The use of facet joint interventions for spinal pain management increased rapidly between 2000 and 2010, followed by slower growth from 2010 to 2019. Post-COVID analyses demonstrated a marked decline in facet joint interventions despite an increasing prevalence of chronic pain among traditional Medicare beneficiaries after 2019, together with multiple contributing factors over time, including enactment of the Affordable Care Act, COVID-19, the Inflation Reduction Act, and other influences. This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. traditional Medicare population across multiple periods from 2000 to 2024. A retrospective cohort study evaluating utilization trends and influencing factors for facet joint interventions in the fee-for-service (FFS) traditional Medicare population in the United States from 2000 to 2024. Data were derived from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2024). Utilization rates per 100,000 Medicare beneficiaries, percentage of change, and geometric average changes were calculated. Facet joint intervention utilization increased rapidly from 2000 to 2010 (15.5% annually), slowed from 2010 to 2019 (4.2% annually), and declined from 2019 to 2024 (-6.1% annually). Episodes followed similar patterns but declined less steeply than procedures (-6.7% vs. -27.1%). By 2024, service rates had returned to approximately 2012 levels (5,016 vs 5,046 per 100,000 beneficiaries). From 2000 to 2010, lumbar and cervical/thoracic facet joint blocks and radiofrequency ablation procedures increased substantially (13.5%-24.6% annually), followed by slower growth from 2010 to 2019 (2.8%-11.0%), a sharp pandemic-related decline from 2019 to 2020 (10.6%-17.4%), and partial recovery with modest growth or stabilization through 2024. Between 2019 and 2024, the episode ratio of facet joint nerve blocks to radiofrequency ablation declined from 1.9 to 1.7 for lumbar procedures and from 2.4 to 2.0 for cervical procedures, attributed to the mandatory radiofrequency policy. Interventional pain-related specialties accounted for the majority of facet joint procedures, increasing their share from 87.3% in 2010 to 95% by 2024, while surgical specialties declined from 4.8% to 2.0%. During the same period, the site of service shifted modestly from office settings (50.7% to 48.8%) and hospital outpatient departments (HOPD) (declining to 20.5%) toward ambulatory surgery centers (ASCs) (25.6% to 30.6%). These findings reflect increasing specialization, recent reductions in treatment intensity, and the influence of policy changes, Medicare Advantage shifts, and broader system pressures on pain management. The analysis was limited to the FFS traditional Medicare population and data availability through 2024, excluding utilization patterns for Medicare Advantage Plans, which covered 54% of Medicare enrollees in 2024. As with other retrospective claims-based studies, inherent limitations related to coding and administrative data apply. This retrospective analysis demonstrates a substantial decline in facet joint intervention episodes, with an overall reduction of 6.7% per 100,000 Medicare beneficiaries and an annual decline rate of 1.4% for episodes from 2019 to 2024. In contrast, services or procedures declined more markedly, with an overall reduction of 27.1% and an annual decline rate of 6.1% per 100,000 Medicare beneficiaries.
Chronic axial spinal pain is a major cause of disability. The literature shows that expenditures related to low back and neck pain and other musculoskeletal disorders continue to rise, not only due to disability but also due to increasing healthcare costs, accounting for the highest expenditure among various disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain. Therapeutic facet joint interventional modalities for axial spinal pain include radiofrequency ablation, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency ablation as a therapeutic modality in managing chronic axial spinal pain of facet joint origin. A systematic review and meta-analysis of randomized controlled trials (RCTs) utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The available literature on radiofrequency ablation in axial spinal pain was reviewed. The quality assessment criteria utilized included the Cochrane review criteria to assess risk of bias and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials. The evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The level of evidence was determined based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.A comprehensive literature search of multiple databases from 1966 to June 2025, including manual searches of the bibliographies of relevant review articles, was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into both qualitative and quantitative analyses. The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of greater than 50% for at least 6 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months). This assessment identified 17 RCTs, including 14 high-quality and 3 moderate-quality studies based on Cochrane criteria, and 11 high-quality and 6 moderate-quality studies based on IPM-QRB criteria. Based on the GRADE assessment, 8 trials demonstrated at least moderate levels of impact and certainty, whereas 7 trials showed low impact with low certainty, and 2 trials demonstrated very low impact and certainty. Despite the availability of multiple studies, the relative paucity of high-quality literature remains a major limitation. Based on this systematic review and meta-analysis of 17 RCTs, the evidence is Level II with moderate certainty and a moderate strength of recommendation for the use of radiofrequency ablation in managing chronic axial spinal pain of facet joint origin.
