BACKGROUND: Football is one of the most popular sports in the world, and it is also a sport with a high rate of injury. The study aims to investigate the effects of physical and mental mixed fatigue (PMF) on knee biomechanics during sidestep cutting maneuvers in elite male soccer players, thereby assessing the potential mechanisms underlying non-contact knee injuries. METHODS: Thirty-six elite male soccer players were recruited (age: 21.61 ± 1.22 years; body mass: 75.16 ± 6.34 kg; height: 175.8 ± 3.53 cm; shoe size: 41–44 EUR). Following a targeted fatigue induction protocol, key lower limb biomechanical data were acquired during anticipated sidestep cutting maneuvers both pre- and post-PMF. Statistical analyses were performed utilizing paired sample t-tests and one-dimensional Statistical Parametric Mapping (SPM1d). RESULTS: Following PMF, knee valgus increased at initial contact (P = 0.022). Kinetic analysis, supported by SPM1d, revealed a marked transition from an extensor-dominant to a flexor-dominant pattern in sagittal knee moments (P = 0.007), alongside elevated knee valgus moments (P = 0.039). Neuromuscularly, quadriceps and lateral gastrocnemius activation (iEMG/RMS) significantly decreased, whereas compensatory increases were observed in the hamstrings and medial gastrocnemius (all P < 0.001). CONCLUSION: While PMF preserved most kinematics, the statistically significant increase in knee valgus, though small in magnitude, suggests an impaired frontal-plane control that may elevate Anterior Cruciate Ligament (ACL) strain. The shift from quadriceps to hamstring dominance reflects a compensatory neuromuscular strategy. These findings emphasize the importance of incorporating cognitive load into injury-prevention programs and monitoring mental fatigue to reduce non-contact knee injury risks.
This study examines the impact of cognitive load (CL) on lower limb biomechanics during the take-off preparation phase of the platform serve in tennis players of varying skill levels. Fifteen elite and fifteen amateur tennis players performed platform serves before and after completing a 30-minute Stroop task designed to induce CL. Key biomechanical parameters, including joint range of motion (ROM), joint moments, centre of mass (COM) displacement, and ground reaction force (GRF), were assessed using both kinematic and kinetic analysis. After CL, the biomechanical performance of amateur athletes significantly decreased compared to elite athletes. Specifically, amateur athletes showed a 14.19° lower ankle joint range of motion in the sagittal plane (p < 0.001), a 0.04-meter lower COM displacement in the frontal plane (p = 0.017), and a 0.15 Nm/BW lower knee extension moment (p < 0.001). CL adversely affects the lower limb biomechanics of amateur players more than elite players, with elite players demonstrating greater stability. These findings suggest that elite players have developed more efficient motor control mechanisms through extensive training. Tailored training interventions that account for different skill levels could enhance performance stability and mitigate the risk of injury.
Treatment for mucopolysaccharidosis II (MPS II; Hunter syndrome) via enzyme replacement therapy with intravenous idursulfase (Elaprase) has been available for over 15 years. This treatment has led to survival of more patients into adulthood and a concomitant rise in the need for transition of care from paediatric to adult care teams; however, implementation of transition pathways is not standardized. This cross-sectional, non-interventional, multi-country qualitative interview study recruited patients with MPS II (n = 13), caregivers of patients with MPS II (n = 23) and healthcare professionals (n = 24) across six countries (Canada, Colombia, Germany, Mexico, the UK and the USA) to investigate approaches to transition of care in MPS II. Data were collected via a sociodemographic questionnaire, a clinical characteristics form and semi-structured interviews. The interviews identified four overarching themes: transition of care approaches and their drivers, components of a successful transition programme, challenges or barriers to transitioning to adult care and suggested improvements to transition of care. Transition pathways showed high variability within and between countries. Participants reported essential items for successful transition, including continuity of care, a key contact person and empowering patients as early as possible in the process. Proposed improvements for transition included additional educational/support resources, psychological support and implementation of protocols to guide a standardized approach. Our study highlights the need for the establishment of common standards for the transition of care from paediatric to adult services for patients with MPS II. Based on the interview responses, we have proposed additional considerations for patients with neuronopathic MPS II. The findings may inform the development of effective transition practices for MPS II and other rare diseases, to optimize the transition of care experience for patients, caregivers and healthcare professionals.
