Posterior glenoid dysplasia (PGD) has been described as an adaptive osseous change in young throwing athletes exposed to repetitive mechanical stress. However, prior studies have lacked consistent definitions, reliable classifications, or sport-specific analysis. This study aimed to analyze and classify PGD in young athletes across various sports and compare its proportion and severity between symptomatic baseball players and athletes from other sports. We retrospectively reviewed 10 years of shoulder CT imaging data from 568 young athletes presenting with shoulder pain: 418 baseball players, 50 overhead athletes, and 100 athletes from other sports. Dysplasia of posterior to posteroinferior glenoid, bone defect size, and additional bone formation were assessed. We established a five-type classification system: Type 0 (normal sharp rim), Type 1 (smooth rounded rim), Type 2 (triangular defect), Type 3 (retreated joint surface with posterior bulging), and Type 4 (new bone formation). PGD was identified in 85.4% of baseball players, 32.0% of overhead athletes, and 9.0% of non-overhead athletes (p<0.001). Type 2 was most common in baseball players (42.6%), and advanced morphological PGD (Types 3-4) was present in 13.4% of baseball players but was absent in other groups. PGD was more commonly observed among overhead athletes, particularly baseball players, within this symptomatic imaging cohort. Advanced morphologic types were identified predominantly in baseball players. These findings provide a structured framework for describing posterior glenoid morphology in throwing athletes and may facilitate future prospective studies investigating clinical relevance and natural history.
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Non-invasive, real-time monitoring of lactate in sweat is critical for personalized health tracking and sports performance optimization. However, conventional enzyme-based lactate sensors suffer from limited stability and high cost, while many reported nanozyme systems exhibit optimal activity only under alkaline conditions, limiting their applicability in physiological environments. In this report, we develop a wearable integrated nanozyme-based electrochemical sensor for sweat lactate monitoring. The sensor comprises cobalt oxide (Co3O4) and cobalt phosphate (Co3(PO4)2) nanoflakes on a screen-printed carbon electrode (SPCE), combined with a microfluidic unit for sweat collection and transport. Co3O4 nanoflakes were electrodeposited and electrochemically activated to form a Co3O4/Co3(PO4)2/SPCE platform for lactate detection. The structural morphologies, surface composition and chemical states, and crystalline information of the modified electrodes were analyzed using various analytical techniques, such as scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray photoelectron spectroscopy, and transmission electron microscopy. The Co3O4/Co3(PO4)2/SPCE exhibited robust electrocatalytic activity for lactate detection at neutral pH, yielding a dynamic range of 1 - 80 mM with a sensitivity of 8.3 μA mM-1 cm-2 and a limit of detection of 0.3 mM. The developed sensor offers good selectivity against common electroactive sweat components (ascorbic acid, uric acid, and glucose). The microfluidic integrated sensor was tested dynamically with different concentrations of lactate, yielding a sensitivity of 5.2 μA mM-1 cm-2. The device was validated by on-body sweat lactate monitoring during cycling, showing excellent accuracy (>91%) versus a colorimetric reference test. The integrated sensor enables real-time sweat lactate analysis for sports monitoring and personalized health tracking.
Background: Ashwagandha, a plant belonging to the Solanaceae family, has gained increasing attention in recent years due to its antioxidant, anti-inflammatory, and adaptogenic properties, and its potential to improve physical performance and support post-exercise recovery. Objectives: This narrative review aims to summarize and critically evaluate the current scientific evidence regarding the effects of Ashwagandha supplementation on exercise-induced oxidative stress, athletic performance, and safety. Methodology: This study is a narrative review based on previously published literature. The synthesis involved evaluating current studies focusing primarily on Ashwagandha supplementation and its relationship to exercise and sports performance. The included sources comprise clinical trials, meta-analyses, and review articles reporting outcomes related to strength, endurance, recovery, and safety. Results: Studies suggest that Ashwagandha dosages of 330-1000 mg daily will increase endurance and facilitate quicker recoveries, with a twice daily dose of 300 mg in combination with weight training increasing muscular strength and hypertrophy. Ashwagandha is also believed to regulate cortisol levels and relieve anxiety and insomnia. Typical dosage levels in the sporting field appear to be higher, at approximately 600 mg/day, but a lower dose will be required by less active people. Side effects are mild in the majority of the literature and no dangerous side effects occur at recommended dosages. Conclusion: Ashwagandha has been found to be safe and effective in a natural supplementary capacity in sports and athletics. The correct dosage and application period of Ashwagandha should be taken into consideration to reap its properties in the human body.
