GI endoscopy forms an important part in a daily practice of a gastroenterologist. Musculoskeletal injuries related to GI endoscopy are on the rise. Observational studies and surveys depict the importance of proper ergonomical environment when performing GI endoscopy. Our aim is to outline preventive measures in gastrointestinal (GI) endoscopy in reducing possibility for occupational injury. We review most relevant studies that outline the gravity of the problem. A detailed analysis of proposed ergonomical recommendations is performed, outlining crucial steps in injury prevention. Proper ergonomical education is a key-step in preventing occupational injury. Robotics and other mechanical solutions offer a variety of approaches tackling the ergonomical challenge. Implementing proper ergonomical education and mechanical solutions lowers the possibility if occupational injury. Strategies and appliances presented are beneficial to all GI endoscopy practitioners.

Traumatic vascular injuries consist in direct or indirect damage to arteries and/or veins and accounts for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Extremities vascular injuries can occur isolated or in association in major trauma with other organ injuries. They account for 1-2% of patients admitted to Emergency Department, for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than the upper ones in adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging notably in polytrauma because of the dilemma of which injury should be prioritized and treatment delay can cause disability or even death especially for limb vascular injury. Our purposes are to discuss the role of Computed Tomography Angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve the definitive diagnosis, and to assess the radiological signs of vascular injuries and the possible pitfalls.

Resilience embodies the personal qualities that enable one to thrive in the face of adversity. A previous Italian study showed that injured workers had a lower level of resilience than non-injured workers. The aim of this paper is to examine the relationship between occupational injuries and psychological resilience. The subjects were 197 drivers from two Finnish waste transport companies. As a part of larger questionnaire, they fulfilled the Connor-Davidson Resilience Scale, which consisted of 25 items. Drivers reported their occupational injuries during the last three years. The drivers involved in occupational injuries had higher score (average 69.3) on Connor-Davidson Resilience Scale than drivers avoided injuries (67.7). According to Student’s t-test the difference between groups was highly significant (t = 40.44, df = 196, p<0.001). The result of this study was contradictory to earlier Italian study. One explanation may be that the Italian study was done with traumatic context with seriously injured patients. Waste transport drivers were rather young and fit males, who had suffered only minor injuries.

A series of conditions can mimic musculoskeletal infections on imaging, complicating their diagnosis and affecting the treatment. Depending on the anatomical location, different conditions can manifest with clinical and imaging findings that mimic infections. Herein we present a wide spectrum of the musculoskeletal disorders of the axial skeleton, long bones, peripheral joints and soft-tissue which may manifest as an infectious process, besides focusing on the potential mimics of osteomyelitis, septic arthritis and infectious spondylodiscitis that are common in clinical practice. We present the typical imaging characteristics of each musculoskeletal infection, followed by mimicking conditions.

Background: Our study investigates the prevalence and causes of injuries among undergraduate dental students during clinical sessions. Methods: The study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported questionnaires and clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure being performed, and the immediate actions taken post-injury. Serological testing was conducted on both students and patients to assess the risk of bloodborne pathogen transmission. Results: The findings revealed a high prevalence of injuries, with needles being the most common cause, followed by burs and dental probes. The most frequent injury type was piercing, primarily affecting the fingers. Periodontal treatments, restorative procedures, and endodontic treatments were the main activities leading to injuries. Despite normal medical records for most patients treated by injured students, serological testing showed significant positivity rates for HCV and HBV. It is noteworthy that most injured students demonstrated their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Our study highlights the critical need for enhanced biosafety awareness and training among dental students to reduce injury risks. Conclusions: These findings underline the necessity for integrated safety protocols and continuous education to improve clinical practices and ensure student safety.

(1) Background: The aim of the research was to present and emphasize the importance of magnetic resonance imaging (MRI) in diagnosing Achilles tendon (AT) ruptures by presenting case reports. (2) Materials and Methods: The sample of respondents included 7 patients (4 males and 3 females, 2 athletes and 5 non-athletes), aged 25 to 58 years, with AT injuries, who were examined and treated at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia. Ankle examinations with MRI were conducted using the Esaote O-scan 0.3 T machine. The examinations were performed without the application of a paramagnetic contrast agent and without the use of anesthesia. Results: The MRI method's sensitivity and overall diagnostic accuracy were excellent, with 100% true positives. In our study, the method accurately detected the presence, location, and severity of AT injuries in all cases. MRI is an important and reliable method for detecting AT injuries, classifying them, monitoring the course of recovery, and assessing the effects of therapy. Conclusions: An unrecognized or delayed diagnosis of an AT injury can lead to chronic changes. Timely diagnosis (clinical examination, ultrasonography, magnetic resonance imaging) and appropriate treatment (conservative or operative) enable patients to return to normal activities, including sports. Unfortunately, the use of MRI is limited by restricted access and the cost of the examination.

Background: This study attempted to construct musculoskeletal JEM using KWCS data and use it to evaluate the burden of these disorders in Korean workers. Methods: This study was conducted using data from the second to the sixth KWCS, and a total of 210,500 people were included. The jobs of the subjects were reclassified based on the unit groups of the 7th Korean Standard Classification of Occupation (KSCO). The intensity of exposure to work-related risk factors for musculoskeletal disorders was classified into ‘high’, ‘moderate’, and ‘low’ for the body segments involving the ‘upper extremities and neck’, ‘lower back’, and ‘lower extremities’. Results: The time of exposure was longest in the standing posture and repetitive hand and arm movements. An analysis of the intensity of exposure by body segments revealed that the highest intensity of exposure was to the upper extremities. For the upper extremities and neck, and the lower back, there was a exposure-response relationship in the association between intensity of exposure and musculoskeletal symptoms. However, for the lower extremities, there was a exposure-response relationship only at high exposure. Conclusion: In this study, a JEM for work-related risk factors for musculoskeletal disorders was constructed for the first time in Korea. The intensity of exposure to musculoskeletal risk factors was estimated for each occupation. The JEM constructed in this study is expected to have high applicability for assessing the risk of musculoskeletal disorders for each job with respect to the upper extremities and neck, and lower back.

