Single Residue Variation in Skeletal Muscle Myosin Enables Direct and Selective Drug Targeting for Spasticity and Muscle Stiffness.

Muscle spasticity after nervous system injuries and painful low back spasm affect more than 10% of global population. Current medications are of limited efficacy and cause neurological and cardiovascular side effects because they target upstream regulators of muscle contraction. Direct myosin inhibition could provide optimal muscle relaxation; however, targeting skeletal myosin is particularly challenging because of its similarity to the cardiac isoform. We identified a key residue difference between these myosin isoforms, located in the communication center of the functional regions, which allowed us to design a selective inhibitor, MPH-220. Mutagenic analysis and the atomic structure of MPH-220-bound skeletal muscle myosin confirmed the mechanism of specificity. Targeting skeletal muscle myosin by MPH-220 enabled muscle relaxation, in human and model systems, without cardiovascular side effects and improved spastic gait disorders after brain injury in a disease model. MPH-220 provides a potential nervous-system-independent option to treat spasticity and muscle stiffness.

Genetic evidence of the causal relationship between chronic liver diseases and musculoskeletal disorders.

BACKGROUND: Chronic liver diseases constitute a major global public health burden, posing a substantial threat to patients' daily lives and even survival due to the potential development of musculoskeletal disorders. Although the relationship between chronic liver diseases and musculoskeletal disorders has received extensive attention, their causal relationship has not been comprehensively and systematically investigated. METHODS: This study aimed to assess the causal relationships between viral hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC), liver cirrhosis, and hepatocellular carcinoma (HCC) with osteoporosis, osteoarthritis, and sarcopenia through bidirectional Mendelian randomization (MR) research. The traits related to osteoporosis and osteoarthritis included both overall and site-specific phenotypes, and the traits linked to sarcopenia involved indicators of muscle mass and function. Random-effect inverse-variance weighted (IVW), weighted median, MR-Egger, and Causal Analysis Using the Summary Effect Estimates were used to evaluate causal effects, with IVW being the main analysis method. To enhance robustness, sensitivity analyses were performed using Cochran's Q test, MR-Egger intercept, MR-PRESSO global test, funnel plots, leave-one-out analyses, and latent causal variable model. RESULTS: The forward MR analysis indicated that PSC can reduce forearm bone mineral density (beta = - 0.0454, 95% CI - 0.0798 to - 0.0110; P = 0.0098) and increase the risk of overall osteoarthritis (OR = 1.012, 95% CI 1.002-1.022; P = 0.0247), while HCC can decrease grip strength (beta = - 0.0053, 95% CI - 0.008 to - 0.0025; P = 0.0002). The reverse MR analysis did not find significant causal effects of musculoskeletal disorders on chronic liver diseases. Additionally, no heterogeneity or pleiotropy was detected. CONCLUSIONS: These findings corroborate the causal effects of PSC on osteoporosis and osteoarthritis, as well as the causal impact of HCC on sarcopenia. Thus, the implementation of comprehensive preventive measures is imperative for PSC and HCC patients to mitigate the risk of musculoskeletal disorders, ultimately improving their quality of life.

CD206+ M2-like macrophages protect against intervertebral disc degeneration partially by targeting R-spondin-2.

OBJECTIVE: This study aimed to explore the specific function of M2 macrophages in intervertebral disc degeneration (IDD). METHODS: Intervertebral disc (IVD) samples from normal (n = 4) and IDD (n = 6) patients were collected, and the expression of M2-polarized macrophage marker, CD206, was investigated using immunohistochemical staining. Nucleus pulposus cells (NPCs) in a TNF-α environment were obtained, and a mouse caudal IVD puncture model was established. Mice with Rheb deletions, specifically in the myeloid lineage, were generated and subjected to surgery-induced IDD. IDD-induced damage and cell apoptosis were measured using histological scoring, X-ray imaging, immunohistochemical staining, and TdT-mediated dUTP nick end labeling (TUNEL) assay. Finally, mice and NPCs were treated with R-spondin-2 (Rspo2) or anti-Rspo2 to investigate the role of Rspo2 in IDD. RESULTS: Accumulation of CD206 in human and mouse IDD tissues was detected. Rheb deletion in the myeloid lineage (RheBcKO) increased the number of CD206+ M2-like macrophages (mean difference 18.6% [15.7-21.6%], P < 0.001), decreased cell apoptosis (mean difference -15.6% [-8.9 to 22.2%], P = 0.001) and attenuated the IDD process in the mouse IDD model. NPCs treated with Rspo2 displayed increased extracellular matrix catabolism and apoptosis; co-culture with a conditioned medium derived from RheBcKO mice inhibited these changes. Anti-Rspo2 treatment in the mouse caudal IVD puncture model exerted protective effects against IDD. CONCLUSIONS: Promoting CD206+ M2-like macrophages could reduce Rspo2 secretion, thereby alleviating experimental IDD. Rheb deletion may help M2-polarized macrophages accumulate and attenuate experimental IDD partially by inhibiting Rspo2 production. Hence, M2-polarized macrophages and Rspo2 may serve as therapeutic targets for IDD.

