Search Results (922)

Background: Upper-extremity morbidity after breast cancer surgery—including pain, lymphedema, and restricted shoulder range of motion—often develops gradually, emerging months after treatment and limiting daily activities. We aimed to characterize morbidity trajectories, physical therapy utilization, and predictors of physical therapy use. Methods: A retrospective multicenter cohort included 1602 women treated with breast surgery 0–36 months earlier. Patient-reported outcomes included Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain, range of motion limitation, axillary web syndrome, and lymphedema. Clinical variables included surgery type and nodal procedure. Outcomes were summarized across four postoperative windows (0–6, 7–12, 13–24, 25–36 months). Logistic and multinomial regression identified predictors of physical therapy uptake and timing (early, ≤3 months vs. late, >3 months; No physical therapy). Results: Anxiety declined across postoperative windows (p < 0.001), and axillary web syndrome decreased from early to later periods (p < 0.001). In contrast, range of motion restriction and decreased function remained common without significant differences between windows (p = 0.145 and p = 0.273). Pain was generally low-to-moderate by median [interquartile range], with a modest rise at 7–12 months (p < 0.001). In adjusted multinomial models (reference: Early physical therapy ≤ 3 months), higher pain was associated with No physical therapy and Late physical therapy (both p < 0.05); lymphedema with No PT and Late physical therapy (both p < 0.05); and axillary web syndrome with Late physical therapy (p = 0.001). Other symptoms (range of motion, function level, anxiety and physical activity) were not independently associated with physical therapy timing. Conclusions: Long-term postoperative morbidity is common. Early assessment and structured follow-up can mitigate its impact and should be embedded as core elements of survivorship health-promotion policy. Full article

Osteoarthritis (OA) in the trapeziometacarpal joint (TM) is a prevalent form of hand OA, yet research on biomarkers specific to hand OA remains limited. This study aims to identify systemic plasma biomarkers at baseline in TM OA patients that are associated with patient-reported outcomes one year post-treatment. Blood samples and clinical data were collected prospectively from 143 TM OA patients undergoing conservative therapy, fat grafting, or surgery, with one-year follow-up. Supervised machine learning with Lasso regularization analyzed associations among 10 systemic biomarkers related to cartilage turnover, bone remodeling, pain, or lipid metabolism. Generalized estimating equation models evaluated baseline biomarker associations with one-year outcomes. Patients averaged 61 years, were mostly female (69%), and were primarily treated conservatively (47%). The machine learning model identified associations between outcomes and biomarkers, including PIIANP, Visfatin, adiponectin, and leptin. Adjusted analyses revealed baseline PIIANP associated with VAS, QuickDASH, and TASD improvements, while Visfatin correlated with VAS worsening. We could identify two different plasma markers that could predict the clinical outcome of TM OA treatment. Baseline PIIANP is associated with improvement, while Visfatin is associated with worsening in TM OA outcomes up to one year post-treatment. Further prospective studies are needed to confirm and solidify these findings. Full article

Individuals with head and neck cancers are living longer than ever before, yet many live with the long-term effects of their cancer and treatment. The purpose of this study was to assess the feasibility of a physiatry assessment clinic (PAC) following neck resection and free flap reconstruction, during which physical function was assessed. Methods: Adult patients participating in a larger prehabilitation study were included. Attendance and the ability to complete the physical function assessment were examined. Exploratory analyses were completed to describe physical function, fitness, shoulder, and neck function among PAC attenders. To further understand PAC feasibility, patient-reported outcomes among PAC attenders and non-attenders were examined over 12 months (QuickDASH, NDII, EAT-10). Results: A total of 36 eligible participants (78.2%) from the larger prehabilitation study were approached to participate in the PAC, and 19 of the 36 attended (52.8%). Participants attended on average 8.6 ± 3.6 weeks post surgery, and 100% were able to complete the functional measures. Exploratory data suggest that those who did not attend (17 of 36 approached) had more advanced disease compared to those who attended (p < 0.05). Patient-reported outcomes suggested better shoulder function and swallow function at 6 months among those who attended the clinic versus those who did not. Conclusions: While recruitment to the PAC and assessment completion demonstrated feasibility, attendance posed challenges for patients. These findings highlight the need for innovative approaches to screening patients and tailoring rehabilitation services based on physical impairment. Full article