Shigella is an important cause of diarrheal morbidity and mortality globally. Data on disease burden across age groups, in different epidemiologic settings, and over time are needed to guide preventive strategies. We examined shigellosis in two sites in Kenya over a 10-year period. We used data from the Population-Based Infectious Disease Surveillance (PBIDS) platform in a rural (Asembo, population ~35,000) and urban (Kibera, population ~23,000) setting. PBIDS participants presenting to surveillance clinics with diarrhea (≥3 loose stools in 24-hour period) had stool collected and cultured; Shigella isolates underwent antimicrobial susceptibility testing. We estimated incidence by dividing Shigella cases by person-years- observation, adjusting for the proportion of diarrhea cases with stool collected and for care-seeking outside surveillance clinics. From January 1, 2010 to December 31, 2019, we isolated Shigella from 23% and 15% of 2,017 and 4,074 stool specimens collected in Asembo and Kibera, respectively; S. flexneri accounted for 61% and 67%, respectively. In Asembo, the adjusted shigellosis incidence was 684/100,000; it was highest in ages 12-23 months (1,873/100,000) and ≥50 years (1,502/100,000). In Kibera, the adjusted incidence was 647/100,000, highest in ages 12-23 (2,828/100,000) and 24-59 months (936/100,000). Incidence declined significantly in Asembo (p = 0.009), but not in Kibera (p = 0.53). Overall, ≥ 97% of isolates were susceptible to ciprofloxacin and ceftriaxone. The shigellosis burden was greatest among young toddlers in both urban and rural areas and was high among older adults in the rural setting. Although resistance to first-line antibiotics was infrequent, continued susceptibility monitoring is warranted.
This study evaluated tibiofemoral loading and medial meniscal stress distribution in individuals with flexible flatfoot (FFF) during walking under different foot progression angle (FPA) conditions. This study analyzed the gait of 28 FFF patients (16 males, 12 females) under three FPA conditions (neutral, toe-in, toe-out). Kinematic (Vicon) and kinetic (Kistler) data were used to estimate tibiofemoral forces in OpenSim. Subsequently, joint angles and muscle forces at peak tibiofemoral forces were used to drive a finite element (FE) model of the knee, enabling the comparison of meniscal von Mises stress, maximum shear stress, and contact pressure across FPA conditions. Tibiofemoral force increased during early stance (9-11%) in the toe-in condition with this increase reaching statistical significance in males (p = 0.008, mean partial η 2 = 0.70 within the SPM-identified cluster). FE analysis showed that peak stresses and contact pressure were primarily localized in the anterior region of the medial meniscus. A consistent directional response to FPA was observed with the lowest peak values occurring in the toe-in condition and the highest values in the toe-out condition. Adjusting FPA modulates intra-articular knee loading via the kinetic chain. For FFF patients, neutral FPA provides stable loading. The toe-in condition presents a complex mechanism: despite increasing tibiofemoral force (notably in males), it reduces peak stress by altering contact mechanics and stress distribution. Therefore, FFF gait interventions must be individualized based on factors like foot morphology, sex, and functional goals.
Nasal myiasis is an exceptionally rare parasitic infestation caused by dipteran fly larvae invading the nasal cavity, typically occurring in immunocompromised individuals or those with poor sanitation exposure. This report presents the first case of nasal myiasis following primary ocular involvement in an otherwise healthy immunocompetent Syrian woman, challenging the classical understanding of risk factors and pathogenesis. The patient initially presented with unilateral ocular symptoms including foreign body sensation and photophobia, with subsequent mechanical extraction of larvae. Ten days later she developed bilateral nasal symptoms including larval expulsion, nasal obstruction and hyposmia. CT scan demonstrated right maxillary sinus mucosal thickening with an irregular hyperdense lesion at its superolateral aspect. The patient underwent functional endoscopic sinus surgery with povidone-iodine irrigation and oral ivermectin therapy, resulting in complete symptom resolution. This case demonstrates that even brief environmental exposures (sheep area exposure in this instance) can lead to sequential ocular-nasal infestation in immunocompetent hosts. The successful treatment with combined surgical and medical therapy provides valuable insights for managing similar cases where mechanical extraction alone may be insufficient. Clinicians should maintain high suspicion for myiasis in patients with characteristic symptoms regardless of immune status, particularly after animal exposure or rural activities. The case highlights the importance of preventive measures including protective eyewear and masks in high-risk environments, and demonstrates the effectiveness of combined surgical and pharmacological intervention in refractory cases.
