The intervertebral disc (IVD) aids in motion and acts to absorb energy transmitted to the spine. With little inherent regenerative capacity, degeneration of the intervertebral disc results in ...intervertebral disc disease, which contributes to low back pain and significant disability in many individuals. Increasing evidence suggests that IVD degeneration is a disease of the whole joint that is associated with significant inflammation. Moreover, studies show elevated macrophage accumulation within the IVD with increasing levels of disease severity; however, we still need to understand the roles, be they causative or consequential, of macrophages during the degenerative process. In this narrative review, we discuss hallmarks of IVD degeneration, showcase evidence of macrophage involvement during disc degeneration, and explore burgeoning research aimed at understanding the molecular pathways regulating macrophage functions during intervertebral disc degeneration.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Objective: Self-assessment deficits, often referred to as impaired insight or unawareness of illness, are well established in people with schizophrenia. There are multiple levels of awareness, ...including awareness of symptoms, functional deficits, cognitive impairments, and the ability to monitor cognitive and functional performance in an ongoing manner. The present study aimed to evaluate the comparative predictive value of each aspect of awareness on the levels of everyday functioning in people with schizophrenia. Method: We examined multiple aspects of self-assessment of functioning in 214 people with schizophrenia. We also collected information on everyday functioning rated by high contact clinicians and examined the importance of self-assessment for the prediction of real-world functional outcomes. The relative impact of performance-based measures of cognition, functional capacity, and metacognitive performance on everyday functioning was also examined. Results: Misestimation of ability emerged as the strongest predictor of real-world functioning and exceeded the influences of cognitive performance, functional capacity performance, and performance-based assessment of metacognitive monitoring. The relative contribution of the factors other than self-assessment varied according to which domain of everyday functioning was being examined, but, in all cases, accounted for less predictive variance. Conclusion: These results underscore the functional impact of misestimating one's current functioning and relative level of ability. These findings are consistent with the use of insight-focused treatments and compensatory strategies designed to increase self-awareness in multiple functional domains.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Background: The goals of this study were to (1) define the epidemiology of acute patellar dislocation, (2) determine the risk of subsequent
patellar instability episodes (subluxation and/or ...redislocation) during the study period, and (3) identify risk factors for
subsequent instability episodes.
Study Design: Prospective cohort study.
Methods: The authors prospectively followed 189 patients for a period of 2 to 5 years. Historical data, injury mechanisms, and physical
and radiographic measurements were recorded to identify potential risk factors for poor outcomes.
Results: Risk was highest among females 10 to 17 years old. Patients presenting with a prior history of instability were more likely
to be female ( P <.05) and were older than first-time dislocation patients ( P <.05). Fewer first-time dislocators (17%) had episodes of instability during follow-up than patients with a previous history
of instability (49%) ( P <.01). After adjusting for demographics, patients with a prior history had 7 times higher odds of subsequent instability
episodes during follow-up than first time dislocators (adjusted odds ratio = 6.6, P <.001).
Conclusions: Patellar dislocators who present with a history of patellofemoral instability are more likely to be female, are older, and
have greater risk of subsequent patellar instability episodes than first-time patellar dislocators. Risk of recurrent patellar
instability episodes in either knee is much higher in this group than in first-time dislocators.
Keywords:
acute patellar dislocation
prospective
outcome
natural history
risk factors
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
We are facing interwoven global threats to public health and ecosystem function that reveal the intrinsic connections between human and wildlife health. These challenges are especially pressing in ...cities, where social-ecological interactions are pronounced. The One Health concept provides an organizing framework that promotes the health and well-being of urban communities and ecosystems. However, for One Health to be successful, it must incorporate societal inequities in environmental disamenities, exposures, and policy. Such inequities affect all One Health interfaces, including the distribution of ecosystem services and disservices, the nature and frequency ofhuman-wildlife interactions, and legacies of land use. Here, we review the current literature on One Health perspectives, pinpoint areas in which to incorporate an environmental justice lens, and close with recommendations for future work. Intensifying social, political, and environmental unrest underscores a dire need for One Health solutions informed by environmental justice principles to help build healthier, more resilient cities.
Background
Specific guidelines for operative versus nonoperative management of anterior cruciate ligament injuries do not yet exist.
Hypothesis
Surgical risk factors can be used to indicate whether ...reconstruction or conservative management is best for an individual patient.
Study Design
Prospective nonrandomized controlled clinical trial; Level of evidence, 2.