Less is known about the development of joint attention in late preterm infants (34 - < 37 weeks of complete gestation). We aimed to examine the effect of late prematurity on the developmental trajectory of joint attention and to investigate whether maternal interactive style could moderate a possible detrimental effect of prematurity on the ability. Participants were 43 late preterm and 29 full-term infants, assessed at 12- and 15-month uncorrected chronological age, and their mothers. Both groups responded more to joint attention over time; however, late preterm infants presented significantly lower levels at both time points. Furthermore, late preterm and full-term infants seemed to display different initiating joint attention trajectories from 12 to 15 months. Maternal behaviors did not influence joint attention nor moderate the effect of prematurity. Results suggest that late prematurity may have a differential impact on distinct behavioral dimensions of joint attention, potentially reflecting the specific mental processes involved in RJA and IJA.
To investigate the growth and developmental characteristics of the temporomandibular joint (TMJ) in adolescents with facial asymmetry and its relationship with mandibular morphological changes. A total of 20 patients aged 8 to 20 years with facial asymmetry who underwent functional orthodontic treatment were included. MRI and cone-beam computed tomography (CBCT) examinations were performed before treatment and at 1-year follow-up. Measurements were conducted using Dolphin Imaging software. Pearson or Spearman correlation analyses were applied to evaluate associations between craniofacial parameters and mandibular growth changes. No significant correlations were observed between ODI or APDI and mandibular growth parameters (P > 0.05). The upper gonial angle (Ar-Go-Na) was significantly positively correlated with mandibular growth changes (diff_D1d1, diff_D2d2), as well as with articular disc volume and contact area (P < 0.05). Articular disc volume was positively correlated with ipsilateral mandibular growth. No significant difference was found between the deviated side and contralateral side in mandibular growth. Mandibular growth is closely associated with the contact area between the TMJ disc and condyle, as well as the upper gonial angle. Orthodontic treatment may promote adaptive remodeling of the TMJ by modifying the biomechanical environment of the mandible, thereby improving facial asymmetry.
The "2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome" retires, replaces, and expands upon the "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults." The primary intended audience for this guideline is clinicians who care for patients across the spectrum of cardiovascular-kidney-metabolic syndrome, an interrelated condition characterized by the interconnections among metabolic risk factors (including obesity and type 2 diabetes), chronic kidney disease, and cardiovascular disease. A comprehensive literature search was conducted from October 29, 2024, to April 14, 2025, to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human subjects that were published since 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of cardiovascular-kidney-metabolic syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients.
This population-based prospective cohort study investigated whether accelerometer-measured step count is associated with incident cardiovascular disease (CVD), independently from genetic risk. The study included UK Biobank participants with valid accelerometer and genetic data and without prevalent CVD at baseline. Genetic risk for CVD was categorised as low (1st fifth), moderate (2nd-4th fifths), and high (5th fifth). Median daily step count was categorised as low (<6,500), moderate (6,500-12,499), and high (≥12,500). The association of genetic risk and step count with incident CVD, defined as a composite of coronary artery disease and ischaemic stroke, was examined using adjusted Cox proportional hazards models. Of 84,286 participants, 4,847 developed CVD during follow-up (median 7.9 years). High genetic risk and low step count were independently associated with higher risk of CVD, with no evidence of a multiplicative interaction (P for interaction = 0.46). Compared with the reference group (low genetic risk and high step count; absolute risk: 62 per 1,000), the highest risk of CVD was observed in participants with high genetic risk and low step count (hazard ratio: 2.81, 95% confidence interval: 2.27-3.46, p < 0.0001; absolute risk: 174 per 1,000). There was an inverse dose-response association between the hazard of CVD and step counts up to 10,000 steps/day, which then plateaued in moderate and high genetic risk groups. High daily step count was associated with lower CVD risk in individuals with moderate and high genetic risk, indicating that walking should be encouraged for all, especially those predisposed to CVD. This study found that walking more each day is linked to a lower risk of developing heart disease and stroke, especially for people with a higher inherited risk of these conditions.People with moderate or high inherited risk who took fewer than 6,500 steps per day were much more likely to develop heart disease or stroke than those who took 12,500 or more steps daily.The benefits of walking increased with more steps participants took up to about 10,000 steps per day, after which the risk levelled off in those at moderate or high inherited risk.