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection. Full article

Origami structures exhibit significant potential for rapid deployment in post-disaster response and temporary architecture due to their ability to quickly fold and deploy. Further development of these structures into modular components that can be assembled into large-scale architectural systems holds great importance for the fields of architecture and civil engineering. In this study, a thin-walled foldable column was developed based on the “pillow box” origami pattern. This column maintains its three-dimensional configuration during folding, owing to its inherent self-locking characteristic. Two crease-weakening strategies (“dashed-line” and “slit-hole”) were proposed and experimentally validated. A systematic numerical study was conducted to investigate the axial compressive performance of pillow box columns with weakened curved creases. The results indicate that both weakening strategies effectively enable folding while preserving global integrity under compression. The pillow box column with “dashed-line” creases (OCC-D) demonstrated superior load-bearing capacity, with a load-to-weight ratio of up to 658.9, nearly twice that of the corresponding conventional square tube. Parametric analysis of the crease geometry further revealed that increasing the number of crease units enhances the load-bearing performance, and the optimal performance is achieved when the spacing between slit openings equals the slit length ($l_h=l_c$). These findings highlight the advantages of pillow box origami columns as thin-walled load-bearing components, offering new insights for the rapid construction and lightweight design of architectural structures. Full article

Objective: This study aims to evaluate the effectiveness of a combined rehabilitative program integrating Graded Motor Imagery (GMI) and Occupational Therapy in improving upper limb function and autonomy in individuals with acquired brain injuries (ABIs), including stroke and traumatic brain injury. Methods: Twelve patients (mean age of 56.4 years) underwent a six-week intervention combining GMI and Occupational Therapy. Outcome measures included the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), Jebsen Taylor Hand Function Test (JTHFT), Canadian Occupational Performance Measure (COPM), 12-Item Short Form Health Survey (SF-12), Numeric Rating Scale for pain (NRS), and Montreal Cognitive Assessment (MoCA). Assessments were conducted at baseline, post-treatment, and at 3- and 6-month follow-ups. Data were analyzed using the Wilcoxon signed-rank test. Results: Statistically significant improvements (p < 0.05) were found in upper limb function (DASH), occupational performance and satisfaction (COPM), and physical health status (SF-12 physical component). Specific gains in hand function—particularly in writing and eating—were detected using the JTHFT. No significant changes were observed in pain perception or mental health outcomes. Conclusions: The integration of GMI with Occupational Therapy appears to be a promising and well-tolerated intervention for enhancing motor function and daily life participation in individuals with ABI. Although the small sample limits generalizability, these preliminary findings support further investigation through larger, controlled studies. Full article

Background: Glenoid radiolucenct lines (gRLL) and glenoid component subsidence (gSC) after anatomic total shoulder arthroplasty (aTSA) have traditionally been linked to implant loosening and functional decline. However, their impact on long-term clinical outcomes remains unclear. This study aimed to evaluate whether gRLL and gSC are associated with inferior clinical or functional results in patients without revision surgery. Methods: In this retrospective study, 52 aTSA cases (2008–2015) were analyzed with a minimum of five years of clinical and radiographic follow-up. Based on final imaging, patients were categorized according to the presence and extent of gRLL and gSC. Clinical outcomes included the Constant-Murley Score, DASH, VAS for pain, and range of motion (ROM). Radiographic parameters included the critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), and cranial humeral head decentration (DC). Group comparisons were conducted between: (1) ≤2 vs. 3 gRLL zones, (2) 0 vs. 1 zone, (3) 0 vs. 3 zones, (4) gSC vs. no gSC, and (5) DC vs. no DC. Results: Demographics and baseline characteristics were comparable across groups. Functional scores (Constant, DASH), pain (VAS), and ROM were largely similar. Patients with extensive gRLL showed reduced external rotation (p = 0.01), but the difference remained below the MCID. Similarly, gSC was associated with lower forward elevation (p = 0.04) and external rotation (p = 0.03), both below MCID thresholds. No significant differences were observed for DC. Conclusions: Neither extensive gRLL nor gSC significantly impaired long-term clinical or functional outcomes. As these radiographic changes can occur in the absence of symptoms, regular radiographic monitoring is essential, and revision decisions should be made individually in cases of progressive bone loss. Full article