Anterior Cruciate Ligament (ACL) injuries rank among the most prevalent and severe types of injuries, significantly impacting both athletes and non-athletes alike. These injuries not only result in immediate physical impairment, such as intense pain, substantial swelling, and a marked loss of mobility, but also carry long-term health consequences that can alter a person's quality of life. Chronic pain, persistent instability, and an increased risk of developing osteoarthritis are among the lasting effects that can follow an ACL injury. An in-depth understanding of the biophysics behind ACL injuries is paramount for devising effective prevention and treatment protocols. Biophysics, which combines principles from physics with biological systems, provides crucial insights into the mechanical and structural integrity of the ACL and its susceptibility to injury under various conditions. This systematic review aims to collate and synthesize the current knowledge surrounding the biophysical mechanisms that underlie ACL injuries. The review encompasses a range of factors, including the biomechanical forces that place stress on the ligament, anatomical structures that may predispose individuals to injury, and physiological conditions that affect ligament health and resilience. Each of these factors plays a crucial role in the incidence and severity of ACL injuries. Biomechanical forces, for example, can involve sudden changes in direction or impact during physical activity, leading to excessive stress on the ACL. Anatomical factors might include variations in bone structure or ligament alignment that inherently increase the risk of injury. Additionally, physiological conditions such as muscle strength, flexibility, and overall ligament health can influence the likelihood and extent of an ACL injury. The findings of this review underscore the necessity of adopting integrated approaches in both injury prevention and rehabilitation. Such approaches must consider the multifaceted nature of ACL injuries, involving not only mechanical and anatomical aspects but also physiological and possibly even genetic factors. By emphasizing a multi-faceted understanding, interventions can be more effectively tailored to address the complex interplay of elements that contribute to ACL injuries. This holistic approach can lead to better outcomes for those at risk of or recovering from ACL injuries, enhancing the efficacy of prevention strategies and rehabilitation protocols.

Improper sitting positions are known as the primary reason for back pain and the emergence of musculoskeletal disorders (MSD) among individuals who spend prolonged time working with computer screens, keyboards, and mice. At the same time, it is well understood that automated technological tools can play an important role in the process of unhealthy habit alteration, so plenty of research efforts are focused on research and technology development (RTD) activities that aim to provide support to the prevention of back pain or the development of MSD. Here, we report on creating a new resource in support of RTD activities aiming at the automated detection of improper sitting positions. It consists of multimodal multisensory recordings of 100 persons made with a video recorder, camera, and wrist-attached sensors that capture physiological signals (PPG, EDA, Skin temperature), as well as motion sensors (three-axis accelerometer). Our multimodal multisensory dataset (MMD-MSD) opens new opportunities for modeling the body stance (sitting posture and movements), physiological state (stress level, attention, emotional arousal, valence), and performance (success rate on the Stroop test) of people working with a computer. Finally, we demonstrate two use cases: improper neck posture detection from pictures and cognitive load detection from physiological signals.

Psoriasis is a lifelong, systemic, immune mediated inflammatory skin condition, affecting 1-3% of the world’s population, with an impact on quality of life similar to diseases like cancer or diabetes. Genetics are the single largest risk factor in psoriasis, with GWAS studies showing that many psoriasis risk genes lie along the IL23/Th17 axis. Potential psoriasis risk genes determined through GWAS can be annotated and characterised using functional genomics, allowing the identification of novel drug targets and the repurposing of existing drugs. The pathogenesis of psoriasis is complex and focusing on the IL23/Th17 axis can provide insight into key cell types, cytokines and intracellular signaling pathways involved. Examination of currently available biological treatments, time to relapse post drug withdrawal and rates of drug primary/secondary drug failure show the need for greater understanding of the underlying genetic mechanisms of psoriasis and how they can impact treatment. This could allow for patient stratification towards the treatment most likely reduce dis-ease burden for the longest period possible.

Background: The Shingrix vaccine helps prevent shingles and its complications in adults 50 and older. While minor side effects are common, severe adverse reactions are thought to be rare, and long-term side effects are not well documented. Case Presentation: A 50-year-old woman with Crohn's disease developed joint pain, effusion, and neurological symptoms such as numbness and tingling shortly after receiving the first dose of Shingrix. Symptoms waxed and waned but persisted for over a year despite anti-inflammatories and specialist referrals. Diagnostic imaging and labs were unrevealing. Conclusion: This case of prolonged somatic and neurological symptoms associ-ated temporally with Shingrix administration reinforces the critical need for thorough pharma-covigilance and investigation of possible long-term adverse vaccine reactions. Provider documen-tation and reporting of individual experiences can help improve the detection of rare vaccine-related risks, elucidate potential risk factors, and refine safety screening. Diligent monitoring and research into longitudinal vaccine outcomes remain paramount, especially following recent emergency au-thorizations.

Ultrasound imaging is a vital imaging tool in musculoskeletal medicine, with the number of publications on ultrasound-guided surgery increasing in recent years. However, ultrasound imaging has drawbacks, such as operator dependency and image obscurity. Artificial Intelligence (AI) and Deep Learning (DL), a subset of AI, can address these issues. DL methods, including segmentation, detection, and localization of target tissues and medical instruments, potentially allow physicians and surgeons to perform ultrasound-guided procedures more accurately and efficiently. This review summarizes recent advances in ultrasound-guided procedures for musculoskeletal diseases and provides a comprehensive overview of the utilization of AI/DL in ultrasound for musculoskeletal medicine, particularly focusing on ultrasound-guided surgery.