Acute tendinous mallet finger (Doyle type I) is commonly treated with continuous immobilization of the distal interphalangeal (DIP) joint; however, treatment success largely depends on patient compliance. Percutaneous intramedullary (IM) Kirschner wire DIP joint transfixation represents a minimally invasive surgical alternative, although the clinical relevance of different pin configurations remains unclear. This study compared conservative and surgical treatment methods and evaluated the impact of different pin configurations on clinical outcomes. This retrospective cohort study included 93 adult patients with acute tendinous mallet finger who presented within 7 days of injury and were followed for at least 12 months. Patients were allocated into three groups: conservative treatment with a tape-reinforced Stack splint (n=33), percutaneous IM Kirschner wire DIP joint transfixation with the pin left exposed (n=30), and IM transfixation with the pin buried within the fingertip pulp (n=30). The primary outcome was residual DIP joint extension lag at final follow-up. Secondary outcomes included functional results according to the Crawford criteria and treatment-related complications. Baseline DIP extension lag did not differ significantly among the groups (p=0.801). At final follow-up, residual extension lag was significantly greater in the conservative group (median 4°) compared with the surgical groups (0.5° and 1°, respectively; p<0.001). Multicategorical analysis of Crawford grades showed no significant intergroup difference (p=0.095); however, dichotomous analysis (excellent + good outcomes) demonstrated significantly higher success rates in the surgically treated groups compared with the con-servative group (p=0.014). Skin maceration was more frequent in the conservative group (p<0.001), whereas pin-site irritation was significantly more common in the exposed pin group (p=0.006). No significant differences were observed among the groups regarding superficial infection. In patients with acute tendinous mallet finger, percutaneous IM Kirschner wire DIP joint transfixation provides superior extension control and higher functional success rates compared with conservative treatment. Although pin configuration does not significantly influence functional outcomes, it affects patient comfort and the complication profile. Treatment decisions should therefore be individualized based on patient compliance and functional expectations.
Traumatic posterior meniscal root tears disrupt normal load transmission, resulting in meniscal extrusion and accelerated osteoarthritis. Although transtibial pull-out repair is widely used, creation of a 4.5-mm tibial tunnel at the joint surface may cause iatrogenic chondral and subchondral bone damage at the root footprint. This study aimed to compare the clinical and radiological outcomes of a modified aperture-preserving pinhole technique, designed to avoid reaming at the tibial joint surface, with those of the standard transtibial pull-out repair. A total of 60 patients with symptomatic posterior meniscal root tears treated between December 2021 and December 2024 were retrospectively analyzed. Patients were divided into two groups according to the surgical technique used. The standard pull-out group (n=30) underwent transtibial repair using a 4.5-mm tibial tunnel created by reaming at the joint surface for suture passage. The modified pinhole group (n=30) was treated with an aperture-preserving technique in which fixation was achieved through a narrow pinhole channel without reaming or drilling at the tibial articular surface, thereby preserving the subchondral bone at the root footprint. In both groups, final fixation was performed using a cortical post-fixation screw. Clinical evaluations were performed preoperatively and at 6 and 12 months postoperatively using the Lysholm Knee Score, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analog Scale (VAS) for pain. Radiological assessment was conducted using magnetic resonance imaging to evaluate meniscal extrusion and healing status, classified as complete healing, partial (loose) healing, or failed healing. Both groups demonstrated significant improvement in all functional outcome scores compared with preoperative values (p<0.001). At the 12-month follow-up, the modified pinhole group showed significantly higher Lysholm, IKDC, and KOOS scores than the standard pull-out group, whereas improvements in VAS pain scores were comparable between groups. Meniscal extrusion decreased postoperatively in both groups, with a significantly greater reduction observed in the modified pinhole group. Complete healing was observed in 80% of patients in the modified pinhole group and 60% in the standard pull-out group. No major complications were recorded during the follow-up period. Both surgical techniques resulted in satisfactory clinical and radiological outcomes for posterior meniscal root repair. However, the aperture-preserving modified pinhole technique was associated with superior functional outcomes, reduced progression of meniscal extrusion, and a higher rate of complete healing. Preservation of the subchondral bone and minimization of iatrogenic joint surface damage may positively contribute to meniscal root healing.