General practice workload is increasing. Routinely reported NHS data describes workload in relation to numbers of appointments and clinicians delivering appointments. However, 'hidden' aspects of general practice workload, such as administrative and supervisory tasks, are not measured. The Hidden Workload Study will examine the full range of tasks that general practice clinicians undertake daily and investigate how workload varies according to clinical role and practice demographics. Participants' lived experience of workload will also be explored through interviews. Utilising the Primary care Academic CollaboraTive's (PACT's) membership and collaborative methodology, mixed quantitative and qualitative methods will be used. All clinicians working in English general practice, including GPs of all grades, resident doctors, nurses, physician associates, pharmacists, and other allied healthcare professionals will be eligible, aiming for >500 participants across >75 practices. Participants will collect data on a randomly allocated day in late 2024 or early 2025. Using a data collection form and timers, participants will record their planned work schedule and then all tasks they complete, including all clinical, administrative, and supervisory tasks, and breaks. Practice demographic data will be collected from NHS Fingertips. For the qualitative arm, 15-20 semi-structured qualitative interviews will also be carried out. Quantitative data will be described according to clinical role and practice demographics, and interviews transcribed and reflexively analysed. The Hidden Workload Study will provide a comprehensive mixed-methods analysis of contemporary general practice workload. Potential explanations for workload variations will be explored, informing future service provision and workforce planning.
The global prevalence of obesity among children and adolescents is a growing concern, with significant implications for long-term health outcomes. Traditional weight loss programs focusing on diet and physical activity have shown limited efficacy. This study aimed to assess the impact of the FatSecret mobile application, a dietary self-monitoring tool, on BMI z-score (ZBMI) in adolescents with obesity, alongside clinical and metabolic parameters, body composition, dietary intake, binge eating behaviors, and quality of life. Sixty adolescents aged 13-17 years with obesity were randomly assigned to either the application group (balanced energy-restricted diet with daily self-monitoring using the FatSecret app) or the control group (balanced energy-restricted diet with a 3-day food record). Both groups were followed for 6 months with monthly consultations, and 34 patients completed the intervention. Both groups experienced significant improvements in ZBMI, body composition, binge eating scores, and insulin levels. Notably, the FatSecret app demonstrated comparable effectiveness to the validated 3-day food record in supporting weight loss and behavioral improvements. While the control group reported a greater increase in polyunsaturated fat intake, the app group showed significant improvements in pain-related quality of life scores. Adherence to dietary monitoring and dropout rates were similar between groups. The use of a mobile phone application demonstrated effectiveness comparable to the traditional, validated 3-day food record in promoting weight loss and metabolic improvements among adolescents with obesity. These findings support its use as a practical alternative for dietary self-monitoring.
Mucopolysaccharidosis II is a rare, X-linked disease, with very few reports of affected female patients. Natural history data describe a predominantly male population, and appropriate disease characterization in female patients is lacking. This analysis explores the somatic disease burden and clinical progression of female patients with MPS II enrolled in the Hunter Outcome Survey (HOS; NCT03292887), a global disease registry. In total, 15 female patients were identified, representing 1.1% of the total patients in HOS. The median ages at first symptom onset and diagnosis were 1.8 and 3.1 years, respectively. A total of 8/14 (57.1%) of patients had cognitive impairment at the latest visit. X-chromosome abnormalities were reported in two patients. Most patients (11/15, 73.3%) had received at least one dose of idursulfase, which was generally well tolerated; no serious adverse events during follow-up were considered treatment-related. Musculoskeletal and ear symptoms were present in all 14 patients with data recorded. Almost all females also experienced neurological, abdominal/gastrointestinal, and pulmonary disease, similar to the symptomatology reported in males. Most patients underwent surgery (41 procedures in 12 patients). Two participants had a male sibling with MPS II who was also enrolled in HOS. Both sibling sets had missense variants and demonstrated several differences in signs/symptoms between the male and female siblings. Notably, only the female siblings displayed cognitive impairment. This report illustrates the disease burden in female patients with MPS II, helping to inform clinicians about the likely prognosis for this extremely rare subgroup of patients.