Association of chronic liver disease with bone diseases and muscle weakness.

The liver is a vital organ involved in nutrient metabolism, hormone regulation, immunity, cytokine production, and gut homeostasis. Impairment in liver function can result in malnutrition, chronic inflammation, decreased anabolic hormone levels, and dysbiosis. These conditions eventually cause an imbalance in osteoblast and osteoclast activities, resulting in bone loss. Osteoporosis is a frequent complication of chronic liver disease (CLD) that adversely affects quality of life and increases early mortality. Sarcopenia is another common complication of CLD characterized by progressive loss of skeletal muscle mass and function. Assessment criteria for sarcopenia specific to liver disease have been established, and sarcopenia has been reported to be associated with an increase in the risk of liver disease-related events and mortality in patients with CLD. Owing to their similar risk factors and underlying pathophysiological mechanisms, osteoporosis and sarcopenia often coexist (termed osteosarcopenia), progress in parallel, and further exacerbate the conditions mentioned above. Therefore, comprehensive management of these musculoskeletal disorders is imperative. This review summarizes the clinical implications and characteristics of osteoporosis, extending to sarcopenia and osteosarcopenia, in patients with CLD caused by different etiologies.

Work-related musculoskeletal disorders and associated factors among weavers working in Bahir Dar City, Northwest Ethiopia: cross-sectional study design.

BACKGROUND: Work-related musculoskeletal disorders are one of the most common public health problems throughout the world. It is a major cause of occupational injury, illness, and disability that leads to an increased rate of sick leave, financial costs for both individuals and society and the health care system. Weavers are among the populations exposed to musculoskeletal disorders due to a lack of occupational safety, health services, and poor working conditions. Yet, little is known about WMSD among weavers in Africa particularly in Ethiopia. Thus, this study aimed to assess the prevalence and associated factors of work-related musculoskeletal disorders among weavers. METHOD: A multi-centered institutional-based cross-sectional study was conducted in Bahir Dar City, Ethiopia among 424 weavers with a response rate of 97.7%. Participants were recruited randomly after proportional allocation was done for each institution and face-to-face interviews were employed to collect data using a well-structured questionnaire adopted from the Nordic musculoskeletal questionnaire and different literature. The data were entered into Epidata and analyzed using SPSS version (Choobineh A, Lahmi M, Shahnavaz H, Khani Jazani R, Hosseini M. Int J Occup Saf Ergon, 10:157-68, 2004). Variables with a P-value < 0.25 in the bivariate logistic regression were entered into a multivariable logistic regression model. Finally, variables with an AOR, a 95% confidence interval, and a P-value of < 0.05 were reported. RESULT: The annual prevalence rate of work-related musculoskeletal disorders among weavers was 76.3% [CI = 72.2 to 80.2%]. Longer working hours [AOR = 3.48, CI = (1.96-6.21)] lack of back support during sitting [AOR = 2.50 (1.293-4.480)], having repetitive movement in weaving [AOR = 4.11(2.029-8.324)], attaining awkward posture [AOR = 3.37(1.875-6.059)] and job stress [AOR = 4.37(2.447-7.816)] was significantly associated with work-related musculoskeletal disorders. CONCLUSIONS: This study revealed a high prevalence of WMSDs among weavers. Our study findings reported that longer working hours, lack of back support during sitting, having repetitive movement in weaving attaining awkward posture, and having job stress were significantly associated with work-related musculoskeletal disorders.