The Cobb angle is critical in assessing adolescent idiopathic scoliosis (AIS) patients. This study aimed to evaluate the error in selecting the cranial and caudal limit vertebrae on AIS digital X-rays of experienced and novice observers and its correlation with the error in measuring the Cobb angle and determining the length of the scoliotic curves. Using the TraumaMeter v.873 software, eight raters (four experienced and four novices) independently evaluated 68 scoliotic curves on 42 AIS X-rays across three sessions one month apart according to Hopkins’ criteria of absolute reliability. Two spine specialist experts using the Cobb method established the gold standard measurements. The percentage of error in the selection of the cranial vertebrae (the most-tilted vertebra above the apex) is higher than in the caudal vertebrae (the most-tilted vertebrae below the apex) (44.7%, CI95% 41.05-48.3 compared to 35%, CI95% 29.7-40.4). The error in the choice of the most tilted vertebrae, in number of vertebrae per scoliotic curve, was MBE (mean bias error) =0.45, CI95% 0.38-0.52 in the cranial and MBE=0.35, CI% 0.69-0.91 in the caudal. The percentage of errors in the choice of boundary vertebrae is lower for the experienced than for the novices, both in cranial and caudal. The experienced chose at least one boundary vertebrae incorrectly in 52% of the meas-urements and the novices in 65.1%. The error in the Cobb angle did not depend on the number of boundary vertebrae chosen incorrectly (r=0.198, p=0.111). Of the 50% of Cobb angle measurements closest to the actual value, 55.4% (454) were obtained by incorrectly selecting at least one boundary vertebra. There was a positive correlation (r=0.673, p=0.000) between the error in selecting the boundary vertebrae and the error in determining the length of the scoliotic curves. The error in quantifying the length of scoliotic curves was MBE=0.43, CI95% 0.35-0.51 vertebrae per curve. We can conclude that errors in selecting boundary vertebrae are common among experienced and novice observers, with a greater frequency of error in the cranial vertebrae. There is no correlation between the error in selecting the boundary vertebrae and the error in measuring the Cobb angle. Contrary to the consensus, the accuracy of determining the length of the scoliotic curve is limited by the Cobb method’s reliance on the correct selection of boundary vertebrae. Inappropriate choice of boundary vertebrae leads to an estimated error in determining the length of the scoliotic curves of 0.805 vertebrae for each boundary vertebra chosen incorrectly.

The number of migrant workers in Saudi Arabia (SA) has gradually increased, particularly in the construction industry, where migrant workers make up 89% of the workforce. They continue to experience exposure to dangerous working conditions and increased risk for occupational injury and hazards due to the work they tra-ditionally perform. To address this challenge, this study explores the differences between migrant and domestic workers’ injury and occupational accident rates in SA’s construction industry. Data were analysed from 121,999 (98.7% migrant and 1.28% domestic workers) reported accidents and injuries obtained from the General Or-ganisation for Social Insurance (GOSI) between 2014 and 2019. Chi-square test was used to examine the asso-ciations of occupational accidents and injuries among migrant and domestic workers. Migrant workers suffered more falls, strikes, collisions, rubbing and abrasions (damage caused by scraping, producing wounds), bodily reactions (e.g., reaction to chemicals), and car accidents than domestic workers. The results also show that migrant workers aged 30-39 and domestic workers 20-29 experienced more severe injuries and increased seasonal mortality throughout the six-year period examined. In addition, domestic workers achieved a higher proportion of full recovery across all types of accidents except transport and car accidents. The findings emphasise the need for ongoing safety education, training, and improved safety measures to protect the health and safety of construction workers, especially migrant workers.

This research aimed to study and compare prevalence of work-related musculoskeletal (MSK) problem and perceived discomfort among port crane operators consisting of quay and rubber tyred gantry (RTG) cranes working in the Laem Chabang Deep-sea Port, Thailand. Direct interviews for a cross-sectional analysis was selected for this unique job with a small amount of sample size. A standardized modified version of the Nordic Musculoskeletal Questionnaire (NMQ) was lunched for 26 male participants, consisting of 11 quay and 15 RTG, where a priori power analysis using G*Power suggested the minimum as 24 for the hypothesis test. Socio-demographic characteristics showed no significant difference among them. The NMQ revealed lower back as the highest prevalent body part (76.9%) followed by neck, shoulders and upper back at the same percentage (23.1%) for all port crane group, with up to 96.2% reporting MSK problem over the past 12 months. And Borg scale rating, assessing the perceived discomfort, revealed lower back with the highest score (2.38) followed by upper back (0.65), shoulders (0.54) and neck (0.5). Remarkably, the comparation between the quey and RTG crane operators on the MSK prevalence (χ2 test) and perceived discomfort levels (Kruskal-Wallis test), regarding different 9 body parts, revealed a significant difference between the two on upper back with quay crane having more problem than the RTG at p &lt; 0.05. while the rest of them were mainly in the same direction. MSK contributors such as: working awkward posture, mental stress, height, trolley distance and vibration are considerably the main causes of this. However, the larger in scale of exposure to those for the quey crane compared to the RTG might have led to the distinguishing MSK problem found in this study which require thoroughly deliberation for the particular solutions.