Osteoarthritis is a degenerative joint disorder characterized by progressive cartilage degradation, subchondral bone alterations, and persistent low-grade inflammation. Recent findings have identified a strong interplay between inflammation and cellular senescence in osteoarthritis. Chronic inflammatory signals promote the accumulation of senescent cells, while senescent cells amplify inflammatory pathways through their senescence-associated secretory phenotype (SASP). This bidirectional loop accelerates tissue damage by perpetuating oxidative stress, matrix degradation, and the release of proinflammatory mediators that reinforce the senescence process. Likewise, the biological activities of olive oil and its bioactive compounds, including monounsaturated and polyunsaturated fatty acids (PUFA), phenolic compounds (mainly ligstroside, oleocanthal, oleuropein, and hydroxytyrosol), squalene, phytosterols, vitamins (particularly vitamin E), and carotenoids, have attracted increased attention. These compounds may synergistically exert their effects through several interrelated mechanisms that influence both inflammatory and senescence pathways. They may modulate key signaling cascades, such as nuclear factor-κB (NF-κB), mitogen-activated protein kinases (MAPKs), and Toll-like receptors (TLRs), that drive the release of proinflammatory cytokines. Moreover, by attenuating SASP, olive oil compounds can potentially attenuate the vicious cycle between inflammation and senescence, slowing cartilage degradation and preserving joint function. Here, we synthesize current findings on the molecular mechanisms and clinical implications of bioactive compounds from olive oil, emphasizing their role in modulating both inflammation and senescence during osteoarthritis.
Rational design of transition metal complexes with desired optical properties is a major challenge due to high computational costs of quantum-chemical methods that can deliver quantitatively reliable results. We present a machine learning framework for predicting absorption and emission maxima in both transition metal coordination compounds and organic chromophores using joint training on a combined experimental data set. Our featurization strategy integrates ligand environment fingerprints (Morgan), metal center features (Coulomb matrices), and topological descriptors from persistent homology analysis. The combined training data set comprises 19,733 absorption and 2675 emission measurements for 17,359 metal complexes (with focus on Ir, Rh, Pt, and Ru systems) and 17,294 absorption and 18,141 emission measurements for 7065 organic molecules across 365 solvents. Among several architectures evaluated, multilayer perceptrons provide the best absorption predictions (RMSE = 33.5 nm, R2 = 0.83, Pearson r = 0.92 for metal-organic compounds), while gated recurrent units are optimal for emission (RMSE = 41.7 nm, R2 = 0.83, Pearson r = 0.90). Models trained jointly on both data sets show good universal applicability with moderate accuracy trade-offs: RMSE increases by approximately 7-19 nm for organic compounds compared to specialized models, and for metal-organic compounds, RMSE increases by 1-2 nm. In contrast, models trained on organic data alone fail catastrophically when applied to metal complexes (R2 = 0.01). For a test set of 35 metal complexes including metal centers beyond the main training distribution (V, W, Cu, and Os in addition to Ir, Rh, Pt, and Ru), our best models achieve an RMSE of ∼28 nm for absorption maxima, comparable to TDDFT-O3LYP predictions but at substantially lower computational costs. SHAP analysis reveals that Coulomb matrix descriptors are most important for metal complex predictions, while Morgan fingerprints prevail for purely organic compounds. The presented approach enables efficient screening of candidate compounds for various photophysical applications orders of magnitude faster than TDDFT calculations.
