The Figure-of-Eight Ligament Reconstruction in Thumb Carpometacarpal Instability: Surgical Technique and Clinical Outcomes.

PURPOSE: This study reviewed the results of the figure-of-eight ligament reconstruction, a technique used in the surgical management of thumb carpometacarpal (CMC) instability. This technique establishes joint stability through forces originating within the CMC joint, providing volar and dorsal support. METHODS: We evaluated the outcomes of 15 patients with nontraumatic, nonarthritic thumb CMC instability treated with the figure-of-eight ligament reconstruction technique. This technique involves routing a graft of the palmaris longus tendon through the base of the first metacarpal and trapezium bone in a figure-of-eight fashion. Preoperative visual analog scale (0-100) for pain and Michigan Hand Outcomes Questionnaire total scores were compared with 3- and 12-month postoperative scores. Secondary outcomes included strength, range of motion, patient satisfaction, return to work, and complications. RESULTS: A significant improvement between intake and 12 months after surgery was observed for both Michigan Hand Outcomes Questionnaire total scores (53, SD 3 vs 70, SD 4) and visual analog scale pain scores (63, SD 4 vs 36, SD 7). Additionally, after surgery, restored thumb CMC joint stability was reported for all patients. Strength and range of motion improved between intake and 12 months after surgery. The median return to work was 6 weeks. Nine (60%) patients rated their satisfaction as "excellent" or "good," and 11 (73%) patients said that they would undergo the surgery again. CONCLUSIONS: The figure-of-eight ligament reconstruction significantly improves pain and function in patients with thumb CMC instability while restoring joint stability and preserving range of motion, making it a suitable technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Co-occurrence of tethered cord syndrome and cervical spine instability in hypermobile Ehlers-Danlos syndrome.

The Ehlers-Danlos Syndromes (EDS) represent a group of hereditary connective tissue disorders, with the hypermobile subtype (hEDS) being the most prevalent. hEDS manifests with a diverse array of clinical symptoms and associated comorbidities spanning the musculoskeletal, neurological, gastrointestinal, cardiovascular, and immunological systems. hEDS patients may experience spinal neurological complications, including cervico-medullary symptoms arising from cranio-cervical and/or cervical instability/hypermobility, as well as tethered cord syndrome (TCS). TCS is often radiographically occult in nature, not always detectable on standard imaging and presents with lower back pain, balance issues, weakness in the lower extremities, sensory loss, and bowel or bladder dysfunction. Cervical instability due to ligament laxity can lead to headaches, vertigo, tinnitus, vision changes, syncope, radiculopathy, pain, and dysphagia. TCS and cervical instability not only share clinical features but can also co-occur in hEDS patients, posing challenges in diagnostics and clinical management. We present a review of the literature and a case study of a 20-year-old female with hEDS, who underwent surgical interventions for these conditions, highlighting the challenges in diagnosing and managing these complexities and underscoring the importance of tailored treatment strategies to improve patient outcomes.

Isolated Polyethylene Insert Exchange for Instability after Total Knee Arthroplasty: Comparable Survival Rates and Range of Motion and Improved Clinical Scores Regardless of Hyperextension.

Background: Isolated polyethylene insert exchange (IPIE) has not been established as a treatment option for hyperextension instability after primary total knee arthroplasty (TKA). The purpose of the study was to evaluate the survival rate and clinical outcomes of IPIE for the treatment of instability with or without hyperextension after TKA. Methods: This study retrospectively reviewed 46 patients who underwent IPIE for symptomatic prosthetic knee instability by dividing them into 2 groups based on the presence of hyperextension (without for group I and with for group IH). Patient demographics, clinical scores, radiographic data, range of motion (ROM), and surgical information were collected. Clinical failure was defined as a subsequent surgery following IPIE for any reason. The survival rate of IPIE and differences in demographics, clinical scores, and ROM were compared. Results: There were 46 patients (91% were women) with an average age of 70.1 years and a mean follow-up of 44.8 months. The average time between primary TKA and IPIE surgery was 6.5 ± 4.2 years, and during IPIE, 2 out of the 8 cruciate-retaining inserts were converted to "deep-dish" ultracongruent inserts while the insert thickness increased from 11.9 ± 1.8 mm to 17.1 ± 3.1 mm. After IPIE surgery, a significantly thicker tibial insert was used in the group with hyperextension (15.39 ± 2.4 mm for group I, 18.3 ± 2.9 mm for group IH; p < 0.001 by independent t-test), and no significant differences were observed in the ROM and clinical scores before and after IPIE between the 2 groups. The overall survival rate for IPIE was 83% at 5 years and 57% at 10 years, and there were no statistically significant differences between the groups using the Cox proportional hazards regression model. Conclusions: IPIE demonstrated an overall survival rate of 83% at 5 years with no difference in the recurrence of instability regardless of hyperextension. This study highlighted the effectiveness of using thicker inserts to resolve instability without significant differences in the ROM or clinical scores between the groups, suggesting its potential as a decision-making reference for surgeons.