Musculoskeletal injuries such as equine osteoarthritis, osteoarticular defects, tendonitis/desmitis, and muscular disorders are prevalent among sport horses, with a fair prognosis for returning to exercise or previous performance levels. The field of equine medicine has witnessed rapid and fruitful development, resulting in a diverse range of therapeutic options for musculoskeletal problems. Staying abreast of these advancements can be challenging, prompting the need for a comprehensive review of commonly used and recent treatments. The aim is to compile current therapeutic options for managing these injuries, spanning from simple to complex physiotherapy techniques, conservative treatments including steroidal and non-steroidal anti-inflammatory drugs, hyaluronic acid, and polyacrylamides, to the promising regenerative therapies such as hemoderivatives and stem cell-based therapies. Each therapeutic modality is scrutinized for its benefits, limitations, and potential synergistic actions to facilitate their most effective application for intended healing/regeneration of the injured tissue/organ and subsequent patient recovery. While stem cell-based therapies emerge as particularly promising for equine musculoskeletal injuries, a multidisciplinary approach is underscored throughout the discussion, emphasizing the importance of considering various therapeutic modalities in tandem.

Age-related disorders of the musculoskeletal system including sarcopenia, osteoporosis and arthritis represent some of the most common chronic conditions worldwide, for which there remains a great clinical need to develop safer and more efficacious pharmacological treatments. Collectively, these conditions involve multiple tissues, including skeletal muscle, bone, articular cartilage and the synovium within the joint lining. In this review, we discuss the potential for oligonucleotide therapies to combat the unmet clinical need in musculoskeletal disorders by evaluating the successes of oligonucleotides to modify candidate pathological gene targets and cellular processes in relevant tissues and cells of the musculoskeletal system. Further, we discuss the challenges that remain for the clinical development of oligonucleotides therapies for musculoskeletal disorders and evaluate some of the current approaches to overcome these.

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality among all ages; despite the advances, understanding pathophysiological responses after TBI is still complex, involving multiple mechanisms. Previous reviews have focused on potential targets; however, the research on potential targets has continuously grown in the last five years, bringing even more alternatives and elucidating previous mechanisms. Knowing the key and updated pathophysiology concepts is vital for adequate management and better outcomes. This article reviews the underlying molecular mechanisms, the latest updates, and future directions for pathophysiology-based TBI management.

Background: Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. Aims: To conduct a systematic review, previously registered with PROSPERO, to identify prevalence, incidence, and injury pattern among Irish dancers and analyse associated risk factors. Methods: Six online databases, plus two dance-specific science publications were searched systematically. Studies were included if the pattern of injuries among Irish dancers were evaluated or the factors associated with injury were analysed, published in English or Portuguese, in peer-reviewed scientific journals. Four reviewers assessed the quality and level of evidence using the Downs and Black criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Results: Eleven articles were included, 8 level 3c (cross-sectional) and 3 level 3b (prospective). Mean DB percentage score was 63% ± 7,2%. Prevalence ranged from 72,2% to 92,6%, affecting mostly the foot/ankle complex. Only 2 articles reported incidence, which ranged from 3,4–10,6 injuries/1000 hours danced depending on injury definition. Psychological factors, elite level, and insufficient/poor sleep were associated with musculoskeletal injury. Conclusions: Injury prevalence and incidence is high in Irish dancers, with the foot and ankle more affected. Due to heterogeneity in injury definitions, methods, and populations, along with the need for improvement in studies quality, recommendations were made for future research.

Tissue engineering, also called “regenerative medicine”, refers to attempt to create functional human tissue from cells in laboratory. This is a field that uses living cells, biocompatible materials, suitable biochemical and physical factors and their combinations, to create tissue-like structures.. To date, no tissue engineered skeletal muscle implants have been developed for clinical use, but it may represent a valid alternative to treat volumetric muscle loss in the near future. Herein, we reviewed the literature and showed different techniques to produce synthetic tissues with the same architectural, structural and functional properties of native tissues.

Back-care knowledge and behaviour may play a vital role in preventing musculoskeletal current and future discomfort and injuries. The aim of the current survey was to explore the level of knowledge regarding ergonomics and posture together with postural behaviour and the incidence of musculoskeletal pain (MSP) in university students in the northeast of England. A mixed methods survey was conducted on a convenience sample of 55 university students. The 32-item valid and reliable questionnaire contains questions on socio-demographics, MSP, knowledge regarding ergonomics and posture (8 closed ended and 8 open-ended items) as well as postural behaviour. Nearly 1.8%, 20% and 78.2% of the university students had poor, fair and good knowledge of ergonomics and posture respectively. Among the 37 students who carried a backpack, 51.4% were found to have poor postural behaviour, 37.8% had fair behaviour and 10.8% had good postural behaviour. Of the 18 students who did not carry a backpack, 55.6% were found to have poor postural behaviour, 27.8% had fair behaviour and 16.6% had good postural behaviour. 70.9% of the students experienced MSP with the most prevalent site of pain being the lower back region. The key themes that emerged from qualitative data (8 open-ended questions) were: “Comfortable posture”, “Correct spinal alignment”, “Spine support”, “less pain and injuries”, “Use knees not the back”, “Keep the object close to body”, “Hands on desk”, “Feet flat on floor” as well as “eyes at screen level”. The findings of this study can be used to develop targeted interventions aimed at educating university students about ergonomics and posture in order to prevent the incidence of MSP. Future research in this field with a large and more representative sample of the university students’ population is strongly recommended to fully understand their knowledge of ergonomics and posture, postural behaviour as well as incidence of MSP.