Geleophysical skeletal dysplasia is an extremely rare condition characterized by predominantly acral skeletal involvement with a progressive course, associated with short stature and short limbs. Skin, joint, and organ involvement have been described; cardiorespiratory involvement is fatal. It is inherited in an autosomal dominant or recessive manner and is associated with variants in genes encoding extracellular matrix proteins: ADAMTSL2, LTBP3, and FBN1. This article describes a series of children with FBN1-associated geleophysical dysplasia who were followed up at a pediatric hospital. All presented with severe short stature and short limbs. Radiological findings were consistent in the hands (brachymetacarpal and brachyphalangeal features, notches in the metacarpals, and delayed ossification of the carpus). There was variability in severity and organ involvement indicators. Given the complexity of the condition and the multiple systems involved, there is a need for recommendations regarding a multidisciplinary approach throughout life and the importance of genetic counseling. La displasia esquelética geleofísica es una condición extremadamente poco frecuente, caracterizada por afectación esquelética predominantemente acral, de curso progresivo, asociado a baja estatura con miembros cortos. Se describe compromiso cutáneo, articular y afectación de órganos; el compromiso cardiorrespiratorio es causante de muerte. De transmisión autosómica dominante o recesiva, está asociada a variantes en genes que codifican proteínas de la matriz extracelular: ADAMTSL2, LTBP3 y FBN1. Este artículo describe una serie de niños con displasia geleofísica asociada a FBN1 en seguimiento en un hospital pediátrico. Todos presentaron déficit grave de estatura, miembros cortos. Los hallazgos radiológicos fueron constantes en manos (braquimetacarpianos, braquifalanges, escotaduras en los metacarpianos, retraso de la osificación del carpo). Existió variabilidad en indicadores de gravedad y compromiso de órgano. Dada su complejidad y la multiplicidad de los sistemas involucrados, surge la necesidad de recomendaciones para un abordaje multidisciplinario a lo largo de la vida y la importancia del asesoramiento genético.
Designing proteins for real-world applications requires the simultaneous satisfaction of multiple physicochemical properties. Structure-based de novo protein design has become the prominent design paradigm, successfully creating numerous proteins. Property optimization is commonly introduced during the sequence generation stage of protein design, i.e., inverse folding. Existing methods primarily rely on fine-tuning inverse folding models to design sequences with desired characteristics. However, multi-property optimization through fine-tuning demands datasets annotated with multiple properties-resources that remain extremely limited. Consequently, structure-based protein design has not yet achieved joint optimization of multiple properties. Here, we present Discriminator-Guided Inverse Folding (DGIF), a framework that guides the inverse folding model by adjusting its internal history states through an auxiliary discriminator module. The discriminator integrates multiple property predictors, each trained independently on a single-property dataset, thereby enabling multi-property optimization in the absence of datasets annotated with multiple properties. In addition to substantial improvements in key traits like thermostability and solubility, DGIF can generate protein sequences optimized for both properties simultaneously, with the designed proteins shifting markedly toward the Pareto front that represents optimal trade-offs. Experimental results validate the effectiveness of DGIF for multi-property protein design.