Comparison of Midterm Outcomes between All-Inside Arthroscopic and Open Modified Broström Procedures as Treatment for Chronic Ankle Instability.

Background: Although the all-inside arthroscopic modified Broström operation (AMBO) and open modified Broström operation (OMBO) for chronic lateral ankle instability (CLAI) showed favorable outcomes up to 1-year short-term follow-up, concerns about the long-term stability of AMBO are still present. Therefore, we aimed to compare midterm outcomes between the 2 methods by extending the observation period. Methods: Fifty-four patients undergoing ankle surgery between August 2013 and July 2017 were included in the AMBO (n = 37) and OMBO (n = 17) groups. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS) were used to evaluate the clinical outcomes. Anterior drawer test and talar tilt angle were used to evaluate the radiological outcomes. The mean follow-up duration was 59.69 months. Results: The 2 groups both showed improved clinical and radiological results statistically. In addition, they did not differ in age, sex, or preoperative AOFAS ankle-hindfoot scale score, VAS score, anterior drawer test, or talar tilt angle. No significant difference in the final follow-up postoperative clinical scores or radiological outcomes was observed. Conclusions: AMBO and OMBO as treatments for CLAI did not yield differing clinical or radiological outcomes at a mean follow-up time point of 59.69 months.

Quantifying instability in neurological disorders EEG based on phase space DTM function.

Classifying individuals with neurological disorders and healthy subjects using EEG is a crucial area of research. The current feature extraction approach focuses on the frequency domain features in each of the EEG frequency bands and functional brain networks. In recent years, researchers have discovered and extensively studied stability differences in the electroencephalograms (EEG) of patients with neurological disorders. Based on this, this paper proposes a feature descriptor to characterize EEG instability. The proposed method starts by forming a signal point cloud through Phase Space Reconstruction (PSR). Subsequently, a pseudo-metric space is constructed, and pseudo-distances are calculated based on the consistent measure of the point cloud. Finally, Distance to Measure (DTM) Function are generated to replace the distance function in the original metric space. We calculated the relative distances in the point cloud by measuring signal similarity and, based on this, summarized the point cloud structures formed by EEG with different stabilities after PSR. This process demonstrated that Multivariate Kernel Density Estimation (MKDE) based on a Gaussian kernel can effectively separate the mappings of different stable components within the signal in the phase space. The two average DTM values are then proposed as feature descriptors for EEG instability.In the validation phase, the proposed feature descriptor is tested on three typical neurological disorders: epilepsy, Alzheimer's disease, and Parkinson's disease, using the Bonn dataset, CHB-MIT, the Florida State University dataset, and the Iowa State University dataset. DTM values are used as feature inputs for four different machine learning classifiers, and The results show that the best classification accuracy of the proposed method reaches 98.00 %, 96.25 %, 96.71 % and 95.34 % respectively, outperforming commonly used nonlinear descriptors. Finally, the proposed method is tested and analyzed using noisy signals, demonstrating its robustness compared to other methods.

Management of the In-Season Athlete with an Anterior Shoulder Dislocation.

Management of the in-season athlete presenting with an anterior shoulder dislocation is a nuanced process that continues to be refined. Options and pathways between nonoperative and operative treatment have undergone many iterations over a century of orthopedic research and advancement. It requires an understanding of sport-specific demands and the individual athlete's goals. The orthopedic surgeon must have mastery of the natural history, treatment options, and outcomes of anterior shoulder dislocations. Balance of these factors is delicate and highly individualized for each athlete; and is why management of the in-season athlete with an anterior shoulder dislocation remains an art for the orthopedic surgeon.

