High-heeled footwear is widely used by women, yet its systemic influence on spatiotemporal gait parameters, pelvic kinematics, and propulsion across a range of heel heights remains incompletely characterised. This study aimed to quantify gait changes across four footwear conditions and assess the contribution of anthropometric characteristics to observed gait variability. A within-subject repeated-measures study was conducted with 75 healthy young adult women (mean age 24.3 years, BMI 21.3 kg/m2) assessed barefoot, in ballerina flats, 8 cm heels, and 12 cm heels using the G-WALK inertial measurement system (BTS Bioengineering). Thirty gait parameters were analysed using the Friedman test with Bonferroni-corrected Wilcoxon post hoc comparisons (αadj = 0.0083), Spearman rank correlations, multiple linear regression, and Kruskal-Wallis tertile analysis. Footwear significantly affected 22 of 30 parameters. Walking speed was higher in all shod conditions than barefoot (up to +9.2%), driven entirely by stride elongation with cadence unchanged, indicating a general effect of footwear rather than heel elevation specifically. Stride length peaked at 8 cm heel (+8.9% vs. barefoot) and declined at 12 cm. Gait symmetry decreased progressively with heel height. Ballerina shoes produced a distinctively dynamic temporal profile-shortest stance duration, lowest double support, and highest single support time-significantly different from both barefoot and heeled conditions. The propulsion index increased height-dependently with heel height, rising 23.3% from barefoot (8.20) to 12 cm heel (10.11; p < 0.001). Pelvic obliquity symmetry was disrupted at 12 cm heel, while tilt symmetry was unaffected. Anthropometric analysis identified 110/600 significant Spearman correlations (23 surviving Benjamini-Hochberg FDR correction) and 29/120 significant regression models (14 surviving FDR); age, body weight, and shoe size were the most consistent predictors, most reliably in the barefoot condition. Heel height exerts condition-specific effects on gait biomechanics. Ballerina shoes produce a gait pattern distinct from both barefoot and heeled walking. Propulsion demand increases height dependently with heel elevation. Because participants walked in their own footwear, the observed effects reflect the combined characteristics of each shoe type rather than heel elevation in isolation. Anthropometric characteristics-particularly age, body weight, and shoe size-are modestly associated with footwear-gait responses and may inform future biomechanical research, although clinical application requires confirmation in standardised-footwear studies and clinical populations.
Pressure injuries among critically ill patients are complications that may lead to increased morbidity, prolonged hospital stays, and higher healthcare costs. Despite this fact, there is limited national data on the prevalence of pressure injuries in Norwegian intensive care units (ICUs). This study describes the prevalence, characteristics of, and associated risk factors for ICU-acquired pressure injuries in Norway. A secondary analysis of the Norwegian data from the international one-day prevalence study, DecubICUs, conducted on 15 May 2018. Data on pressure injuries, patient characteristics, and exposure to potential risk factors were analyzed. Prevalence was calculated based on the presence of one or more ICU-acquired pressure injuries on the study day. This multicenter cross-sectional study included 119 patients from 25 Norwegian ICUs. The prevalence of ICU-acquired pressure injury was 24% (28/119). These 28 patients had 52 ICU-acquired pressure injuries. Of these, the majority were stage I (71%), followed by stage II (27%), and one was categorized as suspected deep tissue injury (2%). The most common locations were the heels (23%), buttocks (23%), ears (17%), nose (12%) and mouth (10%). The risk factor associated with ICU-acquired pressure injuries was LOS-ICU (OR = 1.06/day increase, 95% CI: 1.02-1.11, p = < 0.001). The prevalence of ICU-acquired pressure injury was surprisingly high considering Norway is a high-income country, with a high nurse-to-patient ratio and well-educated critical care nurses. These findings highlight the need for continued focus on early prevention strategies, such as thorough skin assessments, "floating heels" and repositioning of medical devices. This subgroup analysis for Norwegian cases reported in a point-prevalence study presents intensive care unit patients with pressure injuries along with selected case factors. Pressure injuries are complications that appear to remain an intensive care unit challenge, even in units with high nurse to patient ratios.
