mL in the first month, with 23% maintaining a titer ≥ 500 BAU/mL at six months. Of the third dose cohort, 95% had a titer ≥ 500 BAU/mL in the first month after the third dose, with 76% maintaining a titer ≥ 500 BAU/mL at six months. Limitations: Assays used had upper limits. Conclusions: Among maintenance dialysis patients, 20-24% of SARS-CoV-2 infections were undiagnosed. Given this population's vulnerability to COVID-19, ongoing infection control measures are needed. A three-dose primary mRNA vaccine series optimizes seroresponse rate and durability.

Status of Southeast Asia's marine sharks and rays.

In Southeast Asia, elasmobranchs are particularly threatened. We synthesized knowledge from the peer-reviewed and gray literature on elasmobranchs in the region, including their fisheries, status, trade, biology, and management. We found that 59% of assessed species are threatened with extinction and 72.5% are in decline; rays were more threatened than sharks. Research and conservation is complicated by the socioeconomic contexts of the countries, geopolitical issues in the South China Sea, and the overcapacity and multispecies nature of fisheries that incidentally capture elasmobranchs. The general paucity of data, funds, personnel, and enforcement hinders management. Reduced capacity in the general fishery sector and marine protected areas of sufficient size (for elasmobranchs and local enforcement capabilities) are among recommendations to strengthen conservation.

En el sureste de Asia, los elasmobranquios se encuentran particularmente amenazados. Sintetizamos el conocimiento a partir de la literatura gris y revisada por pares sobre los elasmobranquios en la región, incluidos sus pesquerías, estado, mercado, biología y manejo. Nuestra evaluación incluyó x especies de tiburones y y especies de rayas. Descubrimos que el 59% de las especies evaluadas están bajo amenaza de extinción y 72.5% están en declive; de estas, las rayas estuvieron más amenazadas que los tiburones. La investigación y la conservación son complicadas debido al contexto socioeconómico de los países, los temas geopolíticos en el Mar del Sur de China y la sobrecapacidad y naturaleza multiespecie de las pesquerías que capturan accidentalmente a los elasmobranquios. La escasez general de datos, financiamiento, personal y aplicación limita el manejo. La capacidad reducida en el sector generalizado de la pesquería y las áreas marinas protegidas de tamaño suficiente (para los elasmobranquios y las capacidades de aplicación local) se encuentran entre las recomendaciones para fortalecer la conservación.

Conceptual frameworks and key questions for assessing the contribution of marine protected areas to shark and ray conservation.

Marine protected areas (MPAs) are key tools in addressing the global decline of sharks and rays, and marine parks and shark sanctuaries of various configurations have been established to conserve shark populations. However, assessments of their efficacy are compromised by inconsistent terminology, lack of standardized approaches to assess how MPAs contribute to shark and ray conservation, and ambiguity about how to integrate movement data in assessment processes. We devised a conceptual framework to standardize key terms (e.g., protection, contribution, potential impact, risk, threat) and used the concept of portfolio risk to identify key attributes of sharks and rays (assets), the threats they face (portfolio risk), and the specific role of MPAs in risk mitigation (insurance). Movement data can be integrated into the process by informing risk exposure and mitigation through MPAs. The framework is operationalized by posing 8 key questions that prompt practitioners to consider the assessment scope, MPA type and purpose, range of existing and potential threats, species biology and ecology, and management and operational contexts. Ultimately, MPA contributions to shark and ray conservation differ according to a complex set of human and natural factors and interactions that should be carefully considered in MPA design, implementation, and evaluation.

Marcos conceptuales y preguntas clave para evaluar la contribución de las áreas marinas protegidas a la conservación de tiburones y rayas Resumen Las áreas marinas protegidas (AMP) son herramientas importantes para manejar la declinación mundial de tiburones y rayas, por lo que se han establecido parques marinos y santuarios de diversas configuraciones para conservar las poblaciones de tiburones. Sin embargo, el análisis de su eficiencia está compuesto por una terminología inconstante, la falta de estrategias estandarizadas para evaluar cómo las AMP contribuyen a la conservación de tiburones y rayas, y una ambigüedad sobre cómo integrar la información sobre movimientos en los procesos de evaluación. Diseñamos un marco conceptual para estandarizar los términos más importantes (p. ej.: protección, contribución, impacto potencial, amenaza, riesgo) y usamos el concepto de riesgo de portafolio para identificar los atributos clave de los tiburones y las rayas (activos), las amenazas que enfrentan (riesgo de portafolio) y el papel específico que juegan las AMP en la mitigación del riesgo (seguro). La información sobre los movimientos puede integrarse al proceso al guiar la exposición y mitigación del riesgo con las AMP. El marco conceptual es operado con el planteamiento de ocho preguntas clave que invitan a los practicantes a considerar el enfoque de la evaluación, el tipo de AMP y su propósito, gama de amenazas existentes y potenciales, la biología y ecología de las especies, y los contextos operativos y de manejo. Finalmente, las contribuciones que tienen las AMP a la conservación de los tiburones y las rayas difieren de acuerdo con un conjunto complejo de factores naturales y humanos e interacciones que deberían considerarse cuidadosamente en el diseño, implementación y evaluación de la AMP.

School Risk and Protective Factors of Suicide: A Cultural Model of Suicide Risk and Protective Factors in Schools.

There are known cultural variations in correlates of and symptoms related to suicide-related thoughts and behaviors; however, the majority of research that informs suicide prevention in school systems has focused on research based on Euro-American/White students. By exploring school-related risk and protective factors in ethnic-racial minoritized students, we expand existing multicultural models of suicide prevention for school settings. Specifically, this systematic literature review identified 33 studies conducted with American Indian and Alaskan Native, Hispanic and Latinx, Black and African American, and Asian American and Pacific Islander students. Findings underscore the importance of building relationships with the school community and fostering a sense of safety for students, the need to approach school-based suicide prevention and intervention with cultural considerations, and the importance of connecting students and families with providers in culturally sensitive and informed ways. Taken together, schools need to build school-family-community partnerships that promote culturally sensitive approaches to suicide prevention.