The moderating effect of work-related musculoskeletal disorders in relation to occupational stress and health-related quality of life of construction workers: a cross-sectional research.

BACKGROUND: This study aimed to investigate work-related musculoskeletal disorders (WMSDs), occupational stress, and health-related quality of life (HRQoL); identify the factors that affect HRQoL; and investigate the moderating effects of WMSDs on occupational stress and HRQoL. METHODS: The participants were construction workers who had worked in the construction industry for over three months. A total of 178 construction workers voluntarily participated and anonymously completed the musculoskeletal symptoms questionnaire, the Korean Occupational Stress Scale, short-form 36. The moderation effect of WMSDs on occupational stress and HRQoL were analyzed by Haye's Process Macro Model. RESULTS: The results of the study showed that 96 subjects (53.9%) had WMSDs, and the most common pain site was the lower back (33.3%). The group with WMSDs had higher occupational stress than did the group without WMSDs (p < 0.01). Compared with the group without WMSDs, the group with WMSDs displayed significant differences in HRQoL (p < 0.001). Furthermore, the factor affecting HRQoL was WMSDs (p < 0.001). In the impact of occupational stress on HRQoL, WMSDs had a significant moderating effect (p < 0.001). CONCLUSION: The results of this study indicate that construction workers' WMSDs significantly impact occupational stress and HRQoL, and WMSDs have a significant moderating effect on the relationship between occupational stress and HRQoL. Therefore, to improve the HRQoL of workers in the construction industry, it is necessary to develop methods to reduce occupational stress and prevent and treat WMSDs.

Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review.

BACKGROUND: Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. OBJECTIVE: We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. METHODS: We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. RESULTS: Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. CONCLUSIONS: Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. TRIAL REGISTRATION: PROSPERO CRD42022347366; https://osf.io/pxedm/.

Development and Validation of an Automated Classification System for Osteonecrosis of the Femoral Head Using Deep Learning Approach: A Multicenter Study.

BACKGROUND: Accurate classification can facilitate the selection of appropriate interventions to delay the progression of osteonecrosis of the femoral head (ONFH). This study aimed to perform the classification of ONFH through a deep learning approach. METHODS: We retrospectively sampled 1,806 midcoronal magnetic resonance images (MRIs) of 1,337 hips from 4 institutions. Of these, 1,472 midcoronal MRIs of 1,155 hips were divided into training, validation, and test datasets with a ratio of 7:1:2 to develop a convolutional neural network model (CNN). An additional 334 midcoronal MRIs of 182 hips were used to perform external validation. The predictive performance of the CNN and the review panel was also compared. RESULTS: A multiclass CNN model was successfully developed. In internal validation, the overall accuracy of the CNN for predicting the severity of ONFH based on the Japanese Investigation Committee classification was 87.8%. The macroaverage values of area under the curve (AUC), precision, recall, and F-value were 0.90, 84.8, 84.8, and 84.6%, respectively. In external validation, the overall accuracy of the CNN was 83.8%. The macroaverage values of area under the curve, precision, recall, and F-value were 0.87, 79.5, 80.5, and 79.9%, respectively. In a human-machine comparison study, the CNN outperformed or was comparable to that of the deputy chief orthopaedic surgeons. CONCLUSION: The CNN is feasible and robust for classifying ONFH and correctly locating the necrotic area. These findings suggest that classifying ONFH using deep learning with high accuracy and generalizability may aid in predicting femoral head collapse and clinical decision-making.

Psychosocial Factors and Musculoskeletal Symptoms in Office Workers: Validating the Maastricht Upper Extremity Questionnaire.

