The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: a randomized controlled trial.

BACKGROUND: Flatfoot is a musculoskeletal problem associated with dysfunctional active and passive supporting structures of the normal foot curvature. Strengthening of the intrinsic foot muscles or using shoe orthosis are recommend treatment approaches. However, investigating the effect of combining both approaches is still warranted. AIM: To examine the effect of applying short foot exercises (SFE) combined with shoe insole versus shoe insole alone on foot pressure measures, pain, function and navicular drop in individuals with symptomatic flexible flatfoot. DESIGN: Prospective, active control, parallel-group, assessor-blinded, randomized controlled trial and intention-to-treat analysis. SETTING: Outpatient physical therapy clinic of a university teaching hospital. POPULATION: Forty participants with symptomatic flexible flatfoot. METHODS: A six-week treatment protocol of SFE (three sets of 10 repetitions a day) in addition to shoe insole (eight hours a day) (experimental group, N.=20) or shoe insole only (eight hours a day) (control group, N.=20). Clinic visits were made at baseline and every two weeks for monitoring and follow-up. The static and dynamic foot area, force and pressure measures, pain, lower extremity function, and navicular drop were assessed at baseline and postintervention. RESULTS: Forty participants joined the study and 37 (92.5%) completed the six-week intervention period. Foot pressure, pain and function showed a significant interaction (P=0.02 - <0.001) and time (P<0.001) effects with a non-significant group effect in favor of the experimental group. Post-hoc analysis revealed that the experimental group had lesser pain (P=0.002) and better function (P=0.03) than the control group at six weeks. Navicular drop decreased equally in both groups. CONCLUSIONS: Implementation of shoe insole and SFE for six weeks improved pain and function and altered foot pressure distribution greater than shoe insole alone in patients with symptomatic flatfoot. CLINICAL REHABILITATION IMPACT: Wearing shoe insole is an easy, but passive, treatment approach for a flatfoot problem. This study provided evidence regarding the added benefit of SFE. It is recommended that rehabilitation practitioners implement a comprehensive treatment protocol including both shoe insole and SFE for at least six weeks to achieve better results for their flatfoot patients.

Management of CAR T-cell Related Toxicities: What did the Learning Curve Teach us so Far?

Chimeric antigen receptor T cell (CAR-T) therapy is an immunotherapy, which represents a therapeutic breakthrough in the treatment of B-cell malignancies and multiple myeloma. Since the first CAR T-cell approval in 2017, there have been five FDA approved CAR-T products, more approved disease indications for CAR-T therapy, and investigational trials launched for other cancers, including solid organ malignancies. CAR-T therapy possesses unique toxicities. Better understanding of these toxicities over time has helped in more efficient diagnosis, management, and treatment strategies. This review will focus on CAR-T-related toxicities including cytokine release syndrome, immune effector cell associated neurotoxicity syndrome (ICANS), cytokine release syndrome (CRS), and hemophagocytic lymphohistiocytosis (HLH)/ macrophage activation syndrome in terms of assessment, grading, and current management strategies. Additionally, this review will cover future directions and research on CAR-T-related toxicities.

Breast Implant-associated Anaplastic Large Cell Lymphoma.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon lymphoproliferative disorder, mainly associated with textured implants. The average time from the breast implants to the development of BIA-ALCL is about 7 to 10 years, and the median age at the time of diagnosis is in the mid-50s. The exact incidence and prevalence of BIA-ALCL are not known. The pathogenesis of BIA-ALCL remains unclear. Different theories have been postulated, including immune response to textured implants, subclinical bacterial infection, and genetic predisposition. However, none of those theories have yet been proven to be causal in the pathogenesis of BIA-ALCL. BIA-ALCL is histologically similar to but clinically distinct from other CD30-positive T-cell lymphomas such as anaplastic lymphoma kinase-positive, anaplastic lymphoma kinase-negative, and primary cutaneous ALCL. The revised World Health Organization classification of lymphoid neoplasm in 2016 recognized BIA-ALCL as a provisional entity. Suspected cases need proper evaluation and workup to confirm the diagnosis. Surgical resection should be considered for all the cases. However, adjuvant radiotherapy and anthracycline-based chemotherapy are warranted for locally advanced and advanced cases.