Soft tissue tumor imaging in adults: whole-body staging in sarcoma, non-malignant entities requiring special algorithms, pitfalls and special imaging aspects. Guidelines 2024 from the European Society of Musculoskeletal Radiology (ESSR).

OBJECTIVES: The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls. MATERIALS AND METHODS: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in 'group consensus', 'group agreement', or 'lack of agreement'. RESULTS: The three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [18F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity. CONCLUSION: Standardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors. CLINICAL RELEVANCE STATEMENT: These updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors. KEY POINTS: An early, accurate, diagnosis is crucial for the prognosis of patients with soft tissue tumors. These updated guidelines provide best practice expert consensus for standardized imaging algorithms, techniques, and reporting. Standardization can improve the comparability examinations and provide databases for large data analysis.

Standardized reporting of spine and sacroiliac joints in axial spondyloarthritis MRI: from the ESSR-Arthritis Subcommittee.

OBJECTIVES: Apply a modified Delphi-based approach and produce a practical, radiology-specific set of definitions for interpretation and standardization of the multiple MRI findings in axial spondyloarthritis (ax-SpA), specifically to aid the general radiologist with a musculoskeletal interest, working with gold standard basic MRI protocols. MATERIALS AND METHODS: We report the results of a modified Delphi-based consensus of 35 experts from 13 countries in the Arthritis Subcommittee of the European Society of Musculoskeletal Radiology (ESSR). Seventeen definitions were created (i.e., nine for the spine and eight for the sacroiliac joint) and two Delphi rounds were conducted on an electronic database, collated and revised by the project leader with agreement. Group leads were appointed for each definition following the first round. Final definitions included only those that reached a consensus > 80%; if > 50% agreed on exclusion consensus, definitions were excluded. Final results have been shared during the Arthritis meeting at the Annual ESSR Congress. RESULTS: Fourteen definitions, eight for the spine and six for the sacroiliac joint were agreed for standardized reporting. Andersson's, anterior corner sclerotic and costovertebral joint inflammatory lesions of the spine, with active and non-active erosions, and fat metaplasia of the sacroiliac joint reaching the highest consensus (≥ 95%). More than 50% of the experts agreed to exclude joint space inflammation in the sacroiliac joint and tissue backfill. Syndesmophytes reached 76% agreement. CONCLUSIONS: Agreed definitions by expert radiologists using a modified Delphi process, should allow standardized actionable radiology reports and clarity in reporting terminology of ax-SpA. CLINICAL RELEVANCE STATEMENT: The proposed definitions will support reporting from musculoskeletal and general radiologists working with gold-standard basic MRI, improve confidence in lesion assessment, and standardize terminology to provide actionable reports on MRI in patients with ax-SpA. KEY POINTS: Experts applied a modified Delphi method to optimize the definitions of MRI findings of ax-SpA. After two Delphi rounds and one in-person meeting, fourteen definitions reached the agreement threshold. These consensus-based definitions will aid in actionable reporting specifically for the general radiologist with a musculoskeletal interest.

Gut microbiota promoting propionic acid production accompanies caloric restriction-induced intentional weight loss in cats.

Rodent models and human clinical studies have shown gut microbiota-derived short-chain fatty acids (SCFAs) play roles in obesity and insulin resistance. These roles have been minimally explored in cats, where in the USA an estimated 60% of cats are overweight or obese. Overweight/obese research cats (n = 7) were transitioned from a maintenance diet to a reduced calorie diet fed ad libitum for 7 days, then calories were restricted to achieve 1-2% weight loss per week for an additional 77 days. Cats then received their original maintenance diet again for 14 days. Significant intentional weight loss was noted after calorie restriction (adjusted p < 0.0001). 16S rRNA gene amplicon sequencing and targeted SCFA metabolomics were performed on fecal samples. Fecal microbial community structure significantly differed between the four study phases (PERMANOVA p = 0.011). Fecal propionic acid was significantly higher during caloric restriction-induced weight loss (adjusted p < 0.05). Repeated measures correlation revealed the relative abundances of Prevotella 9 copri (correlation coefficient = 0.532, 95% CI (0.275, 0.717), p = 0.0002) significantly correlated with propionic acid composition. Like humans, obese cats experienced an altered microbial community structure and function, favoring propionic acid production, during caloric restriction-induced weight loss.