Dietary patterns greatly affect periodontitis, a chronic inflammatory disease that compromises both dental and systemic health. According to the emerging evidence, periodontal risk is more strongly associated with the overall dietary quality, especially fiber density intake, than any one micronutrient. While the average intake in industrialized countries is only half of the recommended 30 g day⁻¹, high-fiber diets such as the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH), and whole-food plant-based diets are consistently associated with a 20–40% lower periodontitis prevalence. Dietary fiber plays a central role in regulating immune responses, strengthening tissue barriers, improving metabolic homeostasis, and shaping a healthy microbiome through its microbial fermentation products: short-chain fatty acids (SCFAs). This makes it a biologically rational and clinical evidence-supported strategy for the prevention and management of periodontitis. Integrating high-fiber diet recommendations into routine periodontal care and public health policies could be a crucial step towards more comprehensive oral and systemic health management. This narrative review elaborates on the mechanistic, observational, and intervention data highlighting the role of dietary fiber, especially SCFAs, in periodontal health. Full article

Background/Objectives: This study aimed to establish a method for evaluating the pathology of lateral elbow tendinopathy (LET) using ultrasonography. Methods: The LET group consisted of 47 patients with 50 elbows, and the control group consisted of 50 healthy adults with 50 elbows. The variables used for the pathological classification of LET included the peak systolic velocity (PSV) of the radial recurrent artery (RRA), fiber orientation intensity, numeric rating scale (NRS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and duration of symptoms. Classification was performed using principal component and cluster analyses. Results: The PSV of the RRA was significantly higher in the LET group (19.10 ± 4.63 cm/s) than in the control group (16.04 ± 2.96 cm/s). The fiber orientation intensity was significantly lower in the LET group (1.62 ± 0.15) than in the control group (1.73 ± 0.12). LET can be classified into three clusters. Cluster 1 showed decreased fiber orientation and moderate NRS and DASH scores. Cluster 2 demonstrated increased PSV of the RRA and severe NRS and DASH scores. Cluster 3 maintained a normal PSV of the RRA and fiber orientation, with mild NRS and DASH scores. No statistically significant differences were noted in the duration of symptoms between clusters. However, symptom duration tended to be longer in Clusters 1, 2, and 3. Conclusions: This study suggests that LET can be classified into mild, inflammatory, and degenerative phases. Full article

Introduction: Genes in the endolysosome and autophagy pathways are major contributors to hereditary spastic paraplegia (HSP). A pathogenetic link between HSP and Alzheimer disease (AD) involving macroautophagy is well established. Sortilin-related receptor 1 (SORL1), an endosomal trafficking protein, plays a key role in glutamatergic neuron homeostasis and white matter tract integrity. Until now, SORL1 has only been associated with dominant AD and cerebral amyloid angiopathy. Methods: A case of HSP with cerebroretinal vasculopathy (CRV) negative on exome sequencing was further investigated using whole-genome sequencing. RNA-seq, Western blot, and immunofluorescence imaging were performed to explore a potential loss-of-function mechanism. Results: Sequencing revealed a biallelic SORL1 splice donor variant (c.1211 + 1G > A). Transcriptomics confirmed nonsense-mediated decay and aberrant splicing, predicting a disrupted reading frame. Reduced SORLA protein levels and significant enlargement of endolysosomes in patient-derived fibroblasts further cemented the pathogenicity of the variant. Conclusions: The probability that SORL1 acts as a recessive disease-causing gene gathers support from the following data: SORL1 genomic constraint score pRec = 1, high meiotic recombination rates on the locus, phenotype of Sorl1^−/− mice reminiscent of HSP with CRV, and endolysosomal enlargement in SORL1^−/− glutamatergic neurons in vitro. Taken together, SORL1 is probably a new candidate for a recessive form of complicated HSP. Full article