(1) Background: Pedestrian injuries (PIs) represent a significant proportion of road traffic injuries. We aimed at investigating the incidence and mortality of PIs in different age groups and Socio-demographic Index (SDI) categories between 1990 and 2017. (2) Method: Estimates of age-standardized incidence and mortality along with trends of PIs by SDI levels were obtained from the Global Burden of Disease from 1990 to 2017. We also calculated forecasts until 2040. (3) Results: Globally, PIs incidence increased by 3.31% (–9.94 to 16.56) in 2017 compared to 1990. Men have a higher incidence of PIs than women. Forecasted incidence was 132.02 (127.37 to 136.66) per 100,000 population in 2020, 101.52 (65.99 to 137.05) in 2030 and reduced further to 71.02 (10.62 to 152.65) by 2040. Globally across all SDI categories, there was a decreasing trend in mortality due to PIs with the global estimated percentage reduction of 37.12% (–45.19 to –29.04). (4) Conclusions: The results show that PIs are still a burden for all SDI categories despite some variation. Although incidence and mortality are expected to decrease globally, some SDI categories may require particular attention in addition to specific vulnerable age groups. Further studies addressing incidence and mortality patterns in vulnerable SDI categories are needed.

Background: Knee joint is a common site for injury among younger people, the purpose of this study is to measure the skeletal muscle endurance and strength on people with prior knee reconstruction surgery. Methods: Young healthy female subjects were tested who reported having knee reconstruction surgery of over one year prior to testing. The skeletal muscle endurance index of the hamstring and quadriceps muscles was determined as the decline in the specific muscle acceleration in response to 2, 4, and 6 Hz electrical stimulation. Maximal isometric muscle strength (MVC) was measured in the hamstring and quadriceps muscles. Results: The hamstring muscles in the affected leg had less endurance than the non-affected leg at 6 Hz stimulation (55.5 ± 13.2% versus 78.0 ± 13.3%, P = 0.01). Muscle endurance was not reduced in the quadriceps muscles in the affected leg compared to the non-affected leg at 6 Hz stimulation (78.0 ± 13.3% versus 80.3 ± 10.0%, P = 0.69). There were no differences in MVC between the affected and non-affected legs for either the hamstring (P= 0.20) or quadriceps muscles (p = 0.67). Conclusions: Muscle endurance is reduced in the hamstring muscles at least one-year post injury, while hamstring strength is not. Reduced hamstring muscle endurance could be a result of a lack of focus on muscle endurance during rehabilitation after injury and may contribute to re-injury in the particular muscle even in people who have recovered muscle strength.

Objective: To investigate postacute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the current literature studying PLID in patients with a history of COVID-19. The review was performed according to PRISMA Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to 5 uncontrolled prospective and 3 retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), laryngopharyngeal reflux (21%), and muscle tension dysphonia (21%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean=48%). There was an important heterogeneity between studies about inclusion, exclusion criteria and outcomes. Conclusion: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.

Background: With its impressive natural language processing and comprehension skills, ChatGPT-4 (Chat Generative Pre-Trained Transformer) is a technology that shows great promise for use in a number of medical fields. This article provides a thorough description of the possible uses of OpenAI's state-of-the-art language model, ChatGPT-4, in musculoskeletal imaging. Purpose for review: MSK Radiologists need to evolve about their knowledge and understanding of the roles of ChatGPT and its implications in daily practice. We aim to emphasize the advantages of ChatGPT-4 on the musculoskeletal imaging field and its potential to enhance radiologist working checklist review items, and the overall productivity of radiology reports. Recent findings: The fact of that specialists in radiology, rheumatology, orthopedic surgery, and other fields are conversant with ChatGPT. Furthermore, opinions are generally well, despite the fact that many people have reservations about the new technology, which is still developing ^[1]. Compared to GPT-4V based ChatGPT, GPT-4 based ChatGPT showed noticeably better diagnostic accuracy. Although ChatGPT, which is based on GPT-4, performed diagnostically on par with radiology residents, however, it demonstrated lower performance than a musculoskeletal radiologist ^[2].

Musculoskeletal models (MSKMs) are used to estimate the muscle and joint forces involved in human locomotion, often associated with the onset of degenerative musculoskeletal pathologies (e.g. osteoarthritis). Subject-specific MSKMs offer more accurate predictions than their scaled-generic counterparts. This accuracy is achieved through time-consuming personalisation of models and manual tuning procedures that suffers from potential repeatability errors, hence limiting the wider application of this modelling approach. In this work we have developed a methodology for identifying and ranking the muscles that are more important to the determination of the joint forces, thus producing reduced but still accurate representation of the musculoskeletal system in shorter timeframes. The methodology hinges on Sobol's sensitivity analysis (SSA) for ranking the muscle importance. The thousands of data points required for SSA are generated using Gaussian Process emulators, a Bayesian technique to infer the input-output relationship between nonlinear models from a limited number of observations. Results show that there is a pool of muscles whose personalisation has little effects on the model predictions. Furthermore, joint forces in subject generic and subject generic models are influenced by different set of muscles, suggesting the existence of a model specific component of the sensitivity analysis.

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies addressed the molecular and cellular mechanisms of action of ESWT. However, no uniform concept could be established in this matter until now. We performed a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results were as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT was described in a study does not automatically mean that this mechanism was relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.