Background: Complaints of the arm, neck, and shoulder (CANS) in the workplace are becoming more prevalent among employees. The Maastricht Upper Extremity Questionnaire (MUEQ) validates upper extremity complaints in 7 domains-including workstation, body posture, break time, job control, job demands, work environment, and social support. The aim of the present study was to translate, adapt, and validate the Persian Version of MUEQ among Iranian office workers. Methods: The psychometric evaluation of the Persian version of the MUEQ employed a comprehensive methodological approach comprising face and content validity assessments, confirmatory factor analysis (CFA), and Cronbach's alpha. A panel of 10 experts assessed the face and content validity of the instrument. In the second phase, through a cross-sectional study, the validity and reliability of the questionnaire were measured by CFA and Cronbach's alpha in a sample of 420 people from the target population in Tehran, Iran. Results: The mean age of the participants was 41.40 ± 7.80 years. Examination of upper limb complaints showed that neck pain was the most common complaint among office workers, with a prevalence of 65%. The CFA results confirmed the questionnaire's structure, with 59 items grouped into 7 subscales, and with fit indices-comparative fit index, 0. 87; root mean square error of approximation, 0.08; goodness of fit index, 0.9. The questionnaire demonstrated strong internal consistency, as all items exhibited Cronbach's alpha values of ≥0.9. Conclusion: The psychometric evaluation of the Persian version of the MUEQ showed that it is a valid and reliable tool for evaluating psychosocial factors in the work environment. Identifying psychosocial factors influential in musculoskeletal problems will lead to better planning to change behavior and design constructive interventions to improve behavior. By addressing psychosocial determinants of musculoskeletal issues at both the individual and organizational levels, we can enhance employees' awareness, self-efficacy, and ability to manage their musculoskeletal health and make informed decisions about their well-being.

Self-reported musculoskeletal disorders and associated factors among HIV/AIDS patients following ART at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia, 2021: Aa cross-sectional study design.

BACKGROUND: Musculoskeletal disorders is an inflammatory, degenerative diseases and disorders that cause pain and functional impairments. Musculoskeletal disorders are common and the major global health concern among people with human immunodeficiency virus/acquired immunodeficiency syndrome which causes physical disability. Despite, it is a recognized health problem among human immunodeficiency virus-positive patients, there is a lack of data on musculoskeletal disorders among patients following anti-retroviral therapy in sub-Saharan Africa, particularly Ethiopia. Therefore, the main aim of the study was to assess the prevalence and associated factors of musculoskeletal disorders among adult human immunodeficiency virus-positive patients following anti-retroviral therapy. METHOD: An institutional-based cross-sectional study was conducted from September 1st to October 1st, 2021 at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. The data was collected through an interview-administered questionnaire and patient medical record review of 324 participants. Binary logistic regression was used to identify associated risk factors of musculoskeletal disorders. The strength of the association was detected by the adjusted odds ratio and P-value. RESULT: The annual prevalence of musculoskeletal disorders among participants was 158 (48.5%) with [95% CI: 43%, 54%], opportunistic infection [AOR, 10.43; 95% CI = 2.76-42.25], type of ART medication used, CD4-count [AOR, 0.13; 95% CI 0.03-0.85], and change in anti-retroviral therapy regimen change [AOR, 8.14; 95%CI 2.06-32.09] were significantly associated with musculoskeletal disorders. CONCLUSION: The prevalence of musculoskeletal disorders was moderate. Recent CD4 count, opportunistic infection, antiretroviral therapy regime at initiation, and anti-retroviral therapy regime change were significantly associated with musculoskeletal disorder. A multidisciplinary approach is required for preventing and treating musculoskeletal disorders among human immunodeficiency virus-positive patients following anti-retroviral therapy.

Magnitude of depression and associated risk factors among patients with musculoskeletal disorder treated in physiotherapy outpatient department in Amhara region comprehensive specialized hospital in Ethiopia: a prospective cross-sectional study.