Achilles tendon xanthoma (ATX) is a rare benign lesion characterized by lipid deposition within the tendon and is often associated with hyperlipidemia and genetic diseases. Surgery is challenging due to the risk of recurrence and its impact on patients' quality of life. Reconstruction using a synthetic ligament has not been previously reported for this condition. A 35-year-old female patient presented with a progressive mass in both heels over 4 years, accompanied by limited ankle dorsiflexion (5°-10°), a Visual Analogue Scale (VAS) score of 6, and an American Orthopaedic Foot and Ankle Society (AOFAS) score of 51. Laboratory evaluation after 6 months of atorvastatin therapy (20 mg/day) revealed persistent hypertriglyceridemia (3.45 mmol/L) and borderline hypercholesterolemia (total cholesterol 5.77 mmol/L, low-density lipoprotein 3.93 mmol/L). Magnetic resonance imaging showed diffuse thickening of both Achilles tendons. After thorough discussion and informed consent, the patient underwent total xanthoma excision combined with Achilles tendon reconstruction using a LARS artificial ligament. At the 2-year follow-up, the patient reported no pain or swelling, achieved a VAS score of 0 and an AOFAS score of 90, and demonstrated full recovery of muscle strength and joint motion without clinical or radiological signs of recurrence or foreign body reaction. Total excision combined with Achilles tendon reconstruction using a LARS artificial ligament might offer a potential alternative for patients with Achilles tendon xanthoma who have high functional demands, considering its avoidance of donor site morbidity, early postoperative recovery, and sufficient biomechanical strength.
In the present study, we describe a new species of Pristimantis inhabiting open ombrophilous forests of Southwestern Amazonia. We describe this new species combining mitochondrial (16S and COI) and nuclear (RAG1) loci, external morphology, bioacoustic and natural history data. The new species is phylogenetically related to other Southwestern Amazonian lowland species of the P.unistrigatus species group (P. croceoinguinis, P. lirellus, P. okmoi and P. carvalhoi). It differs from its closest relatives mainly by its body size (male SVL of 17.7-20.4 mm, n = 29; female SVL of 24.6-26.5 mm, n = 2) and the presence of tympanum, extensive tuberculation (i.e., scapular, ulnar, heels, tarsal and eyelid tubercles), tarsal folds and dentigerous processes of vomers. Moreover, the new species differentiates from its relatives by presenting a yellow groin and gray iris, and by its two types of advertisement calls, consisting of either by a single-note call with duration of 130-254 ms, with three well-defined harmonics, or in three-note call with duration of 421-459 ms, with a single harmonic. The new species is very inconspicuous in its natural habitat due to its small body size, dull coloration, low intensity call, short call activity at dusk (lasting about 20 minutes) and shy behavior. Although open ombrophilous forests of Southwestern Amazonia are still poorly studied, recent studies have revealed a great number of undescribed anuran species under their canopy. Concerningly, the region is the main western route for the expansion of the Amazonian arc of deforestation, which strongly threatens endemic amphibians.
A new species of the genus Jingophrys is described from Xizang, China based on the morphological comparisons and phylogenetic reconstruction. Morphologically, this new speciesJingophrys zhaoermiisp. nov. can be distinguished from other known congeners by a combination of diagnostic characteristics: (1) body size small, SVL 34.5-35.4 mm in adult males and SVL 39.6-43.1 mm in adult females; (2) tympanum distinct, upper margin slightly concealed by supratympanic fold; (3) presence of weak vomerine ridge, absence of vomerine teeth; (4) tongue notch absent; (5) hindlimbs slender, heels meeting when thighs flexed at right angles to the axis of body and tibiotarsal articulation reaching anterior corner of eye or tip of the snout when leg stretched alongside body; (6) fingers with lateral fringes, subarticular tubercles absent; (7) toes with rudimentary webbing at bases and lateral fringes; (8) dorsal skin relatively smooth (lack granules), strong discontinuous X-shaped ridge on center of dorsum, discontinuous dorsolateral ridges absent or weak; (9) sparse large tubercles on flanks, no granules between tubercles; (10) adult males lack nuptial pads. Phylogenetically, it differs from its congeners by uncorrected p-distances of >3.7% for the 16S gene fragment and uncorrected p-distances of >10.1% for the COI gene fragment. Additionally, we provide a new identification key to the genus Jingophrys.