Good Clinical Outcomes and Low Recurrence Rate in Patients undergoing Arthroscopic Revision Latarjet for Failed Arthroscopic Bankart Repair.

BACKGROUND: The role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. OBJECTIVE: To assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. METHODS: Between 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome score (CS), and Single Assessment Numeric Evaluation (SANE). Dislocations, subluxations, complications, pre and postoperative level of activity and degree of osteoarthritis were also assessed. RESULTS: A total of 77 patients, mean age at revision surgery 31.2 ± 9.1 and with either one (n = 59), two (n = 13), or three (n = 4) arthroscopic previous stabilizations underwent revision surgery using arthroscopic Latarjet procedure were studied. Postoperatively, the mean ROWE and CS scores increased from 41.8 ± 16 to 90.7 ± 14.3 (p<0.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (p<0.001), respectively. WOSI decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (p<0.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using SANE score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al were found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six dislocations after revision surgery were reported (7.8%). In four failed cases an Eden-Hybinette procedure was conducted and in remaining two patients an arthroscopic extraarticular anterior capsular reinforcement was performed. Significantly decreased level of athletic activity was observed postoperatively (p= 0.01). CONCLUSIONS: Arthroscopic Latarjet for revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with low rate of recurrences and complications. However, decreased level of athletic activity is expected.

Morphometric analysis of atlas lateral mass in Down syndrome cases with relevance to surgical intervention.

PURPOSE: Surgical stabilization of the Atlas vertebrae is indicated for severe atlantoaxial instability (AAI) in patients with Down syndrome (DS). This study aims to evaluate the morphological characteristics of the Atlas lateral mass (ALM) in patients with DS with regard to safe instrumentation for surgical stabilization and to compare them with non-syndromic group. METHODS: This multicenter, retrospective, case-control study included age- and sex-matched patients with and without DS aged > 7 years with a cervical computed tomography (CT) scan. After three-dimensional CT reconstruction, nine parameters were evaluated for both groups. All included measurements were performed by a neuroradiologist who was blinded to clinical data. RESULTS: Forty-three of 3,275 patients with DS were included in this study. Matching number of consecutive patients without DS were identified (mean age: 16 years). Patients with DS were significantly shorter than those without DS. Seven of nine parameters related to ALM were significantly lower in patients with DS than in those in the control group, including anterior wall height (AH), posterior wall height (PH), their ratio, and arch-ALM angle. On adjusting data for patient height, patients with DS had a smaller PH, lower PH/AH ratio, and steeper arch-ALM angle than the control group. CONCLUSIONS: Patients with DS had a smaller posterior ALM wall and a steeper arch-ALM angle than the control group without DS. This information is important for surgical planning of safe posterior ALM exposure and safe instrumentation for surgical stabilization in patients with DS.

Can magnetic resonance imaging findings effectively diagnose the instability observed on radiographs in patients with degenerative lumbar spinal stenosis?

BACKGROUND: Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs. METHODS: We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups. RESULTS: A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27-3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68-3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32-2.84; P = 0.021) were identified as factors associated with instability. CONCLUSIONS: Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.

The Feasibility of Condylar Screws for Occipitocervical Fusion in Arabs: Computed Tomography-Based Morphometric Study.

