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Stem Cell Reviews and Reports Jun 2024Activation of endogenous neural stem cells (NSC) is one of the most potential measures for neural repair after spinal cord injury. However, methods for regulating neural...
Activation of endogenous neural stem cells (NSC) is one of the most potential measures for neural repair after spinal cord injury. However, methods for regulating neural stem cell behavior are still limited. Here, we investigated the effects of nicotinamide riboside promoting the proliferation of endogenous neural stem cells to repair spinal cord injury. Nicotinamide riboside promotes the proliferation of endogenous neural stem cells and regulates their differentiation into neurons. In addition, nicotinamide riboside significantly restored lower limb motor dysfunction caused by spinal cord injury. Nicotinamide riboside plays its role in promoting the proliferation of neural stem cells by activating the Wnt signaling pathway through the LGR5 gene. Knockdown of the LGR5 gene by lentivirus eliminates the effect of nicotinamide riboside on the proliferation of endogenous neural stem cells. In addition, administration of Wnt pathway inhibitors also eliminated the proliferative effect of nicotinamide riboside. Collectively, these findings demonstrate that nicotinamide promotes the proliferation of neural stem cells by targeting the LGR5 gene to activate the Wnt pathway, which provides a new way to repair spinal cord injury.
PubMed: 38941038
DOI: 10.1007/s12015-024-10747-x -
Health Technology Assessment... Jun 2024Anterior cruciate ligament injury of the knee is common and leads to decreased activity and risk of secondary osteoarthritis of the knee. Management of patients with a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Anterior cruciate ligament injury of the knee is common and leads to decreased activity and risk of secondary osteoarthritis of the knee. Management of patients with a non-acute anterior cruciate ligament injury can be non-surgical (rehabilitation) or surgical (reconstruction). However, insufficient evidence exists to guide treatment.
OBJECTIVE(S)
To determine in patients with non-acute anterior cruciate ligament injury and symptoms of instability whether a strategy of surgical management (reconstruction) without prior rehabilitation was more clinically and cost-effective than non-surgical management (rehabilitation).
DESIGN
A pragmatic, multicentre, superiority, randomised controlled trial with two-arm parallel groups and 1:1 allocation. Due to the nature of the interventions, no blinding could be carried out.
SETTING
Twenty-nine NHS orthopaedic units in the United Kingdom.
PARTICIPANTS
Participants with a symptomatic (instability) non-acute anterior cruciate ligament-injured knee.
INTERVENTIONS
Patients in the surgical management arm underwent surgical anterior cruciate ligament reconstruction as soon as possible and without any further rehabilitation. Patients in the rehabilitation arm attended physiotherapy sessions and only were listed for reconstructive surgery on continued instability following rehabilitation. Surgery following initial rehabilitation was an expected outcome for many patients and within protocol.
MAIN OUTCOME MEASURES
The primary outcome was the Knee Injury and Osteoarthritis Outcome Score 4 at 18 months post randomisation. Secondary outcomes included return to sport/activity, intervention-related complications, patient satisfaction, expectations of activity, generic health quality of life, knee-specific quality of life and resource usage.
RESULTS
Three hundred and sixteen participants were recruited between February 2017 and April 2020 with 156 randomised to surgical management and 160 to rehabilitation. Forty-one per cent ( = 65) of those allocated to rehabilitation underwent subsequent reconstruction within 18 months with 38% ( = 61) completing rehabilitation and not undergoing surgery. Seventy-two per cent ( = 113) of those allocated to surgery underwent reconstruction within 18 months. Follow-up at the primary outcome time point was 78% ( = 248; surgical, = 128; rehabilitation, = 120). Both groups improved over time. Adjusted mean Knee Injury and Osteoarthritis Outcome Score 4 scores at 18 months had increased to 73.0 in the surgical arm and to 64.6 in the rehabilitation arm. The adjusted mean difference was 7.9 (95% confidence interval 2.5 to 13.2; = 0.005) in favour of surgical management. The per-protocol analyses supported the intention-to-treat results, with all treatment effects favouring surgical management at a level reaching statistical significance. There was a significant difference in Tegner Activity Score at 18 months. Sixty-eight per cent ( = 65) of surgery patients did not reach their expected activity level compared to 73% ( = 63) in the rehabilitation arm. There were no differences between groups in surgical complications ( = 1 surgery, = 2 rehab) or clinical events ( = 11 surgery, = 12 rehab). Of surgery patients, 82.9% were satisfied compared to 68.1% of rehabilitation patients. Health economic analysis found that surgical management led to improved health-related quality of life compared to non-surgical management (0.052 quality-adjusted life-years, = 0.177), but with higher NHS healthcare costs (£1107, < 0.001). The incremental cost-effectiveness ratio for the surgical management programme versus rehabilitation was £19,346 per quality-adjusted life-year gained. Using £20,000-30,000 per quality-adjusted life-year thresholds, surgical management is cost-effective in the UK setting with a probability of being the most cost-effective option at 51% and 72%, respectively.