Sternoclavicular joint reconstruction for traumatic acute and chronic anterior and posterior instability: Patient-reported outcomes at a minimum of 2 years.

Background: Instability of the sternoclavicular joint (SCJ) is a rare problem that is often treated closed, with few published outcomes of surgical treatment with tendon graft reconstruction. Methods: We reviewed a consecutive series of patients who underwent tendon graft reconstruction for SCJ instability over a 7-year period. Cases with acute fractures or fewer than 2 years of follow-up were excluded. Pre- and postoperative function and pain were assessed using Single assessment numeric evaluation (SANE), simple shoulder test (SST), and visual analog scale (VAS) outcome measures. Results: Thirty cases were included, with 27 (90%) available for follow-up at a minimum of 2 years postoperatively. SANE scores improved from a median of 40 to 90. SST scores improved from a median of 3 positive responses to a median of 12 on a 12-point scale. VAS scores decreased from a median of 7 to 0 points. One patient underwent reoperation for recurrent instability and wound dehiscence. Three (11%) patients did not achieve a minimum 30% of maximum possible improvement in SST scores. Conclusions: Tendon graft reconstruction for SCJ instability is a safe procedure with a low complication rate and statistically and clinically significant improvements in patient-reported outcome measures at 2-year minimum follow-up. Level of evidence: Level IV: Therapeutic.

Molecular Characteristics of Cisplatin-Induced Ototoxicity and Therapeutic Interventions.

Cisplatin is a commonly used chemotherapeutic agent with proven efficacy in treating various malignancies, including testicular, ovarian, cervical, breast, bladder, head and neck, and lung cancer. Cisplatin is also used to treat tumors in children, such as neuroblastoma, osteosarcoma, and hepatoblastoma. However, its clinical use is limited by severe side effects, including ototoxicity, nephrotoxicity, neurotoxicity, hepatotoxicity, gastrointestinal toxicity, and retinal toxicity. Cisplatin-induced ototoxicity manifests as irreversible, bilateral, high-frequency sensorineural hearing loss in 40-60% of adults and in up to 60% of children. Hearing loss can lead to social isolation, depression, and cognitive decline in adults, and speech and language developmental delays in children. Cisplatin causes hair cell death by forming DNA adducts, mitochondrial dysfunction, oxidative stress, and inflammation, culminating in programmed cell death by apoptosis, necroptosis, pyroptosis, or ferroptosis. Contemporary medical interventions for cisplatin ototoxicity are limited to prosthetic devices, such as hearing aids, but these have significant limitations because the cochlea remains damaged. Recently, the U.S. Food and Drug Administration (FDA) approved the first therapy, sodium thiosulfate, to prevent cisplatin-induced hearing loss in pediatric patients with localized, non-metastatic solid tumors. Other pharmacological treatments for cisplatin ototoxicity are in various stages of preclinical and clinical development. This narrative review aims to highlight the molecular mechanisms involved in cisplatin-induced ototoxicity, focusing on cochlear inflammation, and shed light on potential antioxidant and anti-inflammatory therapeutic interventions to prevent or mitigate the ototoxic effects of cisplatin. We conducted a comprehensive literature search (Google Scholar, PubMed) focusing on publications in the last five years.

Gut microbiota promoting propionic acid production accompanies diet-induced intentional weight loss in cats.

Rodent models and human clinical studies have shown gut microbiota-derived short-chain fatty acids (SCFAs) play roles in obesity and insulin resistance. These roles have been minimally explored in cats, where in the USA an estimated 60% of cats are overweight or obese. Overweight/obese research cats (n = 7) were transitioned from a maintenance diet to a reduced calorie diet fed ad libitum for seven days, then calories were restricted to achieve 1-2% weight loss per week for an additional 77 days. Cats then received their original maintenance diet again for 14 days. Significant intentional weight loss was noted after calorie restriction (adjusted p < 0.0001). 16S rRNA gene amplicon sequencing and targeted SCFA metabolomics were performed on fecal samples. Fecal microbial community structure significantly differed between the four study phases (PERMANOVA p = 0.011). Fecal propionic acid was significantly higher during diet-induced weight loss (adjusted p < 0.05). Spearman correlation revealed the relative abundances of Prevotella 9 copri (ρ = 0.6385, p = 0.0006) and Blautia caecimuris (ρ = 0.5269, p = 0.0068) were significantly correlated with propionic acid composition. Like humans, obese cats experienced an altered microbial community structure and function, favoring propionic acid production, during diet-induced weight loss.