Background: Frailty is known to elevate the risk of all-cause mortality and shorten life expectancy. Although the effects of diet on health are well documented, the specific interaction between diet quality and frailty remains unexplored. This research aims to examine the combined effects of various diet quality scores and frailty on all-cause mortality and life expectancy among middle-aged and older adults. Methods: A total of 151,628 participants were sourced from the UK Biobank for analysis. Frailty phenotype (FP) and frailty index (FI), as two different approaches, were used to assess frailty status. Diet quality was evaluated through seven diet quality scores: the Alternate Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH) score, Mediterranean diet (MED) score, Dietary Inflammatory Index (DII), and three plant-based diet indices (overall PDI, healthful PDI, and unhealthful PDI). Cox proportional hazards models were applied to calculate adjusted hazard ratios (HRs) for overall mortality and predict life expectancy differences. Results: Over a median follow-up period of 12.2 years, 8231 deaths were identified. After accounting for potential confounding factors, frail individuals in the unhealthier tertile of diet scores exhibited markedly elevated mortality risks, ranging from 1.99 to 2.07 based on the frailty index and 2.79 to 3.06 based on the frailty phenotype, compared to their robust counterparts in the healthier tertile. Regardless of frailty categories, a healthier diet was associated with longer life expectancy and with lower mortality risk in a dose–response relationship. Conclusions: The healthier tertile of diet scores was found to mitigate the detrimental effects of frailty, emphasizing diet quality as a modifiable factor in promoting healthier aging. Evidence suggests that it is never too late to adopt healthier dietary habits for significant health benefits. Full article

Flammulina velutipes (enoki mushroom) is a functional edible mushroom rich in antioxidants, polysaccharides, mycosterols, fiber, and minerals. Accumulating evidence highlights its therapeutic potential across diverse pathological contexts, including boosting cognitive function. However, its role in neuromodulation has not been systematically explored. This study examined the effects of methanolic and ethanolic extracts of F. velutipes on primary hippocampal neurons. Neurons were treated with different extract concentrations, followed by assessments of cell viability, cytoarchitecture, neuritogenesis, maturation, and neuroprotection under oxidative stress. The extracts were further characterized by GC-MS to identify bioactive metabolites, and molecular docking combined with MM-GBSA binding energy analysis was employed to predict potential modulators. Our results demonstrated that the methanolic extract significantly enhanced neurite outgrowth, improved neuronal cytoarchitecture, and promoted survival under oxidative stress, whereas the ethanolic extract produced moderate effects. Mechanistic studies indicated that these neuroprotective and neurodevelopmental benefits were mediated through activation of the NTRK receptors, as validated by both in vitro assays and molecular docking studies. Collectively, these findings suggest that F. velutipes extracts, particularly methanolic fractions, may serve as promising neuromodulatory agents for promoting neuronal development and protecting neurons from oxidative stress. Full article