Myofascial pain syndrome (MPS) is a musculoskeletal system disorder that is exceedingly painful and distinct from other chronic pain syndromes. MPS can occur on its own or in conjunction with other muscle disorders. Symptoms of MPS include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and hot and red skin. In addition, symptoms of MTrPs include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and/or hot and red skin. Kenzo Kase, a Japanese chiropractor, invented Kinesiology Tape (KT) in the 1970s, with a potential role in modulating pain, enhancing muscle function and improving ROM. This review aims to examine the underlying mechanisms of MPS and evaluate current therapeutic strategies, with particular emphasis on the mechanism and clinical application of KT in managing MPS. Recent literature highlights the advances in understanding the pathophysiology of MTrP, conventional therapies and their limitations. KT is a dynamic, stretchable tape that resembles human skin which may be utilised to treat pain and muscle activity as well as increase range of motion (ROM). The majority of the time, KT is used in the treatment and prevention of sports injuries. Clinical studies report improvements in pain intensity, muscle flexibility, and ROM following KT application in individuals with MPS, particularly in sports and rehabilitation settings. MPS is a complex pain disorder requiring multimodal management. KT represents a promising non-invasive intervention that may address both pain and functional restoration through neurophysiological and biomechanical mechanisms. While clinical findings are promising, regulatory protocols are yet to be standardised to ensure long term safety and efficacy of KT in the treatment of MPS.
Men show a higher mortality than women, especially at a young age (between 15 and 39 years). They are more likely to engage in unhealthy behaviours and tend not to implement preventative efforts or to seek help. While (mental) health promotion programmes aim to foster healthy behaviours, men often do not feel addressed by them and are therefore reluctant to participate. This synthesis aims at drawing together barriers to and facilitators of male participation in (mental) health promotion programmes and identifying how to best address men in health communication and programme promotion. This rapid qualitative evidence synthesis includes a sample of 21 studies. 18 are qualitative studies and 3 are mixed-methods studies with separately reported qualitative findings that captured the perspectives of males aged 12 to 79 years and of professionals working in men's health on the barriers to and facilitators of participation in (mental) health promotion programmes and on preferred health communication. Studies were purposefully selected to maximise variation across interview content, context, and participant characteristics (e.g., age, occupation). The selection was restricted to studies published between 2015 and 2025. Gender norms were one of the main barriers to participation in men's (mental) health promotion programmes. Preferably such programmes should be integrated into settings attractive or familiar to men, such as sport clubs or handicraft workshops, or the workplace. Peers and peer support played a crucial role within men's health promotion and were found to facilitate positive behavioural changes. When reaching out to men, clinical and stigmatising terminology should be avoided in favour of action-oriented language that emphasises control and practical solutions while keeping the messaging simple and focused on tangible benefits. Health promotion programmes for men require embedding interventions within male-relevant contexts, such as sports, workplaces, and peer networks, that ease participation and reduce stigma. To reach and benefit men, communication strategies should use relatable, non-stigmatising language from credible messengers and should frame self-care as compatible with masculine identities.