Introduction: Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists may use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of ‘fascial connectivity’ evolved two decades ago from a simple anatomical hypothesis called ‘myofascial meridians’. Since then it has been widely researched, as conceptually it makes more sense for functional movements than ‘single-muscle’ theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. Methods: A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine’s scoring). Results: Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. Conclusion: Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

Knee joint injuries, including those affecting the anterior cruciate ligament (ACL), meniscus, and cartilage, present complex challenges in sports medicine and orthopedics due to the intricate cellular and molecular mechanisms involved in tissue damage and repair. Understanding the molecular biology underpinning these processes is crucial for developing effective therapeutic and rehabilitation strategies. This systematic review investigates the impact of mechanical loading on the cellular responses during knee joint injury repair, with a particular focus on the molecular pathways involved in tissue regeneration. Mechanical loading plays a dual role, where controlled early loading can promote tissue repair, while excessive or inappropriate loading can exacerbate tissue damage. Fibroblasts, chondrocytes, and mesenchymal stem cells (MSCs) are central to the repair process, and their activation, proliferation, and differentiation are regulated by key molecular pathways. Upon injury, mechanotransduction pathways such as the integrin/FAK signaling axis are activated, which convert mechanical signals into biochemical responses that regulate cell adhesion, migration, and extracellular matrix (ECM) synthesis. Additionally, mechanosensitive ion channels like Piezo1 and TRPV4 modulate intracellular calcium levels, triggering downstream signaling cascades such as calmodulin/CaMKII, which regulate gene transcription and cellular responses to mechanical stress. The YAP/TAZ pathway, a critical component of the Hippo signaling pathway, responds to mechanical stimuli and regulates cell proliferation and ECM production in fibroblasts and chondrocytes. YAP/TAZ translocate to the nucleus in response to mechanical loading, where they interact with transcription factors such as TEAD, promoting the expression of genes involved in collagen synthesis and tissue repair. In parallel, growth factors like transforming growth factor-beta (TGF-β) and fibroblast growth factor (FGF) activate the TGF-β/Smad and PI3K/Akt signaling pathways, driving MSC differentiation into fibroblasts and chondrocytes, essential for ligament and cartilage repair. Mechanical loading also influences the inflammatory response at the injury site by modulating immune cell activity. Early mechanical loading can shift macrophages from a pro-inflammatory M1 phenotype to an anti-inflammatory M2 phenotype, mediated by growth factors such as TGF-β and interleukin-10 (IL-10). This phenotypic switch promotes tissue regeneration by enhancing ECM synthesis and resolving inflammation, which is crucial for long-term joint health. Matrix metalloproteinases (MMPs), regulated by NF-κB and MAPK pathways, play a role in ECM remodeling, where an imbalance between MMPs and their inhibitors (TIMPs) can lead to excessive matrix degradation, impeding tissue repair. Furthermore, Wnt/β-catenin signaling is activated in response to moderate mechanical loading, promoting chondrocyte proliferation and enhancing cartilage repair by upregulating type II collagen and aggrecan synthesis. However, dysregulation of Wnt signaling under excessive mechanical stress can lead to chondrocyte hypertrophy and cartilage degradation, contributing to osteoarthritis development. This review also explores emerging therapeutic strategies that leverage the molecular biology of knee joint repair, including biologics like platelet-rich plasma (PRP) and MSC-derived exosomes, which deliver bioactive molecules that activate critical regenerative pathways such as TGF-β/Smad and PI3K/Akt. Gene therapies targeting Wnt signaling or YAP/TAZ offer potential for enhancing tissue regeneration by modulating mechanotransduction and repair processes at the molecular level. In conclusion, the molecular biology of cellular responses to mechanical loading is central to knee joint repair following injuries. By understanding these processes and targeting specific molecular pathways, clinicians can optimize rehabilitation protocols and develop novel therapeutic approaches that enhance tissue regeneration, prevent chronic degeneration, and restore joint function. This comprehensive synthesis highlights the importance of integrating molecular insights into treatment strategies for ACL, meniscal, and cartilage injuries to improve patient outcomes.

Orbital fractures are a common finding in facial trauma and serious complications may arise when orbital reconstruction is not done properly. The virtual planning can be used to manufacture patient-specific titanium orbital implants (PSI) through the process of selective laser melting. This method is currently considered the most accurate technique for orbital reconstruction. Even with the most accurate tehniques of bone reconstruction, there are still situations where enophthalmos is present after reconstruction which may be produced by intraorbital soft tissue atrophy. The aim of this paper was to evaluate the orbital soft tissue after postraumatic reconstruction of the orbital walls fractures. 10 patients diagnosed with unilateral orbital fractures were included in this study. A CT scan of the head region with thin slices (0.6mm) and soft and bone tissue windows was done. After data processing, the STL files were exported and the intraorbital fat tissue volume and the muscular tissue volume were masured. The volumes of affected orbit tissues were compared with the volumes of the healthy orbit tissues for each patient. Our findings conclude that a higher or a lower grade of fat and muscular tissue loss is present in all cases of reconstructed orbital fractures.

This study aims to explore the possibility of estimating a multitude of kinematic and dynamic quantities using subject-specific musculoskeletal models in real-time. The framework was designed to operate with marker-based and inertial measurement units enabling extensions far beyond dedicated motion capture laboratories. We present the technical details for calculating the kinematics, generalized forces, muscle forces, joint reaction loads, and predicting ground reaction wrenches during walking. Emphasis was given to reduce computational latency while maintaining accuracy as compared to the offline counterpart. Notably, we highlight the influence of adequate filtering and differentiation under noisy conditions and its importance for consequent dynamic calculations. Real-time estimates of the joint moments, muscle forces, and reaction loads closely resemble OpenSim's offline analyses. Model-based estimation of ground reaction wrenches demonstrates that even a small error can negatively affect other estimated quantities. An application of the developed system is demonstrated in the context of rehabilitation and gait retraining. We expect that such a system will find numerous applications in laboratory settings and outdoor conditions with the advent of predicting or sensing environment interactions. Therefore, we hope that this open-source framework will be a significant milestone for solving this grand challenge.