BACKGROUND: The state of depression that can lead to substance and drug abuse, as well as an increased risk of suicide. Without a doubt, the link between musculoskeletal pain and depression compromises a person's health and drastically lowers their quality of life, resulting in increased incapacity. Depression and musculoskeletal discomfort are two well-known risk factors for long-term sickness absence, which is defined as a period of sickness lasting more than a week, which means chronic musculoskeletal pains, particularly multiple pains, are linked to depression. And early diagnosis and care of depression in musculoskeletal disorder are critical to patients' physical, functional, and occupational results. This study aimed to assess the magnitude of depression and associated risk factors among patients with musculoskeletal disorder. METHOD: Multi-institution cross-sectional study conducted in Amhara region Comprehensive specialized Hospitals from April 1st to May 30th, 2021. The data was collected from 217 participants through interview administrative questioner and patient medical record review. Binary logistic regression was used to identify associated risk factors of depression. The strength of the association was detected by the adjusted odds ratio. RESULT: A total of 217 participate in this study with the age range of 18-80 years. Among the study participants, 57.1% (n = 124) (AOR: 95% CI: 50.7-63.6) were had depression. Treatment duration, and social support were significantly association with depression among patient with musculoskeletal disorder with P < 0.05. CONCLUSION: The magnitude of depression was relatively high among musculoskeletal disorder patients treated in physiotherapy out-patient department. The length of treatment duration (hospital stay) and the status of social support from families and friends were significantly associated with depression among patients with musculoskeletal disorders. A multidisciplinary strategy is required for diagnosing and treating depression in patients with musculoskeletal disorder.

An economic evaluation of pharmacopuncture versus usual care for chronic neck pain: a pragmatic randomized controlled trial.

BACKGROUND: This study aimed to evaluate the cost utility of pharmacopuncture in comparison with usual care for patients with chronic neck pain. METHODS: A 12-week, multicenter, pragmatic randomized controlled trial was conducted, and 101 patients suffering from chronic neck pain for more than six months were randomly placed into the pharmacopuncture and usual care groups to receive four weeks of treatment and 12 weeks of follow-up observations. The quality-adjusted life year (QALY) was calculated using EQ-5D and SF-6D. Concerning costs in 2019, a primary analysis was performed on societal perspective cost, and an additional analysis was performed on healthcare perspective cost. RESULTS: Compared to usual care, pharmacopuncture was superior as it showed a slightly higher QALY and a lower incremental cost of $1,157 from a societal perspective. The probability that pharmacopuncture would be more cost-effective at a willingness-to-pay (WTP) of $26,374 was 100%. Pharmacopuncture was also superior from a healthcare perspective, with a lower incremental cost of $26. The probability that pharmacopuncture would be more cost-effective at a WTP of $26,374 was 83.7%. CONCLUSIONS: Overall, pharmacopuncture for chronic neck pain was found to be more cost-effective compared to usual care, implying that clinicians and policy makers should consider new treatment options for neck pain. TRIAL REGISTRATION: Number NCT04035018 (29/07/2019) Clinicaltrials.gov; Number KCT0004243 (26/08/2019) Clinical Research Information Service.

The risk of an incident hospital contact with a musculoskeletal disorder in Danish occupational fishers: a register-based study.

BACKGROUND: The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. METHODS: This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. RESULTS: Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. CONCLUSION: Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.

A multicomponent quasi-experimental ergonomic interventional study: long-term parallel four-groups interventions.

BACKGROUND: Musculoskeletal disorders (MSDs) are known as one of the main problems affecting the health of industrial workers and can lead to lost working days, functional disability of workers and wasting the financial resources of an organization. Therefore, the present study aimed to evaluating the effect of ergonomic interventions on reducing MSDs and improving working posture in the in a foundry industry workers. METHODS: A field multicomponent cross-interventional study was conducted on workers working in a foundry industry. In this study, 117 male workers were divided into 4 groups, including a control group, a group with specialized ergonomics training, a group with workstation intervention, and a group simultaneously undergoing training and workstation intervention. All 4 groups were evaluated during a period of baseline, 6 and 12-months follow- up. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and direct observations of working postures by using the Quick Exposure Check (QEC) method were used. RESULTS: The results showed that the implemented interventions in the shoulder/arm, back and stress level were effective and the difference in the final score was significant among different groups (P-value > 0.05). In addition, the interventions led to a significant decrease in the QEC scores and musculoskeletal symptom scores in the neck, shoulder, lower back, knee, and lower leg regions among different groups (P-value > 0.05). CONCLUSION: The results showed that workstation modification and training and workstation intervention simultaneously had a greater effect on MSDs and improving working posture compared to training alone.

Technical aspects of virtual augmented reality-based rehabilitation systems for musculoskeletal disorders of the lower limbs: a systematic review.