Plant-Based Dairy Alternatives Contribute to a Healthy and Sustainable Diet.

Plant-based foods are increasing in popularity as more and more people are concerned about personal and planetary health. The consumption of plant-based dairy alternatives (PBDAs) has assumed a more significant dietary role in populations shifting to more sustainable eating habits. Plant-based drinks (PBDs) made from soya and other legumes have ample protein levels. PBDs that are appropriately fortified have adequate levels of important vitamins and minerals comparable to dairy milk. For the PBDs examined, the greenhouse gas emissions were diminished by 59-71% per 250 mL, and the land use and eutrophication impact was markedly less than the levels displayed by dairy milk. The water usage for the oat and soya drinks, but not rice drinks, was substantially lower compared to dairy milk. When one substitutes the 250 mL serving of dairy milk allowed within the EAT Lancet Planetary Health Diet for a fortified plant-based drink, we found that the nutritional status is not compromised but the environmental footprint is reduced. Combining a nutrient density score with an environmental index can easily lead to a misclassification of food when the full nutrition profile is not utilized or only a selection of environmental factors is used. Many PBDAs have been categorized as ultra-processed foods (UPFs). Such a classification, with the implied adverse nutritional and health associations, is inconsistent with current findings regarding the nutritional quality of such products and may discourage people from transitioning to a plant-based diet with its health and environmental advantages.

A Comprehensive Analysis of the Nutritional Composition of Plant-Based Drinks and Yogurt Alternatives in Europe.

Concerns for human and planetary health have led to a shift towards healthier plant-based diets. Plant-based dairy alternatives (PBDA) have experienced exponential market growth due to their lower environmental impact compared to dairy products. However, questions have arisen regarding their suitability as dairy substitutes and their role in food-based dietary guidelines (FBDG). Our study aimed to analyse the nutritional profiles of leading PBDA across Europe and compare them with their dairy counterparts. We examined the nutritional profiles of 309 unflavoured PBDA representing the European market leaders, including 249 plant-based drinks (PBD) and 52 plant-based alternatives to yogurt (PBAY). PBD and PBAY, excluding coconut varieties, were low in saturated fat (<1 g per serving). Seventy percent of PBDA were unsweetened, and most had sugar levels comparable to dairy. Except for soya varieties, PBDA protein levels were lower than dairy. Organic PBDA lacked micronutrients due to legal restrictions on fortification. Among non-organic PBDA, 76% were fortified with calcium, 66% with vitamin D, and 60% with vitamin B12. Less than half were fortified with vitamin B2, and a few with iodine (11%) and vitamin A (6%). PBAY were less frequently fortified compared to PBD. PBDA displayed a favourable macronutrient profile despite lower protein levels, which would be compensated for by other protein-dense foods in a usual mixed diet. Enhancing fortification consistency with dairy-associated micronutrients would address concerns regarding PBDA's integration into FBDG. Our analysis supports the inclusion of fortified PBDA in environmentally sustainable FBDG for healthy populations.

Pharmacological Modulation of Energy and Metabolic Pathways Protects Hearing in the Fus1/Tusc2 Knockout Model of Mitochondrial Dysfunction and Oxidative Stress.