The aim was to investigate the incidence of sepsis and use of antibiotics among extremely preterm infants, given the limited number of population-based studies examining this. This retrospective study in Eastern Denmark included all liveborn infants from 23 + 0 weeks/days to 27 + 6 weeks/days of gestation from 2019 to 21. Data on dispensed intravenous antibiotics were obtained from the regional joint electronic health platform. Early-onset sepsis was defined as occurring within the first 72 h of life and late-onset sepsis from 3 to 90 days. Positive blood culture episodes were classified as proven sepsis. Within the first six months of life, 187 of the 232 (81%) infants received intravenous antibiotics. Empirical treatment was initiated for early-onset sepsis in 164 of the 232 infants (71%) and late-onset sepsis in 118 (51%). Late-onset sepsis accounted for 90% of proven sepsis, predominantly caused by Staphylococcus aureus and Coagulase-negative Staphylococcus. Antibiotic use for late-onset sepsis was three-fold higher than for early-onset sepsis (9902 versus 3413 days per 1000 live births). Sepsis caused two deaths (9 per 1000 live births infants). Suspected early-onset sepsis was the most common indication for antibiotic initiation, but late-onset accounted for most proven sepsis episodes and antibiotic exposure in extremely preterm infants.
Ischemic stroke (IS) imposes a substantial global burden, yet the metabolic pathways linking proinflammatory dietary patterns to its pathogenesis remain unclear. We conducted a 3-phase prospective analysis within 502 410 participants from the UK Biobank. A total of 249 metabolites determined with high-throughput nuclear magnetic resonance spectroscopy and 168 directly metabolites were included. In phase I, sex-specific metabolic signatures were selected based on Energy-Adjusted Dietary Inflammatory Index (E-DII) with least absolute shrinkage and selection operator. In phase II and III, a Cox proportional hazards regression model was used to evaluate the associations of E-DII and selected metabolic signatures with IS risk. The joint effect of E-DII and polygenic risk score were also evaluated. The metabolic signature, comprising 32 metabolites in women and 45 metabolites in men, were determined based on E-DII, with correlation coefficients of 0.279 and 0.296 (P<0.001). The association between E-DII and IS risk was only observed in women (hazard ratio [HR], 1.48 [95% CI, 1.16-1.89]) when comparing the participants in the highest quintile group with those in the lowest. No interaction was found between E-DII and polygenic risk score. We also found that the metabolic signature in women was positively associated with IS risk (HR, 1.59 [95% CI, 1.26-2.01]), and mediated 23.9% of this association. Among the contributing components, albumin, degree of unsaturation, and glycoprotein acetyls were identified as key factors. We identified sex-specific metabolic signatures related to a proinflammatory diet, and confirmed their association with increased IS risk in women.
Chronic low back pain is notoriously challenging to diagnose and manage, especially when imaging fails to reveal a cause. Superior cluneal nerve entrapment is an increasingly recognized, but often overlooked, source of pain that can mimic lumbosacral radiculopathy. We describe a 43-year-old woman with longstanding chronic low back pain unresponsive to physical therapy, extracorporeal shockwave therapy, and targeted sacroiliac joint injections. A physical examination revealed focal tenderness along the posterior iliac crest, a positive Tinel sign, and pain over the iliac crest. Lumbar magnetic resonance imaging was unremarkable. She underwent fluoroscopic and ultrasound-guided superior cluneal nerve blocks in separate sessions; each block produced immediate and complete pain resolution. Superior cluneal nerve entrapment should be considered when a patient has axial low back pain with negative imaging. Ultrasound-guided superior cluneal nerve blocks are a safe and effective alternative to fluoroscopic guidance, offering real-time visualization without radiation exposure.