LIMITATIONS
Not all surgical patients underwent reconstruction, but this did not affect trial interpretation. The adherence to physiotherapy was patchy, but the trial was designed as pragmatic.
CONCLUSIONS
Surgical management (reconstruction) for non-acute anterior cruciate ligament-injured patients was superior to non-surgical management (rehabilitation). Although physiotherapy can still provide benefit, later-presenting non-acute anterior cruciate ligament-injured patients benefit more from surgical reconstruction without delaying for a prior period of rehabilitation.
FUTURE WORK
Confirmatory studies and those to explore the influence of fidelity and compliance will be useful.
TRIAL REGISTRATION
This trial is registered as Current Controlled Trials ISRCTN10110685; ClinicalTrials.gov Identifier: NCT02980367.
FUNDING
This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/140/63) and is published in full in ; Vol. 28, No. 27. See the NIHR Funding and Awards website for further award information.
Topics: Humans; Male; Female; Anterior Cruciate Ligament Injuries; Adult; United Kingdom; Cost-Benefit Analysis; Anterior Cruciate Ligament Reconstruction; Quality of Life; Quality-Adjusted Life Years; Middle Aged; Young Adult; State Medicine; Joint Instability; Adolescent; Technology Assessment, Biomedical
PubMed: 38940695
DOI: 10.3310/VDKB6009 -
The Journal of Manual & Manipulative... Jun 2024To identify factors and barriers, which affect the utilisation of spinal manipulation and mobilisation among infants, children, and adolescents.
Perceived factors and barriers affecting physiotherapists' decision to use spinal manipulation and mobilisation among infants, children, and adolescents: an international survey.
OBJECTIVE
To identify factors and barriers, which affect the utilisation of spinal manipulation and mobilisation among infants, children, and adolescents.
METHODS
Twenty-six international expert physiotherapists in manual therapy and paediatrics were invited to participate in a Delphi investigation using Qualtrics. In Round-1 physiotherapists selected from a list of factors and barriers affecting their decision to use spinal manipulation and mobilisation in the paediatric population and had opportunity to add to the list. Round-2 asked respondents to select as many factors and barriers that they agreed with, resulting in a frequency count. The subset of responses to questions around barriers and facilitators are the focus of this study.
RESULTS
Twelve physiotherapists completed both rounds of the survey. Medical diagnosis, mechanism of injury, patient presentation, tolerance to handling, and therapist's knowledge of techniques were the dominant deciding factors to use spinal manipulation and mobilisation among infants, children, and adolescents across spinal levels. More than 90% of the respondents selected manipulation as inappropriate among infants as their top barrier. Additional dominant barriers to using spinal manipulation among infants and children identified by ≥ 75% of the respondents included fear of injuring the patient, fear of litigation, lack of communication, lack of evidence, lack of guardian consent, and precision of the examination to inform clinical reasoning.
CONCLUSION
This international survey provides much needed insight regarding the factors and barriers physiotherapists should consider when contemplating the utilisation of spinal mobilisation and manipulation in the paediatric population.