Traditional surgical treatment for gynecomastia has multiple complications. Recently, energy-based therapies have gained popularity over conventional surgical treatments, including liposuction using radiofrequency energy, power-assisted liposuction, ultrasound-assisted liposuction, and laser-assisted lipolysis (LAL). This work aims to assess LAL efficacy and glandular tissue treatment using a 1470-nm laser for gynecomastia to correct breast volume, flaccidity, and skin tightening without its removal. This prospective, single-blinded randomized controlled trial was conducted on 30 patients enrolled in the National Institute of Laser Enhanced Sciences outpatient clinic who had gynecomastia classified according to the Simon standard. The participants were randomly allocated to 2 groups: group 1 (n = 15) received conventional liposuction (suction-assisted liposuction), and group 2 received LAL (1470-nm diode laser) treatment. Patients were assessed using the BREAST-Q scale. All patients achieved satisfactory results. The BREAST-Q scores were significantly higher in group 2 compared with group I (P < 0.005). Visual analog scale scores significantly decreased in group 2 (P < 0.001) compared with group 1. Group 2 had significantly improved aesthetic outcomes compared with group 1 (P < 0.001). In group 1, skin retraction and hematoma incidence were significantly greater than in group 2 (P = 0.014, <0.001). The LAL described is safe and reproducible. It showed a higher BREAST-Q value, a significantly better aesthetic outcome, and fewer postoperative complications.
To characterize utilization of antibiotics, including those with higher antimicrobial resistance potential, among people with type 1 diabetes and type 2 diabetes in England. Cohort study in the Clinical Practice Research Datalink, including 524 285 patients with type 2 diabetes and 33 843 with type 1 diabetes alive on 1 January 2015, matched to two non-diabetes patients on age-sex-practice and followed up to 31 December 2019. Antibiotic counts and rates were calculated for UK AWaRe (Access, Watch, Reserve) antibiotic categories. Poisson regression estimated rate ratios (RRs) of antibiotic prescriptions for diabetes versus non-diabetes, adjusting for confounders including infection count, and further stratified by age, sex, ethnicity, and deprivation. Higher antibiotic prescription rates were found in diabetes groups (type 1 diabetes RR = 2.21, type 2 diabetes RR = 1.57), which were only partially attenuated after full adjustment (type 1 diabetes RR = 1.56, 95% CI 1.55-1.57, type 2 diabetes RR = 1.14, 95% CI 1.13-1.14). Elevated estimates were seen across both Access and Watch AWaRe categories. Prescription rates were higher in females and White participants, and increased with increasing age bands and deprivation. People with diabetes are exposed to more courses of antibiotics even when controlling for infection count, including broader spectrum antibiotics which require monitoring and risk driving antimicrobial resistance.