Head movement is a fundamental component of gait control and environmental orientation during locomotion. Wearable inertial measurement units (IMUs) enable real-time inference of upcoming movement, and early detection of impending head turns during walking is critical for enhancing interactive systems. The study aimed to investigate whether multi-segment IMU data reliably detect and classify upcoming head turns and their direction before and during head turns while walking, and to hypothesize that neural networks effectively capture the temporal integration patterns of early pre-movement and active head turning in gait. Fifty healthy participants performed four head-turning directions (up, down, left, right) while walking, instrumented with eight IMUs placed on the head, chest, left wrist, lower back, and bilateral heels and toes. IMU signals were segmented around detected head turns and processed using a sliding-window strategy across two temporal windows: pre-turn and during-turn phases. Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) networks, including sliding-window variants, were trained for four-class classification. Head-mounted sensors achieved maximum accuracy of 98.91% (pre-turn) and 98.73% (during-turn). Distal segment performance was strong: the SW-LSTM at the right heel achieved 96.93% accuracy and 97.05% precision, while the SW-GRU at the left toe achieved 95.85% accuracy and 95.89% precision. Successfully highlighted the optimized sliding-window sizes for predicting pre-head-turning kinematics during walking from wearable IMU data. The crucial role of head and chest sensing for recognizing pre-head-turning kinematics and direction shows promise for gait applications. Real-world validation demonstrates robust performance across head-turning directions, with practical applications in gait-adaptive systems.
Special Operations Forces (SOF) comprise a segment of military personnel whose tasks and missions often require complex cognition. Sleep is important to maintain peak cognitive performance, as lack of adequate sleep can lead to decrements in reaction time, memory, and other facets of cognition. Little research has assessed the association between sleep quality and cognitive performance in SOF populations. We broadly hypothesized that poorer sleep quality in SOF personnel would be associated with decrements in cognitive performance. A group of 183 male SOF personnel answered questions from the Pittsburgh Sleep Quality Index (PSQI) about their sleep habits during the month prior to their study visit across seven components of sleep quality. Participants also completed ten cognitive tasks using the Senaptec Sensory Station during the same study visit. We compared PSQI and cognitive performance scores using Spearman correlations, exploring any significant correlations (α = .05) further in multivariate analysis. We performed linear regression to assess the potential effect of sleep quality on cognitive performance while controlling for demographics, years of military service, traumatic brain injury history, and mental health symptoms. We used SAS 9.4 for statistical analysis. This study was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill (IRB #14-1364). Poorer sleep was weakly correlated with longer times to accurately capture targets ("Target Capture") and improved inhibitory control ("Go/No-Go" (GNG)). When controlling for confounders, reduced sleep efficiency (β = 1.50, 95% CI: 0.46, 2.54) and more frequent sleep disturbance (β = 2.05, 95% CI: 0.18, 3.91) were both associated with better scores on GNG, which evaluates an individual's ability to quickly distinguish between targets that require a response ("Go") and those that do not ("No-Go"). When adjusting for multiple comparisons using a Bonferroni correction, the association between reduced sleep efficiency and faster/more accurate GNG performance maintained statistical significance (β = 1.50, Bonferroni-corrected 99.2% CI: 0.10, 2.90), but the association between more frequent sleep disturbance and faster/more accurate performance on GNG did not (β = 2.05, Bonferroni-corrected 99.2% CI: -0.46, 4.55). Contrary to our hypothesis, reduced sleep efficiency was associated with better GNG performance in a population of SOF personnel. GNG assesses visual processing speed, reaction time, and decision-making skills under pressure to obtain a measure of inhibitory control, a high-level cognitive process that is a key facet of executive function. Decreased sleep quality impairs these constructs in civilian populations, so the ability to overcome fatigue and execute demanding decisions accurately and with high speed in this population is notable. Future research is needed to determine if the relationship between sleep quality and cognitive performance is possibly related to increased cognitive effort by those with worse sleep or other yet undiscovered determinants of military brain health.