To report the clinical and radiographic outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent or first-time traumatic patellar dislocation accompanied by multiple anatomical risk factors. This retrospective study included 27 patients (27 knees) with a mean age of 22.70 ± 6.27 years (range, 14-35 years) who underwent isolated MPFL reconstruction between June 2019 and December 2023. All patients presented with severe trochlear dysplasia (Dejour types B-D), increased tibial tuberosity-trochlear groove (TT-TG) distance (>20 mm), patella alta (Caton-Deschamps index ≥ 1.2), and lower extremity torsion deformities (femoral anteversion ≥ 25° or external tibial rotation ≥ 30°). Clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Lysholm, Kujala, and Tegner scores. Radiographic parameters (patellar tilt angle (PTA) and lateral patellar displacement (LPD)) were measured on CT scans preoperatively and postoperatively. Return to sports, patient satisfaction (numeric rating scale 0-10 and categorical grades), redislocation rate, and complications were recorded at final follow-up. Mean follow-up was 3.14 ± 1.15 years (range, 1-4.42 years). The mean TT-TG distance was 22.22 ± 1.58 mm (range, 20.32-25.91 mm), the mean Caton-Deschamps index (CDI) was 1.41 ± 0.18 (range, 1.22-2.01), the mean femoral anteversion angle was 29.28° ± 3.88° (range, 25.26°-35.41°) and the mean external tibial rotation angle was 35.42° ± 4.54° (range, 30.62°-47.07°). All functional scores improved significantly (P < .001): Kujala (49.30 ± 9.36 to 87.85 ± 4.59), Lysholm (51.41 ± 9.61 to 88.63 ± 5.71), IKDC (44.46 ± 8.69 to 83.04 ± 3.86), and Tegner score (from 2.00 ± 1.03 to 3.67 ± 0.92). PTA decreased from 24.02 ± 7.07° to 7.31 ± 3.45° and LPD decreased from 10.55 ± 4.33 mm to 0.11 ± 6.28 mm (P < .001). One patient had postoperative subluxation and one experienced redislocation after direct trauma. Mean subjective satisfaction was 8.72. Isolated MPFL reconstruction provides satisfactory short-term clinical outcomes with a low redislocation rate in patients with patellar instability and multiple severe anatomical risk factors.
The recognition of exercises using skeletal pose sequences is a significant fitness technology, rehabilitation monitoring, and sports analytics. Nevertheless, the current practices tend to ignore the basic biomechanical processes of human motion. This paper presents a Biomechanical-Aware Temporal Learning (BATL), framework that incorporates human kinematic constraints and deep temporal model. The method takes into account three biomechanical limitations objects consisting of joint angle consistency, velocity smoothness, and bone length stability that are not explicitly coded but rather acquired during the learning course of model parameters. Moreover, BATL uses the phase discovery module which is unsupervised and automatically identifies important temporal divisions (preparation, execution and recovery) without manual annotation. BATL was tested on 146 video samples (157 different samples in total, including 146 squats, 126 push-ups, 146 bicep curls, 146 shoulder-presses) with an estimated test accuracy of 93.33% ± 0.94% percent (mean ± standard deviation on 5-fold cross-validation with random seeds 42, 123, 456, 789, 101). It has 3.57M parameters, requires 13.6 MB memory, and inference can be performed in BatL-only mode only in 5.2 ms per 30-frames sequence (end-to-end pipeline depending on OpenPose pose estimate in 1.574 seconds). It outperformed the baseline techniques by 6.22%-14.44%, and ablation experiment showed that incorporation of biomechanical constraints actually improved accurately by 7.78%. These results imply that even inductive bias involving the use of domain knowledge can be more effective than the benefits that can only be achieved with a more complicated model. Overall, biomechanical knowledge and deep learning offer certain prospects to the activity recognition system, in particular, movement quality and time.
Prior research suggests that being entrapped in helplessness and an inability to escape aversive circumstances may undermine individuals' well-being. In the present study, however, drawing on gratitude-based perspectives, we propose that a team-level grateful climate may buffer the detrimental effects of entrapment on athletes' well-being. A three-year, six-wave longitudinal design was employed with 283 Taiwanese student-athletes (165 males, 118 females; M age = 16.72 years, SD = 0.47) nested within 62 sports teams. Multilevel modeling showed that external entrapment negatively predicted changes in both hedonic and eudaimonic well-being over time. In addition, a significant cross-level moderation effect indicated that teams characterized by higher levels of team-level grateful climate attenuated the detrimental association between internal entrapment and well-being over time. Notably, in teams with low team-level grateful climate, internal and external entrapment exhibited distinct patterns of association with well-being, suggesting differentiated regulatory mechanisms. These findings underscore the importance of considering both the type of entrapment and the social context in which athletes are embedded. Implications and practical applications are discussed.
