The gut microbiota has been linked to the emergence of obesity, metabolic syndrome and the onset of type 2 diabetes through decreased glucose tolerance and insulin resistance. Uncontrolled diabetes ...can lead to serious health consequences such as impaired kidney function, blindness, stroke, myocardial infarction and lower limb amputation. Despite a variety of treatments currently available, cases of diabetes and resulting complications are on the rise. One promising new approach to diabetes focuses on modulating the gut microbiota with probiotics, prebiotics, synbiotics and fecal microbial transplantation. Differences in gut microbiota composition have been observed in preclinical animal models as well as patients with type 2 diabetes and complications such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, cerebrovascular disease, coronary heart disease and peripheral artery disease compared to healthy controls. Severity of gut microbiota dysbiosis was associated with disease severity and restoration with probiotic administration in animal models and human patients has been associated with improvement of symptoms and disease progression. Characterizing the gut microbiota dysbiosis in different diseases and determining a causal relationship between the gut microbiota and disease can be beneficial in formulating therapeutic interventions for type 2 diabetes and associated complications. In this review, we present the most important findings regarding the role of the gut microbiota in type 2 diabetes and chronic complications as well as their underlying mechanisms.
The tibial tubercle osteotomy (TTO) is a versatile tool for unloading patellar and trochlear focal chondral defects as well as treating patellofemoral arthritis with or without patellofemoral ...instability. The TTO indirectly functions to address chondral defects in the patellofemoral joint (PFJ) by unloading compressive forces in the affected area and preventing further chondral deterioration and pain. Since its inception, the TTO technique has undergone iterative modification and refinement. The Fulkerson anteromedialization has persisted as the workhorse of modern TTO procedures with good surgical results, though it is not without limitations. Recently, the use of novel surgical systems such as the multidirectional tibial tubercle transfer as well as concomitant soft tissue balancing procedures have been implemented to address challenges posed by the classic Fulkerson technique and improve TTO customizability and reproducibility. In addition, TTO has increasingly been used in conjunction with concomitant procedures such as autologous chondrocyte implantation and osteochondral allograft transfer in the PFJ, to protect the restored cartilage from repeat injury. Though the anteriorization TTO has long been supported to help alleviate pathologic joint compression, recent advancements in surgical guides as well as combined procedures involving multiplane TTO, cartilage restoration, and soft tissue balancing allow for customization of treatment that more thoroughly addresses the complex anatomy and pathology in the PFJ. This article aims to provide an overview of the rationale and recent advancements in the use of TTO to unload and treat chondral defects in the PFJ.
Background
Calcium plays an essential role in physiologic processes, including trauma's “Lethal Diamond.” Thus, inadequate serum calcium in trauma patients exacerbates the effects of hemorrhagic ...shock secondary to traumatic injury and subsequently poorer outcomes compared to those with adequate calcium levels. Evidence to date supports the consideration of calcium derangements when assessing the risk of mortality and the need for blood product transfusion in trauma patients. This review aims to further elucidate the predictive strength of this association for future treatment guidelines and clinical trials.
Methods
Publications were collected on the relationship between i‐Ca and the outcomes of traumatic injuries from PubMed, Web of Science, and CINAHL. Manuscripts were reviewed to select for English language studies. Hypocalcemia was defined as i‐Ca <1.2 mmol/L.
Results
Using PRISMA guidelines, we reviewed 300 studies, 7 of which met our inclusion criteria. Five papers showed an association between hypocalcemia and mortality.
Conclusions
In adult trauma patients, there has been an association seen between hypocalcemia, mortality, and the need for increased blood product transfusions. It is possible we are now seeing an association between low calcium levels prior to blood product administration and an increased risk for mortality and need for transfusion. Hypocalcemia may serve as a biomarker to show these needs. Therefore, hypocalcemia could potentially be used as an independent predictor for multiple transfusions such that ionized calcium measurements could be used predictively, allowing faster administration of blood products.
Introduction
Non‐pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological ...rigor and continues to produce mixed results.
Methods
In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.
Results
Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.
Discussion
We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.
Disparities in research publications are common in the physiotherapy and rehabilitation fields.
A small proportion of published research arises from low-income and middle-income countries (LMICs),
...home to 85% of the world's population. Systems-level, institutional-level, and individual-level factors contribute to these disparities. With urgent and unified actions, global health and the standard of physiotherapy research in LMICs can be improved and strengthened. In this editorial, we will discuss the challenges encountered by researchers from LMICs in conducting and publishing high-quality research and propose potential strategies to address these challenges.
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