Premature ovarian insufficiency (POI) is associated with reduced bone mineral density (BMD) and fracture risk, but the causal direction remains unclear. Clarifying this is crucial for individualized patient management and understanding shared biology between bone and ovary. To investigate the bidirectional genetic causal relationships between POI and bone health using Mendelian randomization (MR). We performed bidirectional two-sample MR using genome-wide association study summary statistics. Primary analyses used the inverse-variance weighted method, with MR-Egger and weighted median as supplements. Sensitivity analyses included tests for pleiotropy and heterogeneity. Multiple testing was controlled using the false discovery rate. Forward MR found no significant causal effect of genetically predicted POI on 29 bone health outcomes (all FDR P > 0.05). Reverse MR suggested nominally significant associations: higher genetically predicted heel BMD was associated with lower POI risk (OR = 0.792, 95% CI: 0.635-0.988, P = 0.039), while genetic susceptibility to wrist fracture (OR = 1.44, 95% CI: 1.038-1.986, P=0.025) and pelvic fracture (OR=1.177, 95% CI:1.056-1.312, P=0.003) were associated with increased POI risk. This study found no genetic evidence that POI causally influences bone health deterioration, suggesting that clinical bone loss in POI is likely a secondary consequence. Conversely, exploratory reverse MR analysis identified nominal associations suggesting that inherent bone traits may influence POI risk, offering a novel perspective for risk assessment and highlighting potential bone-ovary biological links; these findings require confirmation in future studies. This study is the first to employ a bidirectional two-sample Mendelian randomization approach to systematically evaluate the genetic causal relationship between premature ovarian insufficiency (POI) and various bone health indicators. The key findings are: 1) After controlling for multiple comparisons, no strong genetic evidence was found that POI leads to decreased bone mineral density (BMD) or increased fracture risk, suggesting that bone deterioration in POI patients is likely a secondary consequence following disease onset; 2) Reverse MR analysis revealed that genetically predicted higher heel BMD is a protective factor for POI, while genetic susceptibility to wrist and pelvic fractures are potential risk factors for POI. These findings provide novel genetic insights into the complex interplay between the skeletal and reproductive systems. The results imply that proactive management of bone health should be a critical component of clinical care for diagnosed POI patients. Furthermore, inherent bone characteristics, such as heel BMD, could be considered for integration into health assessments for young women, offering potential clues for the early identification of individuals at high risk for POI, thereby promoting a shift from reactive disease treatment to proactive, life-cycle risk prevention and management.
IntroductionTourniquet use for ankle fracture fixation surgery is a common but not universally accepted practice due to concerns regarding soft tissue complications. Although prior literature has demonstrated increased short-term postoperative pain, tourniquet use's association with other complications remains under-investigated.MethodsA retrospective cohort study was performed of adult patients undergoing open reduction and internal fixation of a closed rotational ankle fracture (OTA Type 44) between 2012 and 2024 at an urban academic health system. Patients were stratified by tourniquet use. Demographic information, injury characteristics, and operative variables were collected. The primary outcome was the development of postoperative complications-wound dehiscence, fracture-related infection, superficial wound infection, delayed wound healing, peripheral nerve injury, venous thromboembolism, and nonunion. Secondary outcomes were operative time and estimated blood loss. Multivariable logistic regression was used to evaluate the association between tourniquet use and postoperative complications.ResultsA total of 617 patients met the inclusion criteria, including 446 who had a tourniquet inflated during surgery and 171 who did not. No significant differences in baseline patient demographics or comorbidity were observed. After multivariable logistic regression, tourniquet use was not associated with higher odds of any wound complication, fracture-related infection, delayed wound healing, or peripheral nerve injury. Among patients in the tourniquet cohort, 4 developed venous thromboembolism and 7 developed a fracture nonunion. No such complications were observed among patients treated without a tourniquet. Tourniquet use was associated with a modest decrease in estimated blood loss (47.3 ± 44.2 vs 33.9 ± 36.0 mL, P < .001) with no significant increase in operative time.ConclusionTourniquet use during operative fixation of closed rotational ankle fractures was not associated with increased soft tissue or bony complications. The findings support the safety of continued tourniquet use per surgeon preference, provided that appropriate patient selection is employed.