Tightly regulated and robust mitochondrial activities are critical for normal hearing. Previously, we demonstrated that Fus1/Tusc2 KO mice with mitochondrial dysfunction exhibit premature hearing loss. Molecular analysis of the cochlea revealed hyperactivation of the mTOR pathway, oxidative stress, and altered mitochondrial morphology and quantity, suggesting compromised energy sensing and production. Here, we investigated whether the pharmacological modulation of metabolic pathways using rapamycin (RAPA) or 2-deoxy-D-glucose (2-DG) supplementation can protect against hearing loss in female Fus1 KO mice. Additionally, we aimed to identify mitochondria- and Fus1/Tusc2-dependent molecular pathways and processes critical for hearing. We found that inhibiting mTOR or activating alternative mitochondrial energetic pathways to glycolysis protected hearing in the mice. Comparative gene expression analysis revealed the dysregulation of critical biological processes in the KO cochlea, including mitochondrial metabolism, neural and immune responses, and the cochlear hypothalamic-pituitary-adrenal axis signaling system. RAPA and 2-DG mostly normalized these processes, although some genes showed a drug-specific response or no response at all. Interestingly, both drugs resulted in a pronounced upregulation of critical hearing-related genes not altered in the non-treated KO cochlea, including cytoskeletal and motor proteins and calcium-linked transporters and voltage-gated channels. These findings suggest that the pharmacological modulation of mitochondrial metabolism and bioenergetics may restore and activate processes critical for hearing, thereby protecting against hearing loss.

Role of mitochondrial dysfunction and oxidative stress in sensorineural hearing loss.

Sensorineural hearing loss (SNHL) can either be genetically inherited or acquired as a result of aging, noise exposure, or ototoxic drugs. Although the precise pathophysiological mechanisms underlying SNHL remain unclear, an overwhelming body of evidence implicates mitochondrial dysfunction and oxidative stress playing a central etiological role. With its high metabolic demands, the cochlea, particularly the sensory hair cells, stria vascularis, and spiral ganglion neurons, is vulnerable to the damaging effects of mitochondrial reactive oxygen species (ROS). Mitochondrial dysfunction and consequent oxidative stress in cochlear cells can be caused by inherited mitochondrial DNA (mtDNA) mutations (hereditary hearing loss and aminoglycoside-induced ototoxicity), accumulation of acquired mtDNA mutations with age (age-related hearing loss), mitochondrial overdrive and calcium dysregulation (noise-induced hearing loss and cisplatin-induced ototoxicity), or accumulation of ototoxic drugs within hair cell mitochondria (drug-induced hearing loss). In this review, we provide an overview of our current knowledge on the role of mitochondrial dysfunction and oxidative stress in the development of SNHL caused by genetic mutations, aging, exposure to excessive noise, and ototoxic drugs. We also explore the advancements in antioxidant therapies for the different forms of acquired SNHL that are being evaluated in preclinical and clinical studies.

Which Components of the Simple Shoulder Test Show Improvement After Scapulothoracic Fusion for Recalcitrant Scapular Winging? Clinical Results at a Minimum of 5 Years of Follow-up.