BACKGROUND: Newborn screening (NBS) and its genetic version, genetic NBS (gNBS), are now used to identify a broad range of conditions, including metabolic, endocrine, and genetic disorders, leading to significant reductions in infant mortality and long-term complications. Advances in genomic technologies, particularly next-generation sequencing, have enhanced the ability to detect rare diseases early, using gNBS, improving long-term outcomes. The availability and scope of gNBS vary across countries, influenced by national policies and technological advancements. This systematic literature review aims to clarify the specific barriers, opportunities, and more general attitudes that stakeholders express about gNBS for rare diseases. MAIN: We extracted articles from 2010 to 2022. We followed the PRISMA guidelines and registered the review via PROSPERO (CRD42022297678). From an initial retrieval of 4519 records, two selection rounds resulted in a final list of 112 articles, which were assessed across different categories exploring various aspects of gNBS. The most important perceived opportunities in gNBS were the benefits of early intervention to reduce the burden of the diagnostic odyssey. The main identified barriers included three key codes: the stress and risk associated with false results and dealing with uncertainty (n = 25), the psychosocial implications (n = 26), and misunderstandings due to lack of education or communication. The majority of respondents expressed positive views, particularly regarding actionability. CONCLUSION: The results indicate a generally favourable attitude toward newborn screening, with subtle variations in viewpoints. Our findings on these themes can specifically inform how final attitudes are shaped based on particular aspects.
Natural disasters, in particular hurricanes, are linked to hospitals' financial performance, how various parameters affect hospitals' financial metrics, and financial indicators that are extremely relevant in establishing hospitals' sustainability in any eventual emergency (Mah & Andrew, 2022; Schick et al., 2025). Most notably, hurricanes have led to the shutting down of hospitals in rural settings because rural health systems, especially hospitals, have unique issues when they face disasters (Traynor, 2020; Desai et al., 2019). Days Cash on Hand is a key financial indicator used to mark a hospital's capability to recover from a financial crunch, such as a calamity. Data were obtained from the 2023 American Hospital Association (AHA) Annual Survey. The Bonferroni multiple comparisons test reveals that government-owned hospitals keep 101.75 days' worth of cash on hand, whereas private hospitals keep 40.75 days' worth of cash on hand. This results in government hospitals holding 61 more days of cash on hand than their private counterparts.
This study evaluates microplastic contamination within critical agricultural infrastructure by examining the Anzaldúas and Rodhe irrigation canals in Reynosa, Mexico. To ensure geographical representativeness while managing analytical throughput, we implemented an in situ composite sampling design, pooling field triplicates across four strategic locations. We processed the resulting matrices through vacuum filtration onto microstructured silicon nitride nanomembranes, followed by hydrophobic staining with Nile Red fluorophore and automated fluorescence imaging under a TRITC optical channel. Image processing utilized a customized digital watershed segmentation macro to isolate, count, and morphologically classify individual synthetic particles. Our findings reveal a pronounced spatial heterogeneity in pollutant loading, establishing a clear decreasing contamination gradient: Rodhe Internal (RI) > Rodhe External (RE) > Anzaldúas Internal (AI) > Anzaldúas External (AE). The Rodhe Canal emerged as the primary vector for microplastic transport; the internal site (RI) exhibited the highest contamination profile (55.73 particles/mL; 2.99 µg), followed by the external site RE (19.64 particles/mL; 1.52 µg). Conversely, the Anzaldúas Canal displayed substantially lower incidence, yielding 2.61 particles/mL (0.48 µg) at the internal site (AI) and a baseline minimum of 1.31 particles/mL (0.09 µg) at the external site (AE). Morphological analysis identified fragments and fibers as the predominant particle types. Crucially, all sites exceeded laboratory blanks by 13.05 to 557.3 times, demonstrating persistent anthropogenic alteration. This work establishes the first regional quantitative baseline within this vital agricultural corridor, validating an efficient, high-throughput diagnostic tool to guide targeted water management policies in northeastern Mexico.