STUDY DESIGN: Retrospective, cross-sectional study. OBJECTIVES: Occipitocervical fusion is indicated for various conditions. Some techniques require placement of screws in the occipital condyle. The objective of this study was to analyze the morphometric features of the occipital condyle among Arabs. METHODS: Computed tomography (CT)-based morphometric analysis of occipital condyles of 200 Arab skeletally mature patients (400 condyles) was done. Axial width of at least 8 mm and coronal height of at least 6.5 mm are the cutoff values for feasibility of condylar screw placement. RESULTS: The mean age of the patients was 48.0 ± 18.3 years. Males were 53.5% (107) of the sample. The mean axial condylar width and length were 8.5 ± 1.5 mm and 20.3 ± 2.6 mm, respectively, while the mean axial screw angle was 35.9° ± 5.5° from midline. The mean sagittal condylar length and height were 16.1 ± 1.9 mm and 8.8 ± 1.5 mm, respectively. The mean condylar coronal height was 8.2 ± 1.4 mm. Based on axial width and coronal height measurements, 150 (37.5%) condyles could safely fit a 3.5 mm condylar screw. One hundred and four (55.9% female condyles) condyles cannot fit a screw in females, while 46 (21.5% male condyles) condyles cannot fit a screw in males. CONCLUSIONS: Condylar screw for occipitocervical fusion is feasible for the majority of Arabs in our sample; however, this applies to slightly less than half of the female condyles. Detailed preoperative radiological planning is critical to avoid complications related to occipital condyle screw placement.

Imaging evaluation of hip capsule disorders: a comprehensive review.

The hip capsule and capsular ligaments play crucial roles in providing hip stability and mobility. Their role in hip pathologies is being increasingly recognized, underscoring the need for thorough imaging evaluation, which is better performed through MRI-arthrography. Various diseases affect the hip capsule directly or indirectly. Improper mechanical loading, as seen in conditions such as femoroacetabular impingement or chondrolabral pathology, can induce capsule thickening, whereas thinning and laxity of the capsule are characteristics of microinstability. Inflammatory conditions, including adhesive capsulitis of the hip, crystal deposition disease, polymyalgia rheumatica, and infections, also lead to capsular changes. Traumatic events, particularly posterior hip dislocations, cause capsule ligament disruption and may lead to hip macroinstability. Friction syndromes can lead to capsular edema due to impingement of the adjacent capsule. Hip arthroscopy can result in various postoperative findings ranging from fibrotic adhesions to focal or extensive capsule discontinuation. Although the significance of hip capsule thickness and morphology in the pathogenesis of hip diseases remains unclear, radiologists must recognize capsule alterations on imaging evaluation. These insights can aid clinicians in accurately diagnosing and effectively managing patients with hip conditions.

Outcomes following Arthroscopic Treatment of Off-Track Hill-Sachs Lesions Using Fresh Osteochondral Allograft Plugs: A Case Series.

BACKGROUND: Osteochondral allograft (OCA) transplantation is a well-described technique for the treatment of large, engaging Hill-Sachs lesions (HSLs). Traditionally, OCAs are size-matched to the defect, which can be expensive and time-consuming, and the majority of described techniques require an open approach. Recently, an all-arthroscopic approach to Hill-Sachs OCA transplantation using premade plugs was described, eliminating the need for size-matching and graft harvest. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate postoperative outcomes of patients who have undergone arthroscopic treatment of HSLs using premade OCA plugs. We hypothesized that these patients would have improved pain and function without recurrent instability. METHODS: A retrospective chart review was performed using operative reports for a single surgeon with search terms "Hill-Sachs" and "allograft." Patients were excluded if an open approach was used or if graft harvest was performed. Postoperative imaging was reviewed to assess for graft incorporation and reconstitution of the HSL. Recurrent instability and reoperation were recorded. Patients completed surveys including the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). RESULTS: Five patients were identified through chart review and met inclusion criteria. All patients underwent concurrent labral repair and two patients underwent a concurrent open Latarjet procedure. Postoperative radiographs showed reconstitution of the HSLs in all patients. There were no complications in the postoperative period with no recurrent instability or reoperations in any patient. The average ASES score was 87% (higher score indicating better outcome) with standard deviation 9.7, and the average WOSI score was 27% (lower score indicating better outcome) with standard deviation 8.3. CONCLUSION: Favorable outcomes can be expected after arthroscopic treatment of Hill-Sachs lesions using premade OCA plugs. Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches.

Clinical and Molecular Variables Associated With Early Progression to Checkpoint Inhibitors in MSI-High Metastatic Colorectal Cancer: A Retrospective Cohort Study.