Topics: Humans; Adolescent; Child; Manipulation, Spinal; Physical Therapists; Infant; Female; Delphi Technique; Male; Surveys and Questionnaires; Child, Preschool; Clinical Decision-Making; Attitude of Health Personnel; Adult
PubMed: 38940281
DOI: 10.1080/10669817.2024.2363033 -
Acta Chirurgica Belgica Jun 2024Doctors with disability are likely to face major life crises and distressing emotions from unforeseen circumstances that threaten their physical well-being. We aimed to... (Review)
Review
Doctors with disability are likely to face major life crises and distressing emotions from unforeseen circumstances that threaten their physical well-being. We aimed to review surgeons with disabilities to identify work-related risk factors that may cause surgeons pain and disability. Surgeons who were struck with unpredicted disasters leading to disabilities were also in focus of our interest.We conducted a 10-year literature review. Citations about surgeons' physical disabilities were complemented from gray literature with commentaries of disabled surgeons. The quantitative citations were quality assessed by MERSQI scores. For the qualitative study part, the severely traumatized surgeons were assessed by means of Cullberg's crisis phases (CCP) and analysed from Tedeschi and Calhoun's post-traumatic growth perspective (PTG).Altogether 3593 citations from PubMed were studied, and 10 citations met inclusion criteria with a total of 11591 participants. We included 6 surgeons subjected to highly traumatic events complicating their medical career. Our quantitative citations' MERSQI mean score was 11.73 (SD .79). We found that our quantitative findings fell on Evidence grade II (moderate quality = 11.26 - 12.00 scores), Work-related pain including musculoskeletal pain and occupational injuries can lead to physical disabilities. The accidentally traumatized surgeons fought through the four CCP phases and reached the PTG stage.The surgical workforce is at high risk of work-related musculoskeletal morbidity which can progress to chronic pain and disruption of surgeon's career. Surgeons with disabilities faced serious barriers in their career. Institutions and healthcare systems must urgently develop support strategies for surgeons with disabilities.
PubMed: 38940065
DOI: 10.1080/00015458.2024.2369745 -
Cureus May 2024The Achilles tendon is vital for walking and running, but it's also the most frequently ruptured tendon. Ruptures often occur without direct trauma and present with...
The Achilles tendon is vital for walking and running, but it's also the most frequently ruptured tendon. Ruptures often occur without direct trauma and present with acute posterior ankle/heel pain. Various factors like age, biomechanical properties, degeneration, and mechanical factors influence susceptibility to rupture. Mechanisms of injury vary, including weight-bearing forefoot pushing off and sudden dorsiflexion of the ankle. Management goals focus on minimizing morbidity, swift recovery, and preventing complications through tailored interventions. Systemic lupus erythematosus (SLE) can also contribute to tendon rupture, especially with prolonged corticosteroid use. A 32-year-old female presented to the ER after injuring her left foot during a basketball game. She was diagnosed with an Achilles tendon rupture and underwent surgery to repair it. However, she experienced delayed wound closure and needed a skin graft. Two months later, she suffered another rupture in a different location, requiring a tendon transfer surgery. She was finally diagnosed with SLE after tests by the Rheumatology Department. Treatment commenced, and she began rehabilitation four weeks post-surgery. Surgical management of ruptured Achilles tendon involves techniques like open repair, percutaneous repair, mini-open repair, and augmentative repair. Open repair involves a direct approach with a posteromedial incision to align tendon stumps using various stitching techniques. Conservative treatment involves immobilization and non-weight-bearing for at least four weeks post surgery. For rare cases of Achilles tendon rupture caused by lupus, treatment focuses on managing the underlying disease with medications like hydroxychloroquine and glucocorticosteroids. Comprehensive evaluation, including musculoskeletal assessment, is crucial for lupus patients. SLE needs to be considered as a potential cause, especially in cases of recurrent ruptures or additional musculoskeletal symptoms. Surgical management should be tailored to individual patient needs, while also considering surgeon proficiency and preferences.
PubMed: 38939241
DOI: 10.7759/cureus.61231 -
Physical Therapy in Sport : Official... Jun 2024To evaluate non-contact injury prevention strategies of professional men's soccer clubs in elite North American league soccer. To understand the application, perceived...