Methods
Patients were classified as high, moderate, or low risk using preinjury sports participation and knee laxity measurements. Early anterior cruciate ligament reconstruction (within 3 months of injury) was recommended to high-risk patients and conservative care to low-risk patients. It was recommended that moderate-risk patients have either early reconstruction or conservative care, according to the day of presentation. Assessment of subjective outcomes, activity, physical measurements, and radiographs was performed at mean follow-up of 6.6 years.
Results
Early phase conservative management resulted in more late phase meniscus surgery than did early phase reconstruction at all risk levels (high risk, 25% vs 6.5%; moderate risk, 37% vs 7.7%, P =. 01; low risk, 16% vs 0%). Early- and late-reconstruction patients’ Tegner scores increased from presurgery to follow-up (P <. 001) but did not return to preinjury levels. Early-reconstruction patients had higher rates of degenerative change on radiographs than did nonreconstruction patients (P <. 05).
Conclusions
Early phase reconstruction reduced late phase knee laxity, risk of symptomatic instability, and the risk of late meniscus tear and surgery. Moderate- and high-risk patients had similar rates of late phase injury and surgery. Reconstruction did not prevent the appearance of late degenerative changes on radiographs. Relationship between bone contusion on initial magnetic resonance images and the finding of degenerative changes on follow-up radiographs were not detected. The treatment algorithm used in this study was effective in predicting risk of late phase knee surgery.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The Absorb bioresorbable vascular scaffold (BVS) has high rates of target lesion failure (TLF) at three years. Low wall shear stress (WSS) promotes several mechanisms related to device TLF. We ...investigated the impact of BVS compared to XIENCE V (XV) on coronary WSS after device deployment.
In the prospective, randomised, controlled ABSORB III Imaging study (BVS n=77 or XV n=36), computational fluid dynamics were performed on fused angiographic and intravascular ultrasound (IVUS) images of post-implanted vessels. Low WSS was defined as <1 Pa. There were no differences in demographics, clinical risks, angiographic reference vessel diameter or IVUS minimal lumen diameter between BVS and XV patients. A greater proportion of vessels treated with BVS compared to XV demonstrated low WSS across the whole device (BVS: 17/77 22% vs XV: 2/36 6%, p<0.029). Compared to XV, BVS demonstrated lower median circumferential WSS (1.73 vs 2.21 Pa; p=0.036), outer curvature WSS (p=0.026), and inner curvature WSS (p=0.038). Similarly, BVS had lower proximal third WSS (p=0.024), middle third WSS (p=0.047) and distal third WSS (p=0.028) when compared to XV. In a univariable logistic regression analysis, patients who received BVS were 4.8 times more likely to demonstrate low WSS across the scaffold/stent when compared to XV patients. Importantly, in a multivariable linear regression model, hypertension (beta: 0.186, p=0.023), lower contrast frame count velocity (beta: -0.411, p<0.001), lower post-stent residual plaque burden (beta: -0.338, p<0.001), lower % underexpanded frames (beta: -0.170, p=0.033) and BVS deployment (beta: 0.251, p=0.002) remained independently associated with a greater percentage of stented coronary vessel areas exposed to low WSS.
In this randomised controlled study, the Absorb BVS was 4.8 times more likely than the XV metallic stent to demonstrate low WSS. BVS implantation, lower blood velocity and lower residual post-stent plaque burden were independently associated with greater area of low WSS.
The effects of water temperature (14, 18, 22 and 26°C) and age (2-y-old, 6.7g; 3-y-old, 25.7g) on the gastrointestinal evacuation (GIE) time and apparent nutrient digestibility coefficients (ADC) for ...greenlip abalone (Haliotis laevigata). GIE time of greenlip abalone was evaluated using a marker diet containing chromic oxide and the total faecal collection technique. Additionally, GIE values were compared from samples collected from abalone that were sampled once only or repeatedly to compare the rigour of each method. GIE time was also assessed using radiography. GIE times were significantly affected by water temperature (P<0.001) and age (P<0.05). GIE times decreased for both age classes with increasing temperatures, and the GIE time of 2-y-olds was significantly faster than for 3-y-olds. GIE times never exceeded 60h. There was no significant effect of either factor on the duration that the marker diet was voided, suggesting that differences in GIE times are due to factors other than the transit of feed through the intestine. Dry matter ADCs were not affected by temperature (P>0.05) but were affected by age (P<0.001; 2-y-old <3-y-old). Protein and energy ADCs were not affected by temperature or age. Results may be used to predict purging times and also indicate that further investigations into feeding frequencies are recommended.