BACKGROUND: About one third of patients with deficient mismatch repair/microsatellite instability-high metastatic colorectal cancer (dMMR/MSI-H mCRC) experience primary resistance or early progression on immune checkpoint inhibitors (ICI), while others benefit from exceptionally long-lasting responses. In this single-centre retrospective study, we aimed to identify variables associated with improved overall survival (OS) as well as early disease progression. METHODS: All dMMR/MSI-H mCRC patients treated with ICI between 2014 and 2022 were included. Baseline patient demographics, tumour characteristics as well response and outcome data were recorded. OS was estimated using the Kaplan-Meier method. Uni- and multivariate cox regression analysis was used to identify parameters associated with improved OS. Clinicopathological factors associated with early progression (≤ 12 months after treatment initiation) were assessed using uni- and multivariate logistic regression analysis. RESULTS: About 84 ICI-treated dMMR/MSI-H mCRC patients were included. Progressive disease occurred in 37 (44%) patients, but only in 11 (19%) patients with disease control at 12 months. Median OS was 80 months and improved outcome was associated with a lower neutrophile-to-lymphocyte ratio (NLR) (P = .004) and the presence of immune-related adverse events (irAEs) (P = .015). Early progression was associated with poor performance status (P = .036), a higher blood CRP level (P = .033) and absence of irAEs (P = .002). CONCLUSION: Disease progression in ICI-treated dMMR/MSI-H mCRC rarely occurs in patients experiencing disease control for at least 12 months. Performance status, presence of immune-related adverse events, CRP levels, CEA levels and NLR can be helpful to identify those patients that may benefit from ICI treatment, guiding clinicians in therapeutic decisions.

Femoral head decentration on hip MRI: comparison between imaging planes, methods of contrast administration, and hip deformities.

OBJECTIVES: To compare the prevalence of femoral head decentration (FHD) on different MR imaging planes in patients undergoing direct/indirect hip MR arthrography (MRA) with asymptomatic controls and to evaluate its association with osseous deformities. METHODS: IRB-approved retrospective single-center study of symptomatic hips undergoing direct or indirect hip MRA at 3 T. Asymptomatic participants underwent non-contrast hip MRI at 3 T. FHD was defined as a continuous fluid layer between the acetabulum and femoral head and assessed on axial, sagittal and radial images. The association of intra-articular/intra-venous contrast agents and the prevalence of FHD was evaluated. The association of FHD with osseous deformities and joint damage was assessed using multiple logistic regression analysis. RESULTS: Three-hundred ninety-four patients (447 hips, mean age 31 ± 9 years, 247 females) were included and compared to 43 asymptomatic controls (43 hips, mean age 31 ± 6 years, 26 females). FHD was most prevalent on radial images and more frequent in symptomatic hips (30% versus 2%, p < 0.001). FHD prevalence was not associated with the presence/absence of intra-articular contrast agents (30% versus 22%, OR = 1.5 (95% CI 0.9-2.5), p = 0.125). FHD was associated with hip dysplasia (OR = 6.1 (3.3-11.1), p < 0.001), excessive femoral torsion (OR = 3.0 (1.3-6.8), p = 0.010), and severe cartilage damage (OR = 3.6 (2.0-6.7), p < 0.001). CONCLUSION: While rare in asymptomatic patients, femoral head decentration in symptomatic patients is associated with osseous deformities predisposing to hip instability, as well as with extensive cartilage damage. CRITICAL RELEVANCE STATEMENT: Decentration of the femoral head on radial MRA may be interpreted as a sign of hip instability in symptomatic hips without extensive cartilage defects. Its presence could unmask hip instability and yield promise in surgical decision-making. KEY POINTS: The best method of identifying femoral head decentration is radial MRI. The presence/absence of intra-articular contrast is not associated with femoral head decentration. Femoral head decentration is associated with hip deformities predisposing to hip instability.

Lateral to medial fluoroscopic view improves the accuracy of identifying the MPFL femoral footprint using Schottle's technique.