BACKGROUND: Scapular winging is an uncommon but important cause of shoulder pain and disability. Surgical management can include soft tissue procedures such as split pectoralis major transfer, the Eden-Lange procedure, or a triple tendon transfer. When these procedures do not alleviate symptomatic winging or are inappropriate, scapulothoracic fusion is an alternative, but data on its longer-term effectiveness are sparse. QUESTIONS/PURPOSES: (1) What changes in outcome scores were observed (VAS, Single Assessment Numeric Evaluation [SANE], and Simple Shoulder Test [SST] scores), and what proportion of the patients improved by an amount larger than the minimum clinically important difference (MCID) for the outcome tool in question? (2) Which components of the SST are patients able to perform at a minimum of 5 years? (3) What complications occurred after surgery? METHODS: We performed a retrospective study in a single, large, urban referral medical center of patients who underwent scapulothoracic fusion. Between January 2011 and November 2016, 15 patients underwent scapulothoracic fusion to treat symptomatic scapular winging. Only patients with nondystrophic etiology were included in the analysis (n = 13). Of the 13 remaining patients, one patient was lost to follow-up and another patient died during data collection, leaving 11 patients for the final analysis. Six patients had brachial plexus injuries affecting multiple nerve roots and periscapular muscles, and five had persistent symptoms despite prior tendon transfer. The median age of the patients was 43 years (range 20 to 67 years), and there were six male and five female patients. All patients had a minimum of 5 years of follow-up. There was a median follow-up of 79 months (range 61 to 128 months). The VAS pain score (range 0 to 10, higher scores represent more pain; MCID = 2), SST score (range 0 to 12, higher scores represent less pain and better shoulder function; MCID = 2.3), and SANE score (range 0 to 100, higher scores represent better shoulder function; MCID = 28) were recorded before surgery and at the most recent follow-up. We compared scores from before surgery with those taken at the most recent follow-up and ascertained the proportion of patients whose improvement exceeded the MCID. The number of patients achieving fusion (as confirmed by a CT image), complications, and reoperations was recorded via a record review as well as direct patient query by telephone. RESULTS: The median VAS pain score improved from 7 (range 3 to 10) preoperatively to 3 (range 2 to 5) at the latest follow-up (p < 0.001). The median SANE score improved from 30 (range 0 to 60) preoperatively to 65 (range 40 to 85) at the latest follow-up (p < 0.001). The median SST score improved from 0 (range 0 to 9) to 8 (range 5 to 10) at the latest follow-up (p < 0.001). Ten of 11 patients had improvements exceeding the MCID for VAS, six of 11 had improvements for SANE scores, and nine of 11 had improvements for SST. Preoperative to postoperative improvements in these components of the SST were seen (responses of "yes"): comfort at rest (three of 11 improved to 11 of 11; p < 0.001), sleep comfortably (three of 11 improved to 11 of 11; p < 0.001), place coin on shelf (two of 11 improved to 10 of 11; p < 0.001), lift 1 pound above shoulder (two of 11 improved to eight of 11; p = 0.03), and carry 20 pounds with the arm at side (one of 11 improved to nine of 11; p < 0.001). All 11 patients had successful fusion noted on CT images. There were three complications (progression of glenohumeral arthritis, broken wires, and perioperative chest tube placement) and one reoperation for progression of glenohumeral arthritis with subsequent total shoulder arthroplasty. CONCLUSION: Patients with recalcitrant symptomatic scapular winging often undergo an exhaustive course of clinical examinations, diagnostic tests, physical therapy, and multiple surgical procedures. Those with brachial plexus palsy with involvement of multiple nerves may continue to have symptoms despite nonoperative management and subsequent soft tissue tendon transfers. Scapulothoracic fusion could be considered for patients with persistent pain and decreased function because of recalcitrant scapular winging who are either not candidates for the procedure or have persistent symptoms despite prior soft tissue procedures. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Ankle and Foot: Focus on Inflammatory Disease.

The ankle and foot have numerous bones and complex joints that can be affected by several types of inflammatory arthritis with different patterns and various radiologic signs, depending on the phase of the disease. Involvement of these joints is most frequently seen in peripheral spondyloarthritis and rheumatoid arthritis in adults and juvenile idiopathic arthritis in children. Although radiographs are a mainstay in the diagnostic process, ultrasonography and especially magnetic resonance imaging allow early diagnosis and are crucial diagnostic tools. Some diseases have typical features based on target populations (e.g., adults versus children, men versus women), but others may have overlapping imaging characteristics. We highlight key diagnostic features and describe appropriate investigations to guide clinicians toward the correct diagnosis and provide support during disease monitoring.

Nutritional Content of Non-Dairy Frozen Desserts.

There is a growing interest in non-dairy alternatives fueled by concerns about personal health and the health of the planet. Sales of non-dairy frozen desserts have increased along with other non-dairy alternatives such as plant-based beverages, cheeses, yogurts and creamers. The aim of this study was to conduct a cross-sectional survey of plant-based frozen desserts to determine their nutritional content. A total of 358 plant-based frozen desserts were analyzed from the nutrition label listed on the commercial container. The various products were based upon coconut (n = 126), oat milk (n = 63), almonds (n = 42), cashews (n = 25), soy (n = 11), macadamia milk (n = 9), olive oil (n = 8), faba bean (n = 8), canola oil (n = 8), rice milk (n = 6), sunflower milk (n = 6), avocado (n = 5), pea protein (n = 5) and various fruits, nuts and mixed blends (n = 36). While 90% of the frozen desserts had high sugar levels, 73% had high levels of saturated fat (due to the presence of coconut oil) and only one in four had high levels of fat. None of the products were fortified with calcium, vitamin D or B12, but one in six products had iron levels/serving of at least 10% of Daily Value (DV) and 1 in 6 had protein levels/serving similar to regular dairy ice cream. Food manufacturers need to produce new non-dairy frozen desserts that are more nutritious, since few brands (such as those based upon avocado, apple and hemp protein, or fava bean) presently provide consumers choices with lower saturated fat and sugar levels and/or higher protein levels.