INTRODUCTION: Musculoskeletal disorders are one of the most common causes of physical disability. The rehabilitation process after musculoskeletal disorders is long and tedious, and patients are not motivated to follow rehabilitation protocols. Therefore, new systems must be used to increase patient motivation. Virtual reality (VR) and augmented reality (AR) technologies can be used in this regard. In developing such systems, various technologies and methods of movement recognition are used; therefore, this study aims to summarize the technical aspects of using VR/AR in rehabilitation and evaluate and discuss efficient methods of investigating studies using the Statement of Standards for Reporting Implementation Studies (StaRI). METHODS: Search in four scientific databases was done systematically based on PRISMA through online search engines from inception to June 2021. These databases include Medline (PubMed), Scopus, IEEE, and Web of Science. An updated search was also conducted on 17 December 2021. The research used keywords and MeSH terms associated with VR/AR, musculoskeletal disorder, and rehabilitation. Selected articles were evaluated qualitatively using the Standards for Reporting Implementation Studies (StaRI) statement. RESULTS: A total of 2343 articles were found, and 20 studies were included. We found that 11 (55%) studies used Kinect technology as input tools, and 15 (75%) studies have described the techniques used to analyze human movements, such as dynamic time warping (DTW) and support vector machines (SVM). In 10 (50%) studies, the Unity game engine was used for visualization. In 8 studies (40%), usability was assessed, and high usability was reported. Similarly, the results of the review of studies according to the StaRI checklist showed poor reporting in the title and discussion of the studies. CONCLUSIONS: We found that academic studies did not describe the technical aspects of rehabilitation systems. Therefore, a good description of the technical aspects of the system in such studies should be considered to provide repeatability and generalizability of these systems for investigations by other researchers.

Deep Learning Approach for Diagnosing Early Osteonecrosis of the Femoral Head Based on Magnetic Resonance Imaging.

BACKGROUND: The diagnosis of early osteonecrosis of the femoral head (ONFH) based on magnetic resonance imaging (MRI) is challenging due to variability in the surgeon's experience level. This study developed an MRI-based deep learning system to detect early ONFH and evaluated its feasibility in the clinic. METHODS: We retrospectively evaluated clinical MRIs of the hips that were performed in our institution from January 2019 to June 2022 and collected all MRIs diagnosed with early ONFH. An advanced convolutional neural network (CNN) was trained and optimized; then, the diagnostic performance of the CNN was evaluated according to its accuracy, sensitivity, and specificity. We also further compared the CNN's performance with that of orthopaedic surgeons. RESULTS: Overall, 11,061 images were retrospectively included in the present study and were divided into three datasets with ratio 7:2:1. The area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the CNN model for identifying early ONFH were 0.98, 98.4, 97.6, and 98.6%, respectively. In our review panel, the averaged accuracy, sensitivity, and specificity for identifying ONFH were 91.7, 87.0, and 94.1% for attending orthopaedic surgeons; 87.1, 84.0, and 89.3% for resident orthopaedic surgeons; and 97.1, 96.0, and 97.9% for deputy chief orthopaedic surgeons, respectively. CONCLUSION: The deep learning system showed a comparable performance to that of deputy chief orthopaedic surgeons in identifying early ONFH. The success of deep learning diagnosis of ONFH might be conducive to assisting less-experienced surgeons, especially in large-scale medical imaging screening and community scenarios lacking consulting experts.

The Effect of Key Anthropometric and Biomechanics Variables Affecting the Lower Back Forces of Healthcare Workers.

Wearable devices are becoming ubiquitous and can be used to better estimate postures and movements to reduce the risk of injuries. Thirty-three participants were recruited in this study to perform two daily repetitive patient transfer tasks while the full body movements were acquired using a set of magneto-inertial wearable devices. The use of wearable devices allowed for the estimation of the forces provoked on the lower back during the entire task performance. In postures where the forces exceeded the warning threshold found in the literature, healthcare workers were considered to have a greater risk of injury. Additionally, the maximum force exerted by each hand to avoid injury to the spinal column was also estimated. Knowing the key anthropometric variables associated with musculoskeletal disorders (MSDs) will enable engineers and researchers to design better assistive devices and injury prevention programs in diverse workplaces.