PURPOSE: This study investigated the effect of different fluoroscopy settings on the accuracy of locating Schottle's point during medial patellofemoral ligament (MPFL) reconstruction. METHODS: The centre of the MPFL femoral footprint was identified and marked on 44 dry femurs. Two standard true lateral knee fluoroscopic images were obtained: (1) medial to lateral (ML) and (2) lateral to medial (LM). The deviation between the anatomically determined MPFL femoral footprint and the fluoroscopically identified point was measured on both fluoroscopic images. An 'acceptable tunnel location' was defined as within a 5- or 7-mm margin of error from the anatomic MPFL footprint. Distal femoral morphometric dimensions were also measured using digital calipers. Statistical analysis determined discrepancies between techniques and their relation to femoral morphometry. RESULTS: The LM view yielded a significantly smaller distance between the anatomical MPFL footprint and Schottle's point compared to the ML view (3.2 ± 1.5 vs. 4.5 ± 2.1 mm, p < 0.001). The LM view achieved acceptable tunnel locations, meeting the 5-mm error criterion in 90.9% of cases, while the ML view achieved 65.9% (p < 0.001). Both views yielded acceptable tunnel locations at similar rates using the 7-mm error criterion (n.s.). The anatomic MPFL footprint was displaced towards the anterior and proximal location in the ML view in reference to the Schottle point. No correlation was observed between any of the morphometric measurements and the deviations. CONCLUSIONS: This study demonstrated that using the LM fluoroscopic view improves the accuracy of femoral tunnel placement when identifying the MPFL footprint via the Schottle technique. Adopting the LM view in surgical practice will help surgeons locate the anatomical femoral footprint accurately, replicating the native MPFL and enhancing clinical outcomes. LEVEL OF EVIDENCE: Level 4, cadaveric study.

Effect of Progressive Balance Control Strategies on Chronic Ankle Instability in Middle-Aged Obese Women.

INTRODUCTION: Chronic ankle instability (CAI) is a disease characterized by persistent feelings of instability in the ankle joint and a propensity for recurrent ankle sprains. It is often caused by ligamentous laxity or neuromuscular deficits. Middle-aged obese females represent a demographic subset at increased risk for CAI due to factors such as reduced proprioception and increased loading on the ankle joint. The gaps in the current evidence suggest that more research is needed on middle-aged obese females, who are particularly vulnerable to CAI due to physiological changes associated with poor balance. OBJECTIVES: This study aims to determine the effect of progressive balance control strategies on CAI in middle-aged obese women. METHOD: In this experimental study, 72 patients with CAI in middle-aged women were selected randomly using a simple random sampling method. Females aged 35-45 with a body mass index (BMI) greater than 27 kg/m2 and a history of ankle sprains greater than one and having residual symptoms. The experimental group (Group B) received progressive balance control strategies, and the conventional group (Group A) received conventional balance exercises. Foot and ankle ability measure (FAAM) scale, push-and-release test (PART), single-leg stance test (SLST), evaluations, and star excursion balance test (SEBT) were used for pre- and posttreatment. RESULTS: The experimental group post-intervention for static balance, dynamic balance, and postural control tests showed extremely significant improvement with a p-value of <0.0001. Between groups A and B, the dynamic balance was considered very significant, with a p-value of 0.0001. In the single-leg stance test, Group B's result was significantly greater than that of Group A's (63.4 + 16.1 and 63.4 + 16.1). PART results indicate that Group B is more significant than Group A (0.76 and 0.51, respectively). CONCLUSIONS: The study concluded that progressive balance control strategy training is effective in middle-aged obese women with CAI.

Displaced sigmoid notch fracture and higher patient age are associated with distal radioulnar joint subluxation.

Background/aim: Distal radius fractures (DRFs) are frequently associated with distal radioulnar joint (DRUJ) instability. The purpose of this study is to evaluate the effect of the sigmoid notch and ulna styloid fracture types on DRUJ subluxation following closed reduction and casting of DRFs via calculating radioulnar ratio (RUR) on postreduction computed tomography (CT) images. Materials and methods: In our study, postreduction CT images of 202 patients with distal radius fractures were evaluated retrospectively. CT images were evaluated for RUR, sigmoid notch fracture, and ulna styloid types. Sigmoid notch fractures were classified as nondisplaced in the sigmoid notch fractures (NDS) and displaced sigmoid notch (DS) fractures; ulna styloid fractures were grouped as the proximal half ulna styloid (PHUS) and distal half ulna styloid (DHUS) fractures. Results: The mean age of Rozental type 3b (62.8 years) was significantly higher among others. The mean RUR value was significantly higher in Rozental type 3a in compared to type 1a and type 2 fractures. PHUS fractures were more common with DS fractures than DHUS fractures. Conclusion: DS fractures and higher patient age are associated with DRUJ subluxation on postreduction CT images following DRFs. DS fractures are seen more commonly with PHUS fractures than DHUS. Patients with PHUS should be carefully assessed for sigmoid notch fractures and DRUJ congruency. These findings could be helpful for preoperative decision making in the treatment of DRFs.