•Gastrointestinal evacuation (GIE) time is significantly affected by water temperature.•There was a significant effect of age on GIE time; 3-y-old greenlip abalone exhibited a longer GIE time than 2-y-old abalone.•The duration between the start and end time of faecal excretion, did not differ due to either water temperature or age.•The GIE times can be used to assess purging periods for animals of a comparable size at specific water temperatures.•There was no effect of either water temperature or age on protein or energy digestibility coefficients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Intervertebral disc (IVD) degeneration is a common pathological condition associated with low back pain. Recent evidence suggests that mesenchymal signaling cells (MSCs) promote IVD regeneration, but ...underlying mechanisms remain poorly defined. One postulated mechanism is via modulation of macrophage phenotypes. In this manuscript, we tested the hypothesis that MSCs produce trophic factors that alter macrophage subsets. To this end, we collected conditioned medium from human, bone marrow-derived STRO3
MSCs. We then cultured human bone marrow-derived macrophages in MSC conditioned medium (CM) and performed single cell RNA-sequencing. Comparative analyses between macrophages cultured in hypoxic and normoxic MSC CM showed large overlap between macrophage subsets; however, we identified a unique hypoxic MSC CM-induced macrophage cluster. To determine if factors from MSC CM simulated effects of the anti-inflammatory cytokine IL-4, we integrated the data from macrophages cultured in hypoxic MSC CM with and without IL-4 addition. Integration of these data sets showed considerable overlap, demonstrating that hypoxic MSC CM simulates the effects of IL-4. Interestingly, macrophages cultured in normoxic MSC CM in the absence of IL-4 did not significantly contribute to the unique cluster within our comparison analyses and showed differential TGF-β signaling; thus, normoxic conditions did not approximate IL-4. In addition, TGF-β neutralization partially limited the effects of MSC CM. In conclusion, our study identified a unique macrophage subset induced by MSCs within hypoxic conditions and supports that MSCs alter macrophage phenotypes through TGF-β-dependent mechanisms.
Background: The most reliable and valid instruments for assessing patient outcome after patellar dislocation have not been identified.
Hypothesis: Knee-specific and general health instruments will ...differ in validity and reliability for patients with patellar dislocation.
Study Design: Prospective cohort study.
Methods: Subjects consisted of 153 patients with acute patellar dislocation (110 with first-time dislocations and 43 with a history
of patellofemoral subluxation or dislocation). We administered the modified International Knee Documentation Committee form,
Kujala, Fulkerson, Lysholm, Tegner, Short Form 36, and Musculoskeletal Function Assessment instruments on two separate occasions
(test-retest reliability). Validity was assessed by comparing scores of the two groups and by comparing scores of patients
with and without recurrent subluxations/dislocations during follow-up.
Results: The knee-specific instruments yielded the highest test-retest reliability. The knee-specific and general health instruments
identified higher disability levels in the patients with a history of patellofemoral problems than in those with first-time
dislocations. The general health instruments identified higher disability levels in patients with patellar dislocation than
published norms. The Fulkerson and Lysholm scales were the only instruments to differentiate between patients with and without
recurrent subluxations/dislocations.
Conclusions: Knee-specific scales yielded higher reliability coefficients and stronger validity than did general health instruments. Knee-specific,
general health, and activity level instruments are complementary and in combination provide a more complete assessment for
patients with patellar dislocation.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract Despite multiple lines of evidence suggesting that people with schizophrenia tend to overestimate their ability to perform everyday tasks such as money management, self-report methods are ...still widely used to assess functioning. In today's technology driven financial world patients are faced with increasingly complex financial management tasks. To meet these challenges adequate financial skills are required. Thus, accurate assessments of these abilities are critical to decisions regarding a patient's need for support such as a financial trustee. As part of the larger VALERO study, 195 patients with schizophrenia were asked to self-report their everyday financial skills (five common financial tasks) with the Independent Living Skills Survey (ILSS). They were also assessed with performance-based measures of neuro-cognition and functional capacity with a focus on financial skills. In addition, a friend, relative, or clinician informant was interviewed with the ILSS and a best estimate rating of functioning was generated. Scores on the performance-based measures of financial skills and neuropsychological tests were uncorrelated with self-reported financial activities. Interviewer and all informant judgments of financial abilities were also minimally correlated with performance on functional skill tests. Discrete financial skills appear to be challenging for clinicians to rate with accuracy without the use of direct assessments. Direct assessment of financial skills seems prudent when making determinations about the need for guardianship or other financial supervision.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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