Background: Musculoskeletal pain is a non-negligible multifaceted condition affecting more than 30% of the global population. Superficial heat therapy (HT) through increasing tissues temperatures plays a role in increasing local metabolism and function and relieving pain. Knee pain and sports represent two relevant fields of superficial HT application. Methods: In the present paper a panel of experts performed a narrative review of the literature regarding the role of superficial HT in the management of knee pain and sport activities. Results: According to the reviewed literature, HT represents a therapeutic option in the management of musculoskeletal pain due to three main effects: pain relief, promotion of healing and return to normal function and activity. Moreover, HT plays a role in sport activities both before and after exercise. Before performing sports, HT helps in preparing muscles for performance. After performing sports, it is capable to promote recovery and healing pathways. Combining and sequencing superficial heat and cold therapy represent an interesting topic of study. Overall, application of heat wraps for superficial HT can be considered safe. Conclusions: Despite being an ancient method, HT shows to be a potentially beneficial and safe option in the management of several conditions including KP and sports. The key in the application of superficial HT is a multimodal and multidisciplinary approach.

Causation concepts for work-related musculoskeletal disorders vary among authors and academic disciplines. Major causation concepts are single-event and repetitive motion. The aim of this short communication is to share findings from a recent survey, conducted by the U.S. Bureau of Labor Statistics of United States employers about work-related musculoskeletal cases, and more specifically, about whether the employers regard the cause of their employee’s musculoskeletal problem as being from a single exposure or from multiple exposures. Recommendations are offered for using terminology consistent with employer understandings.

Background. In a changing European agricultural context, diversification of dairy farms is gaining attention. This study seeks to (1) assess musculoskeletal pain prevalence associated with tasks such as butter, yogurt, and cheese production; and (2) analyze associated risks. Methods. Observing 31 mostly female workers, it utilized the ERGOROM questionnaire, a methodology adapted from the Institut National de Recherche et de Sécurité, and Key Indicator Method forms. Results. Findings revealed that tasks like load carrying (42% of workers), manual work (17%), and awkward postures (14%) resulted in musculoskeletal pain, predominantly in the lower back (65%), neck (39%), and dominant upper limb areas (shoulder: 61%, elbow: 26%, and wrist: 65%). While psychosocial risks remained low, concerns arose from workload, hygiene standards, and resource unpredictability. Conclusions. As dairy farming evolves from artisanal to semi-industrial, the study emphasizes the importance of ergonomic adaptations to protect farmer health and prevent musculoskeletal disorders during diversification.

Chikungunya virus is a re-emerging mosquito-borne alphavirus. Outbreaks are unpredictable and explosive in nature. Fever, arthralgia, and rash are common symptoms during the acute phase. Diagnostic tests are required to differentiate chikungunya virus from other co-circulating arboviruses, as symptoms can overlap, causing a dilemma for clinicians. Arthritis is observed during the sub-acute and chronic phases, which can flare up, resulting in increased morbidity that adversely affects activities of daily living. During the 2019 chikungunya epidemic in Thailand, cases surged in Bangkok in the last quarter of the year. Here, we demonstrate the chronic sequelae of post-chikungunya arthritis in one of our patients 1 year after the initial infection. An inflammatory process involving edema, erythema, and tenderness to palpation of her fingers' flexor surfaces was observed, with positive chikungunya IgG and negative IgM tests and antigen. The condition produced stiffness in the patient’s fingers and limited their range of motion, adversely affecting daily living activities. Resolution of symptoms was observed with a short course of an anti-inflammatory agent. More research is required to determine whether sanctuaries enable chikungunya virus to evade the host immune response and remain latent, flaring up months later and triggering an inflammatory response that causes post-chikungunya arthritis.

Needlestick and other sharp injuries (NSIs) are critical occupational hazard for healthcare workers. Exposure to blood and body fluids through NSIs increases the risk of transmission of blood-borne pathogens among them. The objectives of this study were to estimate the one-year incidence of NSIs and investigate its associated factors among the healthcare workers in Saudi Arabia. A cross-sectional online survey was conducted between October and November 2021. A total of 361 healthcare workers participated in the survey from all over Saudi Arabia. The one-year incidence of NSIs among healthcare workers is estimated at 22.2%. More than half of the injury event (53.8%) was not reported to the authority by the healthcare worker. Incidence of NSIs was highest among the physicians (36%) and is followed by nurses (34.8%), dentists (29.2%), and medical technologists (21.1%). The likelihood of injury is higher (OR: 2.51; 95% CI: 1.04, 6.03) among the works aged 26 – 30 years compared to the 20 – 25 years age group and the workers directly deal with needles or other sharp objects while working (OR: 5.90; 2.69, 12.97). The high incidence rate of injury and low reporting rate highlight the needs of an education program targeting healthcare providers with higher risk.

Chest trauma is a critical medical condition that encompasses a range of injuries and can result from various causes. Prompt and accurate diagnosis is crucial in managing chest trauma patients and radiology plays a pivotal role in this aspect. Imaging modalities in chest trauma aid in precise diagnosis and treatment planning. Especially, X-rays remain the initial imaging modality of choice due to their accessibility, speed, and ability to detect acute life-threatening conditions. Computed Tomography (CT) Scan offers detailed cross-sectional images allowing for comprehensive evaluation of chest trauma and surgical planning when necessary. Ultrasound (US) is increasingly valuable tool due to its portability and real-time imaging capabilities, aiding in rapid assessment at the bedside. Magnetic Resonance Imaging (MRI) is less commonly used due to time constraints and limited availability. Radiological imaging serves various purposes in the diagnosis and management of chest trauma such as early detection and triage, characterization and severity assessment, surgical planning, follow-up and monitoring of chest trauma. Reduction of radiation exposure, advancements in imaging technology (dual-energy CT, contrast-enhanced imaging) and Artificial Intelligence (AI) algorithms are crucial challenges and deserve attention. A multidisciplinary approach integrating radiological expertise remains fundamental in ensuring optimal outcomes for patients with chest trauma.