Outer hair cell function is normal in ßV spectrin knockout mice.

Reports have proposed a putative role for ßV spectrin in outer hair cells (OHCs) of the cochlea. In an ongoing investigation of the role of the cytoskeleton in electromotility, we tested mice with a targeted exon deletion of ßV spectrin (Spnb5), and unexpectedly find that Spnb5(-/-) animals' auditory thresholds are unaffected. Similarly, these mice have normal OHC electromechanical activity (otoacoustic emissions) and non-linear capacitance. In contrast, magnitudes of auditory brainstem response (ABR) wave 1-amplitudes are significantly reduced. Evidence of a synaptopathy was absent with normal hair cell CtBP2 counts. In Spnb5(-/-) mice, the number of afferent and efferent nerve fibers is decreased. Consistent with this data, Spnb5 mRNA is present in Type I and II spiral ganglion neurons, but undetectable in OHCs. Together, these data establish that ßV spectrin is important for hearing, affecting neuronal structure and function. Significantly, these data support that ßV spectrin as is not functionally important to OHCs as has been previously suggested.

Virucidal Activity of Over-the-Counter Oral Care Products Against SARS-CoV-2.

PURPOSE: The oral cavity is an important entry point for SARS-CoV-2 infection. This study tested whether four commercially available mouthrinses and dentifrices have in vitro virucidal activity against SARS-CoV-2 (=4 log10 reduction in viral titer). MATERIALS AND METHODS: One part of stock SARS-CoV-2 virus plus one part 0.3 g/l bovine serum albumin were mixed with eight parts of test product solution. After 30 s for the rinses, or 60 s for the dentifrices, the mixture was quenched in an appropriate neutralizer, serially diluted, and inoculated onto Vero E6 cells to determine viral titer. Triplicate runs were performed for each test condition with appropriate controls for test product cytotoxicity, viral interference, and neutralizer effectiveness. Test products included: 1.5% hydrogen peroxide (H2O2) rinse; 0.07% cetylpyridinium chloride (CPC) rinse; 0.454% stannous fluoride (SnF2) dentifrice A; and 0.454% SnF2 dentifrice B. RESULTS: ?The 1.5% H2O2 rinse, 0.07% CPC rinse, SnF2 dentifrice A, and SnF2 dentifrice B all produced > 4 log10 reduction in SARS-CoV-2 titer. CONCLUSION: All four test products displayed potent virucidal activity in vitro. Clinical studies are warranted to determine what role, if any, these oral care products might play in preventing transmission of SARS-CoV-2 or in the management of patients currently diagnosed with COVID-19 illness.

The minimal clinically important differences of the Simple Shoulder Test are different for different arthroplasty types.