In the new intelligent medical system, miniaturized wearable biological detection sensors are crucial for real-time monitoring of human health, especially when combined with flexible microneedle arrays that can penetrate skin without causing injury. In real life, moderate exercise is highly beneficial to human health, whereas excessive physical activity can cause irreversible harm to the body. Therefore, there is a need for a portable sensor capable of monitoring human movement in real time, so as to enable rational planning of exercise routines. In this context, the CeO2-PANI sensor was constructed through the photocatalytic polymerization of the flexible microneedle array (MNs array) and the detection electrode (CeO2-PANI electrode). It features the excellent mechanical property and highly sensitive detection. MN array can withstand a stress of 116.24 N. The superior lactic acid detection performance of the sensor, including a wide linear range (0.01-50 mM), high sensitivity (0.179 mA mM-1 cm-2) and a low detection limit (0.75 μM). Meanwhile, the sensor can measure the environmental pH value within a wide range of 2 to 10. The sensor also exhibits excellent selectivity, allowing for accurate detection even in complex simulated body fluid environment. This study proposes a strategy for an applicable biological sensor with miniature wearables, which provides the development of the health monitoring system that is non-invasive and integrated. It can also provide a novel strategy for the development of new wearable real-time sports monitoring devices, enabling rational planning of exercise status and the proportion of exercise duration.
Prolonged sedentary behavior and slump sitting posture may impair neuromuscular function; however, acute effects on postural sway and potential differences between athletes and non-athletes remain unclear. Therefore, this study aims to examine the acute effects of prolonged slump sitting on postural sway in female athletes and non-athletes. In this study, 24 females (12 athletes, 12 non-athletes; age 18-30 years) completed balance assessments using the Biodex Balance System, followed by a 30-minute standardized slump sitting protocol. Outcomes included static postural stability test (PST), Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), and limits of stability (LOS). Group differences were analyzed using analysis of covariance (ANCOVA). Prolonged slump sitting significantly influenced selected postural sway outcomes. Athletes demonstrated greater post-intervention sway compared with non-athletes in the Overall Stability Index (p = 0.01) and the eyes-closed firm-surface mCTSIB condition (p = 0.02). A significant group difference was also observed in static left LOS performance (p = 0.01). In a nutshell, the present study demonstrated that prolonged slump sitting may influence postural sway in female athletes and non-athletes, with specific differences emerging between groups under certain sensory and stability conditions. By highlighting the potential impact of slump sitting on postural stability, this research contributes to the fields of sports science, ergonomics, and rehabilitation, emphasizing the need for strategies that mitigate the negative effects of prolonged sedentary behavior.