BACKGROUND: Extensive macular atrophy with pseudodrusen-like appearance (EMAP) is a rare retinal disorder characterized by bilateral macular atrophy and subretinal drusenoid deposits (SDDs), typically occurring earlier and progressing faster than age-related macular degeneration. A possible association between EMAP and rheumatic fever (RF) has been proposed, but its prevalence in this population remains unclear. METHODS: In this cross-sectional study, 118 patients (236 eyes) with valvular disease secondary to RF were prospectively screened at a tertiary cardiology clinic. EMAP was defined by vertically predominant macular atrophy with SDDs and exclusion of alternative diagnoses. Multimodal imaging included spectral-domain optical coherence tomography and fundus autofluorescence. Demographic, clinical, and cardiologic parameters were descriptively analyzed between patients with and without EMAP, and compared between those with and without SDDs using appropriate statistical tests. RESULTS: Two patients (1.69%; 95% confidence interval [CI], 0.47–5.97%) met diagnostic criteria for EMAP. Both were women aged 62 and 73 years, with RF onset during childhood and long disease duration (54 and 62 years). SDDs were identified in 12 patients (10.17%; 95% CI, 5.91–16.94%), including both EMAP cases. Patients with SDDs were significantly older (p = 0.007), had longer RF duration (p = 0.032), and received a greater cumulative benzathine penicillin prophylaxis burden (p = 0.029). CONCLUSIONS: EMAP is uncommon among patients with RF-associated valvular disease, suggesting that additional genetic or environmental factors may be necessary for disease manifestation. The prevalence of SDDs highlights potential subclinical retinal involvement associated with chronic systemic inflammation in this patient population.
Employee health is an important factor that influences the productivity and economic success of companies. The goal of health management in companies is to improve employee health by implementing different kinds of interventions, including checkups (voluntary preventive health examinations) that cover a broad set of tests and questions, to give a comprehensive snapshot of the employee's health and uncover priorities for prevention and health promotion. By analyzing health checkup information on a company-wide level, subgroups with increased need for health management interventions may be identified before productivity loss occurs. This study thus analyzed data from a company's health checkup to form an employee health index (EHI) using principal component analysis (PCA) to adequately summarize the data. Additionally, this study investigated whether EHI values were associated with the number of absent workdays on the department level. The study population consisted of employees of a German automotive company. In total, data from 71,054 voluntary health checkups conducted between 2006 and 2016 were analyzed. PCA resulted in five components in three different health aspects (musculoskeletal disorders, mental health, and physiology). Based on these components, departments were categorized as having low, medium, and high needs for health management interventions. Poisson regression was used to analyze differences in absent workdays between departments with low compared to medium or high need for health management interventions. Components describing musculoskeletal disorders and physiology were associated with a change in the rate of absent days per employee. However, results were inconsistent over different time intervals. Therefore, although the presented EHI was to a certain extent associated with future absent workdays, using checkup data to investigate more specific health problems and outcomes related to individual job-related activities or tasks instead of general measures seems to be a more appealing approach.
Pregnancy is accompanied by physiological changes that alter foot structure and loading conditions, which may contribute to foot pain, instability, and an increased risk of falls. Gestational weight gain and pregnancy-related changes in passive soft-tissue compliance occur simultaneously, making it difficult for clinical studies to distinguish their individual contributions to transverse arch deformation. The purpose of this study was to independently quantify the effects of increased body weight and reduced soft tissue stiffness on transverse foot arch geometry during pregnancy and to clarify their potential mechanical relevance. A computed tomography (CT) -based subject-specific finite element (FE) model and a full factorial design were used to independently quantify the effects of body weight (W) and tissue stiffness (K) on the transverse arch. The reference-condition FE prediction was benchmarked against in-shoe plantar pressure measurements from the same participant, showing close agreement for forefoot and heel peak pressures (< 3% difference). A 4 × 4 factorial analysis was then performed across sixteen conditions, including the reference condition and the 1st, 2nd, and 3rd trimester pregnancy states. Under the prescribed W-K schedule, the greatest model-predicted flattening occurred in the second trimester, corresponding to the stage with the largest prescribed reduction in tissue stiffness. Regression analysis showed that increased load was the primary driver of transverse widening of the midfoot, whereas modelled reductions in passive tissue stiffness predominantly governed loss of arch height and curvature. Interaction effects between load and tissue stiffness were minimal, indicating largely independent mechanical pathways. Model-predicted stresses in the medial cuneiform, intermediate cuneiform, and cuboid were highest in the second trimester. Within this single-subject static FE framework, gestational weight gain (W) and modelled reductions in passive tissue stiffness (K) influenced the tarsal transverse arch through distinct mechanical pathways. Increased W was more strongly associated with transverse widening, whereas lower modelled K was more closely related to vertical flattening and loss of arch curvature. Among the simulated conditions, the most pronounced model-predicted flattening occurred in the second trimester, consistent with the prescribed second-trimester minimum in K. These findings provide a mechanical interpretation of pregnancy-related transverse arch deformation and may help guide future studies of supportive exercise and footwear strategies. Not applicable.