A new species, Anuridahuangxiei sp. nov., discovered from the bank of the Huangpu River in Shanghai, East China, is described and illustrated. It is characterized by the special reticulations on the body, the absence of ocelli, 18-22 elliptical vesicles on PAO, six blunt sensilla with distinct heel and trilobed apical vesicle on Ant. IV, seta p3 in front of p2-p4 line on thoracic segments II and III, seta p2 present on Abd. I-IV, and slender sensilla on dorsal side. In addition, the complete mitochondrial genome of the new species was sequenced and analyzed. Its COI barcode was also compared with other 19 species of the subfamily Pseudachorutinae and the genetic distances between them were calculated.
This study investigates age-related shape changes, morphological integration, and modularity in the human talus-calcaneus complex throughout postnatal development (0-10 years). Geometric morphometric analyses were performed on three-dimensional landmark data from 23 individuals binned into four age groups, considering both the talus and calcaneus. Statistical analyses included Procrustes ANOVA to assess age effects, two-block partial least squares to quantify inter-bone integration, and Covariance Ratio tests to evaluate modular organization within each bone. Trabecular bone architectural parameters from micro-CT scans were analyzed in parallel. Marked age-related shape changes were detected in both the talus and calcaneus, with pronounced morphological transitions observed between the middle age groups (1-3 and 3-6 years). The two bones exhibited strong morphological integration across all age classes, representing the first quantitative assessment of talus-calcaneus integration during ontogeny. Modular organization was confirmed also within each bone. Trabecular bone architectural analysis via micro-CT revealed distinct developmental patterns: the talus exhibited higher initial bone volume fraction with subsequent stabilization and stable trabecular thickness, while the calcaneus showed progressive increases in both bone volume fraction and trabecular thickness, alongside higher anisotropy values, presumably reflecting adaptation to its more direct role in experiencing impact forces during heel strike. The talus-calcaneus complex exhibits highly coordinated ontogenetic timing and strong morphological integration across both external morphology and internal trabecular architecture. These adaptations highlight the sophisticated interplay within this skeletal unit, supporting its function as an integrated biomechanical system critical for understanding human locomotor evolution and foot development.
Venous thromboembolism (VTE) is a potentially life-threatening complication following orthopaedic surgery. While prophylaxis is well-established in joint arthroplasty, its role after Achilles tendon repair remains controversial. Despite being a soft-tissue procedure, prolonged postoperative immobilization increases VTE risk, with some studies reporting symptomatic rates as high as 7%. However, no prior studies have assessed whether pharmacologic VTE prophylaxis breaks-even in this population. A literature review and the TriNetX Research Network were used to identify symptomatic VTE rates within 30 days of primary Achilles tendon repair without pharmacologic prophylaxis. The cost of treating a symptomatic VTE was estimated from published data and adjusted to 2025 US dollars. Retail drug pricing was obtained from an online pharmacy database. A break-even analysis was conducted to determine the absolute risk reduction (ARR) and number needed to treat (NNT) required for aspirin (81 mg and 325 mg), warfarin (5 mg), enoxaparin (40 mg), and rivaroxaban (20 mg) to be cost-effective. A sub-analysis compared postoperative bleeding and transfusion rates in patients who received chemoprophylaxis versus those who did not. Among 8935 patients undergoing Achilles tendon repair without chemoprophylaxis, 47 developed a symptomatic VTE (0.526%). Aspirin and warfarin broke-even across all VTE rates, with NNTs ranging from 9217 to 10 547. Warfarin still broke-even when including international normalized ratio (INR) monitoring costs. Enoxaparin and rivaroxaban only broke-even at the highest VTE rate (7.2%), with NNTs of 131 and 390, respectively, and required higher VTE treatment costs to be justified. In this study, we found that aspirin 81 mg, aspirin 325 mg, and warfarin break-even for VTE chemoprophylaxis following Achilles tendon repair. Enoxaparin and rivaroxaban failed to break-even. Chemoprophylaxis decisions should be individualized, weighing patient risk and economic considerations.