OBJECTIVE
To evaluate non-contact injury prevention strategies of professional men's soccer clubs in elite North American league soccer. To understand the application, perceived effectiveness and barriers to implementation.
DESIGN
Online cross-Sectional Study.
SETTING
North American elite soccer teams.
PARTICIPANTS
96 medical and performance support staff of elite North American teams.
MAIN OUTCOME MEASURE
The survey consisted of 20 questions and captured 1) practitioners' demographics; 2) perceptions of risk factors; 3) the use of assessment and monitoring strategies; and 4) perceptions of the implementation of injury prevention programmes'.
RESULTS
Injury prevention programmes were perceived as 'effective' (Median 4, Interquartile range 4-4) and reduced injury rates (n = 94, 98%, 95 CI% 93 to 99). A range of potential risk factors were rated as "very important" (4.58 ± 0.52 Likert scale points; mean ± standard deviation). A multi-disciplinary approach to the design, application and monitoring of programmes was generally adopted. Competing training priorities (n = 75, 78%, 95 CI% 69 to 85) and game schedules (n = 71, 74%, 95 CI% 64 to 82) were the most prevalent barriers to injury prevention implementation.
CONCLUSIONS
Injury prevention programmes were perceived as effective in reducing non-contact injuries. Managing the conflicting priorities between scheduling training, tactical and conditioning goals were considered the key barriers to desired implementation.
PubMed: 38935993
DOI: 10.1016/j.ptsp.2024.06.003 -
Medicine and Science in Sports and... Jun 2024Overuse musculoskeletal injuries (MSKIs) remain a significant medical challenge in military personnel undergoing military training courses; a further understanding of...
INTRODUCTION
Overuse musculoskeletal injuries (MSKIs) remain a significant medical challenge in military personnel undergoing military training courses; a further understanding of the biological process leading to overuse MSKI development and biological signatures for injury risk are warranted. The purpose of this study was to determine the association between overuse MSKI occurrence and physiological characteristics of allostatic load (AL) characterized as maladaptive biological responses to chronic stress measured by wearable devices in US Marine Corps officer candidates during a 10-week training course.
METHODS
Devices recorded energy expenditure (EE), daytime heart rate (HR), sleeping HR, and sleep architecture (time and percent of deep, light, REM sleep, awake time, total sleep). Flux was calculated as the raw or absolute difference in the average value for that day or night and the day or night beforehand. Linear mixed-effect model analysis accounting for cardiorespiratory fitness assessed the association between overuse MSKI occurrence and device metrics (α = 0.05).
RESULTS
Sixty-nine participants (23 females) were included. Twenty-one participants (eight females) sustained an overuse MSKI. Overuse MSKI occurrence in male participants was positively associated with daytime HR (β = 5.316, p = 0.008), sleeping HR (β = 2.708, p = 0.032), relative EE (β = 8.968, p = 0.001), absolute flux in relative EE (β = 2.994, p = 0.002), absolute EE (β = 626.830, p = 0.001), and absolute flux in absolute EE (β = 204.062, p = 0.004). Overuse MSKI occurrence in female participants was positively associated with relative EE (β = 5.955, p = 0.026), deep sleep time (β = 0.664, p < 0.001), %deep sleep (β = 12.564, p < 0.001) and negatively associated with absolute flux in sleeping HR (β = -0.660, p = 0.009).
CONCLUSIONS
Overuse MSKI occurrences were associated with physiological characteristics of AL including chronically elevated HR and EE and greater time in restorative sleep stages, which may serve as biological signatures for overuse MSKI risk.
PubMed: 38934495
DOI: 10.1249/MSS.0000000000003507 -
Sensors (Basel, Switzerland) Jun 2024For individuals with spinal cord injuries (SCIs) above the midthoracic level, a common complication is the partial or complete loss of trunk stability in the seated...