A bibliometric analysis of the top 50 cited studies related to acromioclavicular joint instability.

Background: Acromioclavicular joint (ACJ) injury is a common orthopaedic condition accounting for over 40 % of all shoulder injuries. The purpose of this study is to assess the research trends and characteristics of the top 50 cited articles on ACJ instability. Methods: A systematic search was conducted in Web of Science to identify articles primarily related to ACJ injury or instability. Characteristics including citation number, country of origin, journal and institution of publication, impact factor, authorship, level of evidence, patient demographics, and study type were analyzed and recorded. Results: Research output on ACJ instability has been steadily increasing, with the top 50 cited studies predominantly presenting Level IV evidence. These studies primarily focused on treatment outcomes which included predominantly male patients and exhibited a large variation in citation counts. The American Journal of Sports Medicine was the most productive journal, and the USA was the most productive nation. Conclusion: There is an increasing number of publications in the ACJ instability literature, primarily concentrated in a few institutions and journals, and focusing mainly on treatment outcomes. A significant portion of these publications are of low scientific quality, and there is a notable lack of research on outcomes for females.

Integrative Omics Uncovers Low Tumorous Magnesium Content as A Driver Factor of Colorectal Cancer.

Magnesium (Mg) deficiency is associated with increased risk and malignancy in colorectal cancer (CRC), yet the underlying mechanisms remain elusive. Here, we used genomic, proteomic, and phosphoproteomic data to elucidate the impact of Mg deficiency on CRC. Genomic analysis identified 160 genes with higher mutation frequencies in Low-Mg tumors, including key driver genes such as KMT2C and ERBB3. Unexpectedly, initiation driver genes of CRC, such as TP53 and APC, displayed higher mutation frequencies in High-Mg tumors. Additionally, proteomic and phosphoproteomic data indicated that low Mg content in tumors may activate epithelial-mesenchymal transition (EMT) by modulating inflammation or remodeling the phosphoproteome of cancer cells. Notably, we observed a negative correlation between the phosphorylation of DBN1 at S142 (DBN1S142p) and Mg content. A mutation in S142 to D (DBN1S142D) mimicking DBN1S142p upregulated MMP2 and enhanced cell migration, while treatment with MgCl2 reduced DBN1S142p, thereby reversing this phenotype. Mechanistically, Mg2+ attenuated the DBN1-ACTN4 interaction by decreasing DBN1S142p, which in turn enhanced the binding of ACTN4 to F-actin and promoted F-actin polymerization, ultimately reducing MMP2 expression. These findings shed new light on the crucial role of Mg deficiency in CRC progression and suggest that Mg supplementation may be a promising preventive and therapeutic strategy for CRC.

Use of peptide nucleic acid probe to determine telomere dynamics in improving chromosome analysis in genetic toxicology studies.

Genetic toxicology, strategically located at the intersection of genetics and toxicology, aims to demystify the complex interplay between exogenous agents and our genetic blueprint. Telomeres, the protective termini of chromosomes, play instrumental roles in cellular longevity and genetic stability. Traditionally karyotyping and fluorescence in situ hybridisation (FISH), have been indispensable tools for chromosomal analysis following exposure to genotoxic agents. However, their scope in discerning nuanced molecular dynamics is limited. Peptide Nucleic Acids (PNAs) are synthetic entities that embody characteristics of both proteins and nucleic acids and have emerged as potential game-changers. This perspective report comprehensively examines the vast potential of PNAs in genetic toxicology, with a specific emphasis on telomere research. PNAs' superior resolution and precision make them a favourable choice for genetic toxicological assessments. The integration of PNAs in contemporary analytical workflows heralds a promising evolution in genetic toxicology, potentially revolutionizing diagnostics, prognostics, and therapeutic avenues. In this timely review, we attempted to assess the limitations of current PNA-FISH methodology and recommend refinements.