The genetic architecture of bovine hoof and leg conformation traits remains incompletely understood, particularly in dairy cattle and with respect to non-additive effects. Moreover, the limited genetic resolution of previous studies hampered the identification of candidate variants. This study aimed to investigate traits in Swiss Holstein (HO) and Brown Swiss (BS), comprising bone structure, heel depth, foot angle, locomotion, rear leg rear view, and rear leg set in HO, and heel depth, foot angle, hock quality, and rear leg side view in BS, by (1) estimating trait heritabilities, (2) identifying QTL using additive and non-additive GWAS based on imputed whole-genome sequence (WGS) variants, (3) detecting candidate genes and variants using Bayesian fine-mapping, (4) assessing the effects of the recessive HYAL1 on conformation, longevity, and production traits in French HO, and (5) clinically characterizing HYAL1-homozygous HO. Heritability estimates ranged from 0.10 to 0.28 in HO and from 0.10 to 0.26 in BS. Additive and non-additive GWAS detected 25 significant associated regions (P ≤ 5 × 10-8) for bone structure and locomotion in HO and for heel depth and hock quality in BS. Conditional analyses reduced these to 15 unique QTL and Bayesian fine-mapping prioritised 17 candidate variants (3 in HO, 14 in BS), including 15 additive, one dominant, and one recessive effect. A nonsense variant in HYAL1 (NP_001017941.1:p.(Gln93*)) showed a significant recessive effect on bone structure in HO (P = 1.62 × 10-17). The harmful allele was observed predominantly in HO at 4.4% in Swiss and 8.4% in French HO. Analyses in the French population further showed adverse effects on six-year survival, indicating early culling after the first lactation, and 14 routinely recorded conformation and production traits, most notably locomotion and rear leg rear view. Clinical examination of HYAL1-homozygotes revealed polysynovitis. This study indicates a predominantly polygenic architecture of hoof and leg conformation traits in HO and BS cattle and show that integrating imputed WGS data with non-additive analyses of proxy phenotypes improves the detection and refinement of QTL and candidate variants. In particular, the identification of a recessive HYAL1 nonsense variant associated with bone structure in HO uncovered a hidden Mendelian disorder.
Laminins initiate basement membrane (BM) assembly by adhering to cells, establishing cytoskeletal links through integrin and dystroglycan receptors, and by polymerizing to form a sheet-like provisional matrix that recruits other BM components to complete assembly. Laminin polymerization is mediated by the LN domain tips of the three short arms that bind together to form "polymer nodes" connecting adjacent laminins. The first step of this assembly is the low affinity binding of a β-LN domain to a γ-LN domain, followed by a higher affinity binding of an α-LN domain to the β-γ complex. Negative staining, mutagenesis, and cryo-electron microscopic studies have revealed the polymer node is organized as a triskelion connected by "toe-to heel" LN interactions. A related structure using toe-to-heel LN interactions is seen in the polymer inhibiting complex formed when netrin-4 binds to laminin γ1. LAMA2-deficient related dystrophy, affecting muscle, peripheral nerve and brain, results from nonsense, missense, and deletion mutations of the LAMA2 gene. A clinical subset is caused by in-frame mutations in the α2-LN domain that prevent polymerization. A dystrophic mouse model (dy2J/dy2J) was used to develop a method of disease amelioration by expressing laminin-binding proteins that bear a functional α1-LN domain to enable polymerization. A model for the more common severe dystrophy (dy3K/dy3K), in which α2-laminins are replaced by α4-laminins, benefits from double expression of laminin-binding proteins that enable polymerization and that bind to dystroglycan. Such approaches, using adeno-associated virus (AAV) delivery of genes encoding these proteins, hold promise in the development of treatments for the human condition.
Human walking must maintain temporal coordination while adapting to perturbations. However, it remains unclear whether different gait events show similar or distinct temporal responses during adaptive walking. Using split-belt treadmill walking as a model of asymmetric temporal perturbation, we examined inter-event timing variability for heel strike (HS) and toe off (TO) in healthy young adult males. Variability was quantified as the coefficient of variation (CV) of inter-event intervals during baseline walking, early adaptation, and late adaptation. To assess perturbation-related temporal responses, we also calculated baseline-referenced changes in variability (ΔCV) and their magnitude (|ΔCV|). HS exhibited higher absolute timing variability across walking phases and larger baseline-referenced changes during split-belt walking. In contrast, TO showed comparatively lower variability and smaller deviations from baseline in the present analysis. Double-support time symmetry was also altered during early adaptation and partially recovered later, indicating concurrent reorganization of whole-gait temporal coordination. These findings suggest that gait events do not contribute uniformly to temporal adjustment during split-belt walking. Event-specific analysis of baseline-referenced variability may therefore provide a useful perspective for describing temporal responses to locomotor perturbation.