For individuals with spinal cord injuries (SCIs) above the midthoracic level, a common complication is the partial or complete loss of trunk stability in the seated position. Functional neuromuscular stimulation (FNS) can restore seated posture and other motor functions after paralysis by applying small electrical currents to the peripheral motor nerves. In particular, the Networked Neuroprosthesis (NNP) is a fully implanted, modular FNS system that is also capable of capturing information from embedded accelerometers for measuring trunk tilt for feedback control of stimulation. The NNP modules containing the accelerometers are located in the body based on surgical constraints. As such, their exact orientations are generally unknown and cannot be easily assessed. In this study, a method for estimating trunk tilt that employed the Gram-Schmidt method to reorient acceleration signals to the anatomical axes of the body was developed and deployed in individuals with SCI using the implanted NNP system. An anatomically realistic model of a human trunk and five accelerometer sensors was developed to verify the accuracy of the reorientation algorithm. Correlation coefficients and root mean square errors (RMSEs) were calculated to compare target trunk tilt estimates and tilt estimates derived from simulated accelerometer signals under a variety of conditions. Simulated trunk tilt estimates with correlation coefficients above 0.92 and RMSEs below 5° were achieved. The algorithm was then applied to accelerometer signals from implanted sensors installed in three NNP recipients. Error analysis was performed by comparing the correlation coefficients and RMSEs derived from trunk tilt estimates calculated from implanted sensor signals to those calculated via motion capture data, which served as the gold standard. NNP-derived trunk tilt estimates exhibited correlation coefficients between 0.80 and 0.95 and RMSEs below 13° for both pitch and roll in most cases. These findings suggest that the algorithm is effective at estimating trunk tilt with the implanted sensors of the NNP system, which implies that the method may be appropriate for extracting feedback signals for control systems for seated stability with NNP technology for individuals who have reduced control of their trunk due to paralysis.
Topics: Humans; Algorithms; Accelerometry; Torso; Spinal Cord Injuries; Neural Prostheses; Posture
PubMed: 38931600
DOI: 10.3390/s24123816 -
Journal of Clinical Medicine Jun 2024Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries...
Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries (RCIs) are notable for their high prevalence. The critical shoulder angle (CSA) is a significant radiological measure for determining the diagnosis and progression of patients with these conditions. Although there are reports in the international literature about this measure, in our country, guideline values considering these two pathologies are unknown. Our objective was to assess patients diagnosed with GHOA and RCI using an AP X-ray view and the CSA. To conduct this, we identified differences between sexes and age categories. Fifty-nine adult patients with GHOA and RCI were included. CSA grades varied depending on the age category and type of injury evaluated. Significant differences between the age ranges of 40 and 54 ( = 0.05), 55-69 ( = 0.001), and 70-84 ( = 0.017) were observed. Patients with RCI tended to be younger and have a higher CSA compared to those with GHOA. It is important to have more normative values and to continue monitoring the critical shoulder angle in these patients.
PubMed: 38929939
DOI: 10.3390/jcm13123408 -
Journal of Clinical Medicine Jun 2024The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters...
The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of this study is to assess the reliability and construct validity of contact time parameters during the SHT recorded by a video analysis system in anterior cruciate ligament reconstructed (ACLR) patients. We investigated the reliability (intra-rater, standard error of measurement (SEM), and minimum detectable change (MDC)), discriminant validity (operated (OP) versus non-operated (NOP) side), and convergent validity (relationship with strength and psychological readiness) of SHT contact time parameters, number of valid hops and limb symmetry index (LSI) in 38 ACLR patients. Contact time parameters are presented as mean, standard deviation (SD), and coefficient of variation (CV) of contact time. Intra-tester reliability was good to excellent for all contact time parameters. For discriminant validity, the mean and SD contact times of the OP leg were significantly longer than those of the NOP leg, although the difference was smaller than the SEM and MDC values. The number of valid jumps and CV contact time parameters were not significantly different. Isokinetic quadriceps strength (60°/s) was strongly correlated with mean contact time for both legs. However, psychological readiness was not correlated with any of the contact time parameters. Temporal parameters of the SHT measured on video analysis are valid and reliable parameters to assess the performance strategy of the SHT. The results should be interpreted with caution regarding the SEM and MDC values. Further studies are needed to measure criterion validity, inter-rater reliability, and responsiveness.
PubMed: 38929938
DOI: 10.3390/jcm13123407