We report the first confirmed case of a human being bitten by the parasitic forest fly Hippobosca equina (Diptera: Hippoboscidae) Linnaeus, in Slovakia. The incident involved atypically aggressive behaviour of the fly toward the human host and suggests a potentially underestimated health risk for humans. A single specimen of H. equina responsible for the bite was identified and subjected to molecular analyses to assess the presence of zoonotic pathogens. DNA of Bartonella schoenbuchensis (Hyphomicrobiales: Bartonellaceae) Dehio et al. was detected in the collected specimen. This case demonstrates that H. equina may present a greater health concern for humans than previously recognised, particularly during hot, windless conditions that enhance its activity. Increased awareness of human exposure risks in natural and recreational environments is warranted. Uvádzame prvý potvrdený prípad poštípania človeka parazitickou muchou Hippobosca equina (Diptera: Hippoboscidae) Linnaeus, 1758 na Slovensku. Incident zahŕňal atypicky agresívne správanie muchy a naznačuje potenciálne podhodnotené zdravotné riziko pre človeka. Jeden exemplár H. equina zodpovedný za poštípanie bol identifikovaný a podrobený molekulárnym analýzam s cieľom zistiť prítomnosť zoonotických patogénov. V analyzovanom exemplári bola detegovaná DNA Bartonella schoenbuchensis (Hyphomicrobiales: Bartonellaceae) Dehio et al., čo naznačuje možnú vektorovú kompetenciu. Tento prípad ukazuje, že H. equina môže predstavovať väčšie zdravotné riziko pre človeka, než sa doteraz predpokladalo, najmä počas horúcich a bezveterných podmienok, ktoré zvyšujú jej aktivitu. Je opodstatnené zvýšiť povedomie o rizikách expozície človeka v prírodnom a rekreačnom prostredí. Wir berichten über den ersten bestätigten Fall eines Menschen, der von der parasitären Waldfliege Hippobosca equina (Diptera: Hippoboscidae) Linnaeus, 1758 in der Slowakei gestochen wurde. Der Vorfall umfasste ein atypisch aggressives Verhalten der Fliege gegenüber dem menschlichen Wirt und deutet auf ein möglicherweise unterschätztes Gesundheitsrisiko für den Menschen hin. Ein einzelnes Exemplar von H. equina, das für den Stich verantwortlich war, wurde identifiziert und molekular analysiert, um das Vorhandensein zoonotischer Pathogene zu untersuchen. In der untersuchten Probe wurde DNA von Bartonella schoenbuchensis (Hyphomicrobiales: Bartonellaceae) Dehio et al. nachgewiesen, was auf eine mögliche Vektorkompetenz hinweist. Dieser Fall zeigt, dass H. equina ein größeres Gesundheitsrisiko für den Menschen darstellen könnte als bisher angenommen, insbesondere unter heißen und windstillen Bedingungen, die ihre Aktivität fördern. Ein erhöhtes Bewusstsein für das Expositionsrisiko des Menschen in natürlichen und Freizeitumgebungen ist erforderlich.
Traumeel (Tr14) and diclofenac gels are commonly prescribed topical treatments for Grade I-II acute lateral ankle sprain (LAS). A meta-analysis of two multi-center trials was performed to compare their clinical efficacy and supplement the evidence in support of topical treatments. Data from two Phase III prospective, randomised, double-blind, reference-controlled clinical trials, TAASS (2013) and TRAUMED (2024) were examined. An Individual Patient Data (IPD) meta-analysis was performed on those with an initial pain VAS (Visual Analogue Scale) score ≥ 50 mm, using the statistical analysis plan from the latter to ensure methodological consistency. A total of 628 patients underwent meta-analysis (mean baseline pain VAS = 72.3, mean age = 32.5). The primary endpoint of the IPD meta-analysis, Area Under the Curve (AUC) of pain VAS scores, indicated beneficial effects of Tr14 gel compared with diclofenac gel, statistically significant on Days 4, 7, and 14 (Day 4 mean difference MDAUC-META = -6.9 [95%CI -13.7 to -0.1], PAUC-META = 0.05; Day 7 MDAUC-META = -26.3 [95%CI -40.4 to -12.2], PAUC-META = 0.0003; Day 14 MDAUC-META = -63.6 [95%CI -92.3 to -34.8]), PAUC-META < 0.0001). A robust Wilcoxon-Mann-Whitney (WMW) analysis revealed percent changes from baseline in pain and function that were significantly superior for Tr14 gel in the pre-planned method of synthesis, compared to diclofenac gel, on all days (all PMETA < 0.05). Finally, translational effect sizes indicated less than "small" superiority on Day 4 (SMD 0.15, OR 0.78, NNT 23), and "small-medium-sized" superiority on Days 7 and 14 (Day 7: SMD 0.31, OR 0.59, NNT 12; Day 14: SMD 0.37, OR 0.53, NNT 10) for pain measured by VAS, as compared to diclofenac gel. The IPD meta-analysis of the TAASS and TRAUMED trials confirms the efficacy of Tr14 gel. In-depth analysis reveals it is a statistically favourable treatment with respect to pain, and function, compared to the gold-standard diclofenac gel. Taking this together, Tr14 gel represents a statistically favourable treatment option for Grade I-II ankle sprain within the context of the analysed endpoints.