Cutaneous and mucosal melanoma are biologically and clinically distinct malignancies whose epidemiology varies markedly across populations and skin phototypes. In Arab and other Eastern Mediterranean populations, melanoma is comparatively uncommon but is frequently diagnosed at an advanced stage and shows a relatively high proportion of acral and mucosal subtypes. Data describing melanoma in the Palestinian population are scarce. We characterised the clinicopathological profile of cutaneous and mucosal melanoma diagnosed at a large Palestinian diagnostic pathology service and placed the findings in a comparative regional context. We performed a retrospective review of all histopathologically confirmed cases of cutaneous and mucosal melanoma reported at Medicare Diagnostic Laboratories, West Bank, Palestine, between May 2008 and May 2026. Demographic variables (age, sex), anatomical site, melanoma subtype, depth of invasion (Clark level), and, where recorded, Breslow thickness and American Joint Committee on Cancer (AJCC) stage were abstracted from pathology records. Diagnoses were confirmed on haematoxylin-eosin sections supported by immunohistochemistry (S100, SOX10, HMB-45, Melan-A). Repeat specimens were consolidated to the patient level, and findings were compared with published series from neighbouring countries. Fifty-seven patients with primary melanoma were identified, comprising 47 cutaneous (82.5%) and 10 mucosal (17.5%) tumours. The mean age at diagnosis was 59.5 +/- 17.0 years (range 10-87), and there was a slight female predominance (30 women, 52.6%; male-to-female ratio 0.90:1). Acral sites (sole, heel, plantar, and subungual regions) accounted for 15 of 47 cutaneous melanomas (31.9%), the most common single location, followed by the head and neck (14, 29.8%). Among mucosal tumours, the anorectum was the predominant site (6 of 10, 60%). A histological subtype was explicitly recorded in only 19 of 57 cases; within this limited subset the nodular pattern predominated (18 of 19), although the large proportion of cases without a stated subtype precludes firm conclusions about the true distribution of melanoma subtypes in this cohort. The Clark level was documented in 27 patients, of whom 26 (96.3%) had level IV-V (deep) invasion. A further 17 patients presented with metastatic melanoma deposits without a primary tumour in the archive. Melanoma in this Palestinian cohort was characterised by a slight female predominance, a high proportion of acral (31.9% of cutaneous) and mucosal (17.5% of all primary) tumours, a predominantly nodular phenotype among the subset of cases with a recorded subtype, and deep invasion at diagnosis. This profile mirrors patterns reported in neighbouring Arab and Eastern Mediterranean populations and contrasts with more lightly pigmented (Fitzpatrick I-II) Western populations. The findings underline the need for improved melanoma awareness, routine examination of acral and mucosal sites, and strengthened cancer registration in Palestine.
Effective management of early diabetic foot ulcers (DFUs) is essential for reducing the risks of amputation and mortality. Affordable wound dressings are particularly important for low-income patients because wound healing often requires prolonged treatment. This case report describes the effects of a combined intervention on wound status and quality of life in a 54-year-old woman with a Grade 2 DFU located on the right heel. Following six weeks of standard wound care administered twice weekly at a local healthcare facility, together with glycemic self-management, the patient's blood glucose level improved from 380 mg/dL to 130 mg/dL. Despite improved glycemic control, wound healing remained limited, and the patient continued to experience substantial impairment in quality of life due to ulcer-related pain. The intervention consisted of a honey/gotu kola/κ-carrageenan base (HGCB) hydrogel film dressing applied daily in a home-care setting, combined with mechanical debridement and structured glycemic self-management. Quality of life was assessed using the Diabetic Foot Ulcer Scale. A cost analysis comparing HGCB hydrogel dressing with standard wound care was performed over an equivalent treatment duration. By week 12, blood glucose remained controlled, while malodor, firmly adherent slough, and peri-wound maceration had resolved, accompanied by marked improvement in quality of life. Furthermore, the cost of care associated with the HGCB hydrogel dressing was approximately half that of standard wound care. Although derived from a single case, these findings provide preliminary data for future larger-scale investigations. No adverse reactions or treatment-related complications were observed during intervention therapy.