Reliability of a Wearable Motion Tracking System for the Clinical Evaluation of a Dynamic Cervical Spine Function.

Neck pain is a common cause of disability worldwide. Lack of objective tools to quantify an individual's functional disability results in the widespread use of subjective assessments to measure the limitations in spine function and the response to interventions. This study assessed the reliability of the quantifying neck function using a wearable cervical motion tracking system. Three novice raters recorded the neck motion assessments on 20 volunteers using the device. Kinematic features from the signals in all three anatomical planes were extracted and used as inputs to repeated measures and mixed-effects regression models to calculate the intraclass correlation coefficients (ICCs). Cervical spine-specific kinematic features indicated good and excellent inter-rater and intra-rater reliability for the most part. For intra-rater reliability, the ICC values varied from 0.85 to 0.95, and for inter-rater reliability, they ranged from 0.7 to 0.89. Overall, velocity measures proved to be more reliable compared to other kinematic features. This technique is a trustworthy tool for evaluating neck function objectively. This study showed the potential for cervical spine-specific kinematic measurements to deliver repeatable and reliable metrics to evaluate clinical performance at any time points.

A Wearable Multi-Modal Digital Upper Limb Assessment System for Automatic Musculoskeletal Risk Evaluation.

Continuous ergonomic risk assessment of the human body is critical to avoid various musculoskeletal disorders (MSDs) for people involved in physical jobs. This paper presents a digital upper limb assessment (DULA) system that automatically performs rapid upper limb assessment (RULA) in real-time for the timely intervention and prevention of MSDs. While existing approaches require human resources for computing the RULA score, which is highly subjective and untimely, the proposed DULA achieves automatic and objective assessment of musculoskeletal risks using a wireless sensor band embedded with multi-modal sensors. The system continuously tracks and records upper limb movements and muscle activation levels and automatically generates musculoskeletal risk levels. Moreover, it stores the data in a cloud database for in-depth analysis by a healthcare expert. Limb movements and muscle fatigue levels can also be visually seen using any tablet/computer in real-time. In the paper, algorithms of robust limb motion detection are developed, and an explanation of the system is provided along with the presentation of preliminary results, which validate the effectiveness of the new technology.

QbD-Optimized, Phospholipid-Based Elastic Nanovesicles for the Effective Delivery of 6-Gingerol: A Promising Topical Option for Pain-Related Disorders.

In this study, elastic nanovesicles, constructed of phospholipids optimized by Quality by Design (QbD), release 6-gingerol (6-G), a natural chemical that may alleviate osteoporosis and musculoskeletal-related pain. A 6-gingerol-loaded transfersome (6-GTF) formulation was developed using a thin film and sonication approach. 6-GTFs were optimized using BBD. Vesicle size, PDI, zeta potential, TEM, in vitro drug release, and antioxidant activity were evaluated for the 6-GTF formulation. The optimized 6-GTF formulation had a 160.42 nm vesicle size, a 0.259 PDI, and a -32.12 mV zeta potential. TEM showed sphericity. The 6-GTF formulation's in vitro drug release was 69.21%, compared to 47.71% for the pure drug suspension. The Higuchi model best described 6-G release from transfersomes, while the Korsmeyer-Peppas model supported non-Fickian diffusion. 6-GTF had more antioxidant activity than the pure 6-G suspension. The optimized transfersome formulation was converted into a gel to improve skin retention and efficacy. The optimized gel had a spreadability of 13.46 ± 4.42 g·cm/s and an extrudability of 15.19 ± 2.01 g/cm2. The suspension gel had a 1.5 µg/cm2/h ex vivo skin penetration flux, while the 6-GTF gel had 2.71 µg/cm2/h. Rhodamine B-loaded TF gel reached deeper skin layers (25 µm) compared to the control solution in the CLSM study. The gel formulation's pH, drug concentration, and texture were assessed. This study developed QbD-optimized 6-gingerol-loaded transfersomes. 6-GTF gel improved skin absorption, drug release, and antioxidant activity. These results show that the 6-GTF gel formulation has the ability to treat pain-related illnesses effectively. Hence, this study offers a possible topical treatment for conditions connected to pain.