BACKGROUND: Preoperative and postoperative patient self-reported measures are the key to understanding the benefit of shoulder arthroplasty for patients with different diagnoses and having different surgical approaches. The minimal clinically important difference (MCID) for patient-reported outcomes such as the Simple Shoulder Test (SST) is often used to document the amount of improvement that is of importance to the patient; however, the MCID may differ for different types of shoulder arthroplasty. The objective of this study was to report the MCID of the SST and the MCID of the percentage of maximal possible improvement (%MPI) for 5 different arthroplasty types. METHODS: Eight hundred eighty-seven patients undergoing shoulder arthroplasty with preoperative SST scores, 2-year postoperative SST scores, and patient satisfaction were included. The sample comprised 368 patients undergoing anatomic total shoulder arthroplasty (aTSA), 330 patients undergoing ream-and-run arthroplasty (R&R), 80 patients undergoing reverse total shoulder arthroplasty (rTSA), 53 patients undergoing cuff tear arthropathy arthroplasty, and 56 patients undergoing hemiarthroplasty. For each type of arthroplasty, the anchor-based method was used for calculating the MCID for both absolute SST scores and %MPI. RESULTS: Significant improvements in SST values were seen for all arthroplasty types. The MCID for SST change was 2.3 overall but ranged from 1.6 for aTSA, to 2.6 for R&R, to 3.7 for rTSA. The MCID for %MPI was 32% overall but ranged from 22% for aTSA to 42% for hemiarthroplasty. The percentage of patients exceeding the MCID threshold was highest for aTSA at 96% and lowest for hemiarthroplasty at 61%. CONCLUSION: The same MCID value may not be appropriate for different types of shoulder arthroplasty. This study reports MCID thresholds that can be used when assessing the effectiveness for each of the common types of shoulder arthroplasty.

Nutritional Profiles of Non-Dairy Plant-Based Cheese Alternatives.

With the growing interest in non-dairy products, there has been a surge of interest in consumers seeking plant-based cheese alternatives spurred by a desire to improve individual health and achieve a more sustainable food supply. The aim of this study was to conduct a cross-sectional survey of non-dairy cheese alternatives available in the United States and to evaluate their nutritional content. A total of 245 non-dairy plant-based cheese alternatives were analyzed using their nutritional facts labels. The various cheese alternatives were based upon coconut oil (n = 106), cashews and coconut (n = 61), cashews (n = 35), oats (n = 16), almonds (n = 7), soy (n = 6), palm fruit oil (n = 5), and other blends (n = 9). Only 3% of these cheese alternatives had 5 g or more of protein, while 19%, 14%, and 1% were fortified with calcium, vitamin B12, and vitamin D, respectively. Almost 60% had high levels of saturated fat, while 15% had low sodium levels. The products based on cashews alone more commonly had the highest protein levels and the lowest sodium and saturated fat levels. Those containing coconut oil more commonly had higher saturated fat and sodium levels and were most frequently fortified with vitamin B12. Few of these products could be considered good dietary sources of either protein or calcium.

Single particle cryo-EM structure of the outer hair cell motor protein prestin.

The mammalian outer hair cell (OHC) protein prestin (Slc26a5) differs from other Slc26 family members due to its unique piezoelectric-like property that drives OHC electromotility, the putative mechanism for cochlear amplification. Here, we use cryo-electron microscopy to determine prestin's structure at 3.6 Å resolution. Prestin is structurally similar to the anion transporter Slc26a9. It is captured in an inward-open state which may reflect prestin's contracted state. Two well-separated transmembrane (TM) domains and two cytoplasmic sulfate transporter and anti-sigma factor antagonist (STAS) domains form a swapped dimer. The transmembrane domains consist of 14 transmembrane segments organized in two 7+7 inverted repeats, an architecture first observed in the bacterial symporter UraA. Mutation of prestin's chloride binding site removes salicylate competition with anions while retaining the prestin characteristic displacement currents (Nonlinear Capacitance), undermining the extrinsic voltage sensor hypothesis for prestin function.

Coupling between outer hair cell electromotility and prestin sensor charge depends on voltage operating point.

The OHC drives cochlear amplification, and prestin activity is the basis. The frequency response of nonlinear capacitance (NLC), which is a ratiometric measure of prestin's voltage-sensor charge movement (dQp/dVm), depends on the location of AC voltage excitation along prestin's operating voltage range, being slowest at the voltage (Vh) where NLC peaks. Here we directly investigate the coupling between prestin charge movement (Qp) and electromotility (eM) at frequencies up to 6.25 kHz, and find tight correspondence between the two at operating voltages displaced from Vh. Near Vh, however, eM shows a slower frequency response than Qp. We reason that coupling is more susceptible to molecular/cellular loads at Vh, where prestin compliance is expected to be maximal. Recent cryo-EM studies have begun to shed light on structural features of prestin that impact its performance against loads. This article is part of the Special Issue Outer hair cell Edited by Joseph Santos-Sacchi and Kumar Navaratnam.