The coach-athlete relationship is central for the development and well-being of adolescent athletes, but the mechanisms underlying this relation are underexplored. Learning life skills may explain these underlying mechanisms; therefore, understanding this line of inquiry can help optimize the coaching process and life skill development. Given this context, this study aims to analyze how the interactions between coaches and adolescent athletes are associated with well-being, as well as understand the statistical mediating role of life skills. A total of 312 Brazilian adolescent athletes participated, completing measures assessing the coach-athlete relationship, life skills and well-being. The paths (coach-athlete relationship → life skills → well-being) were tested using structural equation modeling. As a result, life skills showed a statistical indirect association accounting for 45.7% of the variance explained in the association between the coach-athlete relationship with well-being. Among the dimensions associated with the coach-athlete relationship, commitment emerged as a significant correlate of all life skills. Moreover, complementarity showed a direct association with all three well-being domains. Additionally, closeness showed a specific direct association only with psychological well-being. With regards to life skills, goal setting was positively associated with all three well-being domains, whereas emotional skills showed a negative association, suggesting that they may function as a marker of prior adversity. Taken together, the coach-athlete relationship is not a monolithic construct; its dimensions show functional specificity in their associations. From an applied standpoint, sport-based programs should prioritize building a relationship of commitment as a foundational element to support the intentional teaching of skills.
This cross-sectional study examined whether exposure to long-term resistance and endurance training can counteract muscular weakness on a functional, neurological and structural level in adolescents with cerebral palsy (CP) compared to typically-developed peers (TD) in dependence of training status. Five trained (4 males; mean age: 19.8) and four untrained adolescents with CP (3 males; 20.2) were compared to nine age- and sex-matched TD trained (7 males; 19.8) and nine untrained peers (7 males; 20.3). Isometric and isokinetic measurements assessed strength in knee flexion and extension, voluntary activation (VA) was assessed using the twitch interpolation technique and ultrasound imaging of the quadriceps was performed to assess anatomical cross sectional area (ACSA) and architecture. Linear regression models revealed that CP trained had lower absolute isometric strength (dominant: -18% [-48; 11]; non-dominant: -35% [-58; -11]) than TD untrained while CP untrained showed between 29% and 33% lower strength than TD untrained. VA in CP trained (dominant: -13% [-23; -3]; non-dominant: -10% [-30; 11]) and CP untrained (dominant: -14% [-23; -4]; non-dominant: -8% [-29; 13]) showed similar deficits compared to TD untrained. CP trained showed higher ACSA than TD untrained in the dominant leg of the vastus lateralis muscle (+ 16% [-7; 38]), while the non-dominant side showed lower values (-18% [-45; 9]). Exposure to long-term resistance and endurance training is associated with a smaller gap in muscle strength and muscle volume in the dominant leg of adolescents with CP while neural drive does not seem to be affected through training exposure. It is discussed that training load might have been too low in the non-dominant leg of CP trained to induce relevant neuromuscular adaptations. ClinicalTrials.gov Identifier NCT05859360, date of registration May 16, 2023.
Athlete burnout significantly affects both athlete well-being and performance, potentially influenced by dietary patterns, sleep quality, screen time, and stress-coping strategies. However, the mechanistic interplay among these factors remains unclear. This study utilized a cross-sectional design to examine the relationships between daily health behaviors (including diet, sleep, and screen time), stress coping strategies, perceived psychological strain and athlete burnout among Chinese competitive swimmers. A comprehensive questionnaire was developed, encompassing demographic information, eating behavior (BEDA), sleeping behavior (ASSQ), screen time, stress coping strategies (CSCA), perceived psychological strain (APSQ), and athlete burnout (ABQ). This questionnaire was administered online and distributed to participating athletes through a snowball sampling method during the 2024 Shanghai Youth Swimming Competition to enhance the sample size. Data from 1,071 swimmers (477 females, 44.5%) revealed through Lasso regression analysis that perceived psychological strain emerged as the strongest predictor of athlete burnout (β = 5.07), followed by age (β = 2.19) and athlete level (β = 3.76). Sleep disturbances (ASSQ) demonstrated a weaker yet significant contribution to ABQ (β = 0.92). A temporal inflection point in age-related burnout trajectories was identified at 19 years. This study identified psychological strain (APSQ) as the strongest predictor of burnout (ABQ) among Chinese swimmers (β = 5.07), underscoring the critical need for strain-specific management in prevention strategies. The significant effects of advancing age (β = 2.19) and increased training load (β = 3.76) further revealed the developmental nature of burnout across career stages, necessitating age-targeted interventions. Although sleep disorders (ASSQ) had a weaker influence (β = 0.92), their significant role supports the integration of sleep quality enhancement into a holistic strain-sleep intervention framework. These findings provide a novel pathway for athlete mental health management through prioritized strain regulation, hierarchical age-specific interventions, and synergistic sleep-stress protocols.