To determine whether elite collegiate athletes with a prior hamstring strain injury (HSI) display persistent deficits in hamstring muscle morphology and muscle-tendon unit (MTU) mechanics during sprinting, and whether MRI-informed, subject-specific musculoskeletal models detect limb differences that scaled-generic models overlook. This study analyzed data from the Hamstring Injury (HAMIR) study. Seventy-nine NCAA Division I male football players (106 previously injured vs. 52 uninjured control limbs) completed maximal-velocity over-ground sprints instrumented with inertial measurement units (100 Hz) and underwent 3-T MRI for whole-hamstring volumetry. Sprint kinematics drove both scaled-generic and MRI-informed subject-specific OpenSim models. Peak MTU strain, lengthening velocity, force, and negative work were extracted for biceps femoris long head (BFlh), biceps femoris short head (BFsh), semimembranosus (SM), and semitendinosus (ST). Limb effects were analyzed with linear mixed models (α = 0.05). Previously injured limbs demonstrated ~5% smaller normalized muscle volumes for both BFlh (1.67 ± 0.36 vs. 1.76 ± 0.35 mL/kg/m, p = 0.009) and BFsh (0.92 ± 0.18 vs. 0.97 ± 0.19 mL/kg/m, p = 0.007). Peak MTU lengthening velocity was faster in injured limbs for BFlh (+3%), SM (+5%), and ST (+5%) (all p ≤ 0.02), with no limb differences in joint kinematics, peak strain, or generic-model forces. Subject-specific models revealed lower BFsh peak force (1.10 ± 0.21 vs. 1.14 ± 0.22 × body weight, p = 0.03) and reduced negative work (-13.4 ± 6.8 vs. -15.3 ± 7.5 J, p = 0.01), differences that the generic model did not detect. Although sprint kinematics were similar between limbs, those with prior HSI exhibited persistent BFlh and BFsh atrophy and subtle muscle-specific mechanical deficits. Reduced BFsh force and negative work were evident only with MRI-informed modeling. Integrating imaging with wearable-driven, subject-specific simulations could enhance rehabilitation monitoring and guide loading strategies to mitigate reinjury risk. Trial Registration: ClinicalTrials.gov: NCT05343052.
The electrostatic interactions of phosphate groups and counterions critically affect the structure, function, and reactivity of DNA or RNA. We present a joint experimental-theoretical investigation of dimethyl phosphate (DMP-) in aqueous solution, an established model system of the sugar-phosphate backbone. 31P NMR spectroscopy, as a probe of phosphate-ion association, reveals a systematic shielding of the 31P chemical shift (δiso(31P)) with variations of Mg2+ and Ca2+ content and moderate temperature dependence. Enhanced sampling molecular dynamics (MD) and ab initio (GIAO-DF-LMP2) level of theory are used to reveal the microscopic mechanism. Simulations are performed for a configurational ensemble of DMP--ion geometries and their first solvation shells, demonstrating (i) the spatial convergence of changes of the nuclear shielding constant σiso(31P), (ii) the intramolecular geometric origin of short-time scale σiso(31P) fluctuations, and (iii) an average shift of σiso(31P) of about 3-8 ppm upon contact ion pair formation with Mg2+ or Ca2+ ions. A quantitative analysis of δiso(31P) for varying ion content and temperature allows us to extract the temperature-dependent fraction of the contact ion pair species, indicating that solvent-separated or free ion pairs are the energetically preferred species. The results impose boundary conditions for improvements of phosphate ion force fields and establish the interactions underlying the changes of δiso(31P).
Given the relevance of community-level approaches to suicide prevention, this study aims to examine how neighborhood social cohesion relates to spatial variation in suicide-related emergency calls and whether its inclusion enhances model performance compared to sociodemographic factors alone. We analyzed geocoded data on suicide-related emergency calls (N = 6,271) aggregated across 552 census block groups in Valencia (Spain) from 2021 to 2023, provided by the Valencian Regional Government. Sociodemographic indicators were obtained from official municipal statistics (2020), and neighborhood social cohesion was measured using survey data collected across census block groups between 2021 and 2022. Bayesian hierarchical Poisson models were implemented to estimate area-level associations, including models with (1) sociodemographic covariates only, (2) addition of social cohesion, (3) inclusion of an unstructured spatial random effect, and (4) a full spatial model with structured and unstructured random effects. The model including sociodemographic factors, social cohesion, and an unstructured random effect provided the best overall fit. Including social cohesion markedly improved model fit and revealed a robust negative association with suicide-related emergency calls: areas with lower cohesion showed a higher relative risk. Additionally, indicators of social disorganization were positively associated with call rates, confirming their joint contribution to neighborhood-level differences in suicide-related calls. The results support the association between higher community social cohesion and lower rates of suicide-related emergency calls. Introducing neighborhood-level social cohesion improves the explanatory power of the spatial model, highlighting its role in neighborhood inequalities and its potential to guide targeted preventive interventions.