Background: Acromioclavicular joint (ACJ) injuries frequently result from trauma to the shoulder girdle and are particularly common among young, physically active individuals. These injuries account for approximately 9% of all traumatic shoulder girdle injuries and often lead to functional impairment and pain. The TightRope^® system, LARS™ band, and Bosworth screw are among over 160 currently described surgical techniques for managing ACJ dislocations. However, there is no consensus regarding the optimal surgical approach, particularly for the management of moderate Rockwood Type III ACJ dislocations. Materials and Methods: In this retrospective study, data from 246 patients who underwent surgery for ACJ dislocation between 2010 and 2018 at the Department of Orthopedics and Trauma Surgery, Medical University of Vienna, were analyzed. Patients were divided into four cohorts based on the surgical technique used: Bosworth screw, LARS (acute), LARS (chronic), and TightRope. Clinical and radiological outcomes were assessed pre- and postoperatively using the Visual Analog Scale (VAS), Constant, Disability of the Arm, Shoulder and Hand Score (DASH), Simple Shoulder Test (SST), University of California—Los Angeles Shoulder Score (UCLA), Short Form Health Survey (SF-36), and American Shoulder and Elbow Surgeons score (ASES), as well as radiographic analysis. Radiological measurements of the acromioclavicular (AC) and coracoclavicular (CC) joint spaces were taken on both the injured and uninjured shoulders to analyze and compare the reduction in joint gaps. Results: All surgical methods resulted in significant reductions in AC and CC joint gaps. The TightRope and LARS acute groups showed the greatest reductions, with minimal complication rates. Complication analysis revealed significant differences in clavicular elevation (p < 0.001) and CC-ligament ossification (p = 0.006), which were most frequent in the Bosworth group and least common in TightRope^® patients, with LARS showing intermediate values. AC joint arthrosis was uncommon in all four groups and did not differ significantly (p = 0.13). Overall, TightRope^® was associated with the most favorable complication profile. The postoperative VAS score in the TightRope group was 1.52 ± 2.06, and the Constant score was 96.83 ± 5.41, reflecting high patient satisfaction. Conclusions: All systems led to satisfactory radiological and clinical outcomes, with the LARS™ band showing particular effectiveness in chronic ACJ dislocations. While all techniques provided good results, the TightRope^® system demonstrated the most favorable overall profile in our cohort and may therefore be considered a promising contemporary option. Further studies are needed to determine the optimal treatment for moderate ACJ dislocations and to assess the cost-effectiveness of these surgical techniques. Full article

Background: The progression of cognitive decline is accelerated in older adults with sarcopenia, but the protective dietary factors have remained uncertain. Objective: This study aims to investigate the association between dietary factors and cognitive decline in older adults, and to explore the potential mediating effects of sarcopenic components. Methods: Data from the Mr. OS and Ms. OS cohort study in Hong Kong (N = 3146, aged ≥65 years) were used. Cognitive function was assessed based on the Mini-Mental State Examination (MMSE). Sarcopenic status was assessed according to the Asian Working Group for Sarcopenia 2019 updated consensus. Dietary protein intake and adherence to dietary patterns were assessed using a food frequency questionnaire. Linear regression was used to examine the associations between dietary factors and MMSE scores. Mediation analysis was conducted to identify the possible mediators in the diet–cognition associations. Results: Sarcopenia and its components were associated with baseline MMSE and MMSE changes. Positive associations were observed for plant protein intake (β = 0.79, 95% CI 0.24–1.35) and dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet (β = 0.14, 95% CI 0.02–0.26) and diets with lower Dietary Inflammatory Index (DII) scores (β = −0.18, 95% CI −0.26–−0.09) with better MMSE outcomes. Protective effects were more profound in participants with sarcopenia/severe sarcopenia. The effects of the DASH diet and DII were more profound in female participants, while higher adherence to the Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) diet was associated with an increment in MMSE score in male participants with sarcopenia. Handgrip strength and physical performance are significant mediators in the diet–cognition associations. Conclusions: The protective effects of healthy dietary patterns were beneficial, especially for participants with sarcopenia, while handgrip strength and walking speed potentially mediated the associations. Full article

The aging process, along with an inadequate diet and an inflammatory gut response resulting from dysbiosis, contributes to the pathogenesis of Alzheimer’s disease (AD). Modifying the composition of the gut microbiota through appropriate pre/probiotic-rich diets may act as a preventive option for AD. The variety of functions performed by the gut microbiota makes this ecosystem one of the most important systems in the human body. The Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean–DASH Intervention for Neurodegenerative Delay diet (MIND), and the modified ketogenic–Mediterranean diet (MKD) positively affect the intestinal microflora and may reduce the risk of dementia. A ketogenic diet has a neuroprotective effect and improves cognitive function but leads to a significant decrease in the abundance and diversity of bacterial species in favor of harmful bacteria. A Western-style diet (Western diet, WD) rich in processed products, red meat, simple sugars, and saturated fatty acids has a negative impact on gut microbiota function, increasing the risk of AD. Our review supports the hypothesis that factors like a proper diet and a healthy gut microbiota have a positive impact on the prevention of neurodegenerative diseases, including AD. A thorough understanding of the role the microbiota plays in the proper functioning of the nervous system can aid in the prevention of AD by developing new dietary strategies and dietary lifestyles. Full article