The utility and optimal threshold for serum laboratory tests taken prior to revision shoulder arthroplasty are unknown. We performed a multi-institutional study of consecutive revision shoulder arthroplasties to define the optimal thresholds of serum laboratory samples to predict bacterial presence in intraoperative cultures with and without Definite Periprosthetic Joint Infection (PJI). Multicenter data was collected on 579 revision shoulder arthroplasties. Preoperative serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count differentials, and ratios were reported. Analysis was stratified based on International Consensus Meeting (ICM) Definite and Non-Definite PJI and two different thresholds of culture positivity (≥2 or ≥3). Receiver operating characteristic (ROC) curves were constructed, and area under the curve (AUC), optimal thresholds, and diagnostic utility for each test were calculated. Eighty-three patients (14%) had Definite PJI per ICM criteria while 496 (86%) had Non-Definite PJI. Cutibacterium was the most common bacteria recovered in both Definite PJI and Non-Definite PJI. For Definite PJI using a threshold of ≥3 positive cultures, AUC values were 0.543 for ESR and 0.659 for CRP. Optimal thresholds based on ROC curves were 50.5 mm/hr for ESR and 5.9 mg/L for CRP. Sensitivity and specificity were 0.422 and 0.714, respectively, for ESR and 0.818 and 0.536, respectively, for CRP. For Non-Definite PJI, the AUC value was below 0.5 for ESR indicating the test was worse than chance. AUC values for CRP were 0.533 and 0.540 using thresholds of ≥2 and ≥3 positive cultures, respectively. Optimal threshold based on ROC curves were 9.1. This is the first large-scale, multicenter study of consecutive revision shoulder arthroplasties analyzing the utility of preoperative serum laboratory values in predicting positive intraoperative cultures. Overall diagnostic utility of these tests in predicting bacterial presence is low in the setting of both Definite and Non-Definite PJI, particularly serum ESR. In approaching patients with more obvious clinical symptoms (Definite PJI), optimal cutoff values are 50 mm/hr for ESR and 10 mg/L for CRP. When approaching workup of a patient without obvious signs of infection (Non-Definite PJI), serum ESR and CRP have limited value in predicting presence of bacteria at the time of revision arthroplasty.
Regular exercise promotes health through multiple mechanisms, with DNA methylation serving as a key epigenetic modification involved in the molecular regulation induced by exercise. Peripheral blood, as an accessible tissue, is commonly used to study exercise-induced DNA methylation changes. This systematic review aims to synthesize evidence from human exercise intervention studies on the effects of exercise on peripheral blood DNA methylation and related epigenetic markers, and to evaluate their potential as biomarkers of exercise efficacy. The study protocol was registered in PROSPERO (CRD420251069398). A systematic search was conducted in Pubmed, Web of Science, Cochrane Library, Embase and Scopus databases from database inception through 29 May 2025 for all English-language studies. Eligible studies were included. Risk of bias of randomized controlled trials were assessed using the Cochrane collaboration's tool (version 5.1.0) and quasi-experimental studies were assessed using the JBI Critical Appraisal Checklists for Quasi-Experimental Studies. The results were summarized using narrative synthesis. Twenty-nine studies were included, covering both acute and long-term exercise interventions. Acute exercise induced minor and mostly statistically nonsignificant changes in peripheral blood DNA methylation, whereas long-term exercise elicited significant methylation remodeling in genes related to metabolism, inflammation, and immune function. Exercise dose (frequency, intensity, and duration) and population characteristics influenced the magnitude and scope of methylation responses. Peripheral blood DNA methylation provides robust evidence for exercise-mediated systemic epigenetic regulation and shows promise as a biomarker for exercise adaptation and intervention effects. Future research should optimize intervention designs and methodological standards to deepen understanding of exercise epigenetic mechanisms.