The anterior cruciate ligament (ACL) is a key structure that restricts excessive anterior translation of the tibia and maintains rotational stability. This study aims to dynamically and quantitatively assess the direct effects of ACL resection and total knee arthroplasty (TKA) on lower limb alignment and tibiofemoral joint rotation under passive, unloaded conditions and in the pathological state of osteoarthritis. This retrospective study included 110 patients with varus knee osteoarthritis who underwent Mako for robotic-assisted TKA. Dynamic intraoperative measurements of the lower limb mechanical axis (flexion angle at maximum extension; varus angle) and tibiofemoral rotation at multiple flexion angles (min to max flexion) were recorded at three intervals: pre-ACL resection, post-ACL resection and post-TKA. The variation in rotation amplitude was calculated for successive flexion intervals. Post-ACL resection, a significant decrease in the flexion angle at the maximum extension and varus angle (both p < 0.001) was observed, which was accompanied by increased tibial internal rotation at flexion angles of 60° and above (p < 0.05). Varus alignment was successfully corrected following TKA (p < 0.001). However, tibiofemoral rotational kinematics were significantly modified: the amplitude of internal rotation decreased in the initial flexion arc (min to 30°) but increased in flexion intervals beyond 30° (all p < 0.01). Under passive, unloaded osteoarthritic conditions, ACL resection immediately alters lower limb alignment and increases tibial internal rotation. Although TKA restores coronal alignment, it does not fully restore passive rotational kinematics; whether this affects active weight‑bearing function remains unknown. Accordingly, we hypothesize that rotational stability is as critical as limb alignment in TKA, pending validation with patient-reported outcome measures, functional scores and postoperative follow-up.
The authors describe the development of a custom survey centered around the Three C's and Net Promoter Scores in a high-volume surgical private practice with limited resources and no research coordinator. This paper aims to examine whether an abbreviated survey can serve as a practical alternative to lengthy validated PROMs in tracking post-surgical recovery outcomes in a private practice setting. A retrospective, de-identified analysis was conducted on prospectively collected patient-reported outcome surveys administered via email preoperatively and 120-days postoperatively. Of 2,908 surveys administered, 101 patients undergoing four high-volume procedures (CTR, meniscectomy, TKR, hernia) with matched pre- and post-operative responses were included. Paired t-tests with Shapiro-Wilk normality testing were performed in R (version 4.3.2) at α = 0.001. In total, 2,908 surveys were administered between 2021 and 2024 with 719 pre-surgery responses collected and 439 responses to both pre- and post-surgery surveys. The highest volume cases were selected for analysis based on their high surgical volume (> 8 cases), clinical relevance to orthopedics, and their frequent association with post operative recovery function. Surgical patients undergoing Carpal Tunnel Release (CTR) (t = 4.04, p < 0.001), Meniscectomy (t = 3.46, p < 0.001), Total Knee Replacement (TKR) (t = 4.15, p < 0.001), and Total Hip Replacement (THR) (t = 4.71, p < 0.001) demonstrated significant improvements in post-surgical numerical pain score. Similar results were observed in functionality and disruptive stress scores. Researchers observed a calculated NPS of 88.2 of which 400 were promoters, 26 were passives, and 13 were detractors. The authors present this work as an initial signal study demonstrating that a brief and self-administered survey can capture statistically significant improvements in pain, functional difficulty, and psychological stress in a private practice setting with limited research infrastructure. While NPS and work metrics should not be used alone as a gauge of outcomes, they hold significant utility in conjunction with other patient reported outcomes. Reporting requirements by the Center for Medicare and Medicaid Services (CMS) require hospitals to collect pre surgery and one year post surgery (9-15 months) HOOS JR and KOOS JR scores for total joint replacement surgeries, with public reporting set for 2027 and reimbursement effects in 2028. These requirements underscore the need for streamlined solutions. As value-based care becomes a priority, practical strategies are needed to reduce the burden on providers and patients [1].