Treatment-resistant depression (TRD) remains a major clinical challenge, with highly variable responses to ketamine. Immune activation characterizes a subset of patients with TRD. The kynurenine pathway (KP), which integrates immunometabolic signals with glutamatergic neurotransmission, may provide candidate biomarkers to inform personalized treatment. We investigated whether KP metabolites and ratios are associated with ketamine response and clinical outcomes over time. Thirty adults with TRD received six intravenous ketamine infusions over three weeks. At baseline (D1), after the first infusion (D3), and before the final infusion (D18), we quantified serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK), and quinolinic acid (QUIN), and assessed depression severity using the Montgomery-Åsberg Depression Rating Scale (MADRS). Higher baseline KYNA was associated with greater symptom improvement at D18 (β = -21.80, βstd = -0.54, p = 0.002, pFDR = 0.022). Other markers, including TRP, KYNA/KYN, and KYNA/3-HK, showed concordant nominal associations not surviving multiple-comparisons correction. KYNA remained stable over time, and symptom changes did not track with KYNA changes, suggesting KYNA as a trait-like rather than state-dependent marker. Finally, early shifts toward the putatively neurotoxic KP branch (KYN and 3-HK) were associated with reductions in MADRS hopelessness/suicidality scores at D3. QUIN showed a nominal correlation with hopelessness not surviving multiple-comparisons correction. These exploratory findings may point to a role of KP dynamics in ketamine's rapid anti-suicidal effects, but require validation in larger samples. Overall, our findings suggest that a KP profile biased toward neuroprotective metabolites may inform future biomarker studies of response to ketamine treatment.
Plantar fasciitis (PF) is a common cause of plantar heel pain leading to functional limitation and reduced quality of life. While extracorporeal shock wave therapy (ESWT) is a well-established treatment option, the additional benefit of kinesio taping (KT) as an adjunct modality remains unclear. This study aimed to evaluate the short-term effects of combining KT with ESWT on pain and foot function in patients with PF.  Methods: This retrospective comparative study included 116 patients (54 in the KT+ESWT group and 62 in the ESWT-only group) with clinically diagnosed unilateral PF persisting for at least 3 months. Pain and functional status were assessed using the Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), and Foot Function Index (FFI) subscales (pain, disability, and activity restriction) before and after a 3-week treatment period. Between-group differences were evaluated using analysis of covariance (ANCOVA) adjusted for baseline scores and demographic variables. Effect sizes were reported using partial eta-squared (η2) and post-hoc power analysis confirmed adequate study power.  Results: Both treatment groups demonstrated significant improvements from baseline to post-treatment in VAS, RMS, and FFI subscales (all P < .001). After adjustment for baseline scores, the KT+ESWT group showed significantly greater improvement than the ESWT group across all outcome measures (adjusted P < .001 for VAS, RMS, FFI-Pain, FFI-Disability, and FFI-Activity restriction). The observed effect sizes were large (η2 = 0.165-0.280), and the reduction in VAS pain exceeded the minimally clinically important difference, indicating clinically meaningful improvement.  Conclusion: The combined application of KT with ESWT resulted in superior short-term improvements in pain and foot function compared with ESWT alone in patients with PF. The complementary effects of KT in reducing plantar fascia load and enhancing proprioceptive control may augment ESWT's established regenerative and analgesic benefits. Given its simplicity, low cost, and accessibility, KT may be considered a practical adjunct to ESWT in clinical rehabilitation settings. However, as the follow-up period was limited to 3 weeks, the long-term durability of treatment effects remains uncertain. Future randomized controlled trials with extended follow-up are needed to validate these findings.    Cite this article as: Çelik G, Sarı MH, Doğan ŞK, Bal A. Short-term effects of combined kinesio taping and extracorporeal shock wave therapy in patients with plantar fasciitis. Acta Orthop Traumatol Turc. 2026; 60(2), 0640, doi: 10.5152/j.aott.2026.25640.