The Reflections series takes a look back on historical articles from The Journal of the Acoustical Society of America that have had a significant impact on the science and practice of acoustics.
Foot progression angle affects gait and lowerlimb alignment. Altered angles may increase knee and ankle loading and produce tissue loading patterns previously linked to musculoskeletal injury. This study investigates how different foot progression angles modify knee and ankle biomechanics in young adults with flexible flatfoot. 28 participants (aged 18-35 years) with flexible flatfoot completed gait trials under three foot progression angle conditions. Kinematic and kinetic variables were analyzed using one-dimensional statistical parametric mapping. A 1D convolutional neural network was applied to classify progression angle patterns based on flexible flatfoot severity and gait biomechanics. Decreasing foot progression angle reduced the ankle eversion/inversion range and knee abduction and external rotation (p < 0.05). Increasing foot progression angle lowered early stance ankle plantarflexion and increased knee abduction/external rotation (p < 0.05). Kinetically, a smaller foot progression angle reduced peak ankle plantarflexion moment and knee extension moment but increased the first peak of the knee adduction moment and rotational moment fluctuations (p < 0.05). A larger foot progression angle reduced rotational fluctuations and terminal stance knee extension moment (p < 0.05). The convolutional neural network model was most accurate for moderate flexible flatfoot cases, and ankle coronal and knee transverse biomechanics showed the strongest discriminative power. Modifying the foot progression angle can meaningfully alter knee and ankle loading in young adults with flexible flatfoot. Neutral or mild toe-in angles may help mitigate excessive eversion and rotational stress, suggesting a simple noninvasive adjustment that clinicians can incorporate during gait retraining or orthotic prescription. Because biomechanical responses vary across individuals, FPA modification may be the most effective when tailored to patient-specific gait characteristics. In addition, deep-learning-based gait classification shows promise for supporting personalized monitoring and guiding clinical decision-making during rehabilitation.
The Hunter Outcome Survey (HOS) collected global, real-world data on the natural history of mucopolysaccharidosis II and its treatment with intravenous idursulfase. For eligible patients, home therapy offers a convenient alternative to in-clinic therapy. Using data in HOS as of January 2023, we provide an updated assessment of the safety/tolerability profile of home therapy with idursulfase. The analysis population comprised 333 patients who had received at least one home infusion and 708 patients who had never received home therapy. Median (10th percentile [P10], 90th percentile [P90]) age at home therapy start was 8.9 (2.9, 21.1) years. Median (P10, P90) ages at latest visit were 15.5 (7.7, 29.3) years in the home therapy group and 13.9 (5.2, 29.0) years in the no home therapy group. Patients received a median (P10, P90) of 6.0 (0.8, 12.0) years of home infusions after 1.8 (0.3, 8.7) years of in-clinic therapy, and these timings varied by geographic region. The infusion-related reaction (IRR) rate was 0.11/patient-year during home therapy, 0.13/patient-year for the in-clinic period for the same patients (first 6 months excluded), and 0.05/patient-year for patients who never received home therapy (first 6 months excluded). More than 60% of IRRs were categorized as mild. The adverse event (AE) rate was lower during home therapy (0.59 AEs/patient-year) than during the in-clinic period for the same patients (0.86 AEs/patient-year). Among patients who never received home therapy, the rate was 0.60 AEs/patient-year. Deaths occurred at a rate of 2.17 deaths/100 patient-years of home therapy and 3.60 deaths/100 patient-years among patients never treated with home therapy. No deaths were deemed related to treatment. The rate of missed infusions was 0.52/year during the home therapy period compared with 1.42/year during the in-clinic period for the same patients and 0.57/year for patients who never received home therapy. Our data indicate a similar safety/tolerability profile for intravenous idursulfase administered at home and in clinic in patients with mucopolysaccharidosis II.