ObjectiveTo review the costs and cost-effectiveness of telerehabilitation training for upper limb function in people after stroke.Data SourcesMEDLINE, EconLit, and EMBASE databases were searched for studies published between 2013 and 16 March 2026.MethodsThe review included studies of technology-based rehabilitation programmes for individuals after stroke that evaluated costs or cost-effectiveness. Titles and abstracts were screened, and data were independently extracted by two researchers. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Findings were synthesised narratively.ResultsFifteen studies including 963 participants were included. Two studies conducted cost-effectiveness analyses, eight reported cost analyses, and six reported the use of a preference-based measure recommended for cost-effectiveness studies (all used the EQ-5D), with some studies contributing to more than one category. Evidence on costs and cost-effectiveness was mixed, but several studies suggested potential cost savings. Reporting of EQ-5D outcomes was inconsistent across studies.ConclusionsEvidence on the costs of telerehabilitation training for upper limb function primarily focused on therapist time and equipment costs. Few studies included costs associated with equipment maintenance, depreciation, or the need for internet-enabled devices. Reductions in therapist time could offset or exceed technology costs. Further research is needed to evaluate the longer-term costs and cost-effectiveness of telerehabilitation in this population.
Novel invasive genotypes can arise through polyploidisation, hybridisation, or gene flow between populations of distinct origins or related species. Solidago gigantea, a notorious European invader, has long been reported exclusively as tetraploid in its invasive range. Recently, mixed-ploidy populations, including tetraploid and pentaploid plants, were discovered; yet the potential role of the novel pentaploid cytotype (and its progeny) in S. gigantea invasions remains poorly understood. This study aims to elucidate the origin of pentaploids and the cytotype and genetic structure of mixed-ploidy populations, characterise the reproductive mode and mating interactions of pentaploid plants, and assess their fitness and potential contribution to invasiveness using relative DNA content screening, ddRADseq population genetics, and reproductive potential and fitness assessments. Molecular analyses revealed that pentaploids constitute a genetically distinct lineage within S. gigantea. Our results rule out both an autopolyploid origin from the common tetraploid cytotype and an allopolyploid origin via hybridisation with co-occurring native or invasive Solidago species. The pentaploid cytotype reproduces exclusively through clonal propagation; its low genetic variability suggests that the two studied populations may belong to a single extensive clonal genet. Pentaploids produce viable gametes but appear to exhibit strict self-incompatibility, preventing the formation of offspring within the same genotype. However, pentaploid S. gigantea engages in bidirectional mating with co-occurring tetraploid plants, yielding well-developed seeds with offspring ploidy ranging from 4x to 5x (predominantly aneuploid). Despite this cytological variability, progeny from mixed-ploidy populations displayed germination rates and early growth comparable to those from pure tetraploid populations. Notably, at least some tetraploid offspring from 4x-5x crosses successfully established, flowered, and backcrossed with pentaploid plants to produce viable seeds of subsequent introgressed generations. The pentaploid cytotype of S. gigantea introduces a new post-invasion dynamic to its invasive populations. Rather than being an evolutionary dead-end, this cytotype may potentially enhance the species' invasiveness through three evolutionary pathways: (1) a highly successful clonal life strategy enabling both local and long-distance spread; (2) genetic enrichment of tetraploid populations via ongoing interploidy crosses; and (3) establishment of novel aneuploid genotypes due to the remarkable tolerance of chromosomal instability observed in S. gigantea.