Abstract Background: Occipital neuralgia is a debilitating condition and traditional treatments often provide limited or temporary relief. Recently, ultrasound-guided hydrodissection of the greater occipital nerve (GON) has emerged as a promising minimally invasive approach. Objectives: To describe two novel ultrasound-guided hydrodissection with 5% dextrose for GON and discuss their advantages, disadvantages, and considerations. Methods: Two case reports are presented. Case 1 describes a lateral decubitus approach for hydrodissecting the GON between the semispinalis capitis (SSC) and obliquus capitis inferior (OCI) muscles. Case 2 details a cranial-to-caudal approach for hydrodissecting the GON within the SSC and upper trapezius (UT) muscles when the GON pass through these two muscles. Results: Both patients experienced significant and sustained pain relief with improvements in function and quality of life. Conclusions: Ultrasound-guided GON hydrodissection using 5% dextrose is a promising treatment for occipital neuralgia. The lateral decubitus and cranial to caudal approaches provide additional options to address patient-specific anatomical considerations and preferences.

The functional capacity of the cervical spine plays a central role in healthy living. This study evaluated and created a comprehensive strength, range of motion (ROM), and musculoskeletal pain profile of the cervical spine in young adults. 60 physically active individuals (30 males/30 females; 19-24 year-old) participated in the study. Cervical ROM (forward flexion, extension, lateral flexion, and rotation), maximal isometric strength (forward flexion, extension, lateral flexion), and musculoskeletal pains were assessed using an electronic goniometer, a handheld dynamometer, and the Nordic questionnaire, respectively. Data analysis revealed that: a) fe-males had higher ROM values, during extension and lateral flexion, than males (p<0.05), b) males had higher absolute strength values than females in all movement directions, higher rela-tive strength values/body mass (at forward flexion) and flexion/extension ratio values (p<0.05), c) ROM and strength values were not significantly different between right-left sides (p>0.05), d) a great proportion (43.3%) of the participants had cervical pains (no sex-related differences) and e) cervical strength showed significant small negative correlation with pains (p<0.05; r=-0.225 to -0.345). The reference values created may be used by health and fitness professionals to exten-sively evaluate the cervical spine and to design specific exercise programs for injury prevention and rehabilitation.

Introduction People are presenting with chronic musculoskeletal pain at a younger age, and many fulfil criteria for fibromyalgia. We have recently shown a strong association between fibromyalgia symptoms and autistic traits in a self-selected community population, with the relationship mediated in part by the presence of hypermobility. Many respondents also described food sensitivities and intolerances. This study explores relationships between food issues and fibromyalgia symptoms in this population Methods The study used a nonexperimental, correlational design with data collected from a volunteer sample of 442 adults (aged 18-60) who completed online self-report questionnaires assessing each of fibromyalgia symptoms (ACR criteria), autistic traits (RAADS score) and hypermobility (Beighton’s test). Subjects were also asked to record any food sensitivities, allergies, or intolerances, along with their consequences. Correlation analyses and linear regressions were used to test the relationships between these features and each of fibromyalgia, autistic traits and hypermobility. Data was analysed using parametric and non-parametric techniques to assess the strength and significance of relationships, causes of variance and the potential mediating effect of food-related symptoms in the correlation between fibromyalgia features and autistic traits Results Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of fibromyalgia, autistic traits and hypermobility was 40%, 65% and 44% respectively. Half of all subjects reported food sensitivity and 31% reported food intolerance. The incidence of food-related symptoms was higher among subjects who met criteria for fibromyalgia than those who reported autistic traits or hypermobility. Food sensitivity and food intolerance were both more significantly associated with fibromyalgia (r=0.24, p>0.001 and r=0.38, p>0.001) than with autistic traits (r=0.15, p>0.01 and r=0.17, p>0.01). Discussion This is the first community study to provide evidence for a direct association between features of fibromyalgia and reported food intolerance and sensitivity. Although self-selected, the findings in our predominantly young population suggest that gluten and lactose consumption may be associated with higher levels of musculoskeletal pain. Avoidance of these foodstuffs was commonly reported to reduce symptoms. Dietary adjustment may merit further investigation as a therapeutic modality for some patients with fibromyalgia.

This work focuses on the design improvement of a tri-axial piezoresistive accelerometer specifically designed for head injuries monitoring where medium-G impacts are common, for example in sports such as racing cars or American Football. The device requires the highest sensitivity achievable with a single proof mass approach, and a very low error (<1%) as the accuracy for these types of applications is paramount. The optimization method differs from previous work as it is based on the progressive increment of the sensor mass moment of inertia (MMI) in all three axes. The work numerically demonstrates that an increment of MMI determines an increment of device sensitivity with a simultaneous reduction of cross-talk in the particular axis under study. The final device shows a sensitivity increase of about 80% in the Z-axis and a reduction of cross-talk of 18% respect to state-of-art sensors available in the literature. Sensor design, modelling and optimization are presented, concluding the work with results, discussion and conclusion.

Casein Kinase ІІ (CK2) is one of the most versatile kinases. Its involvement in almost all cellular pathways makes it the Master Regulator of biochemical processes in a cell. This kinase is essential in regulating inflammation, cell differentiation, and cell cycle regulation. Often simultaneously. Its emerging role in senescence also indicates its function's centrality in cellular metabolism. The strategy to target this kinase to treat musculoskeletal disorders seems effective. These disorders often include a component of inflammation, dysregulated cell differentiation, and aging. This review focuses on CK2 target discovery and the diversity of its substrate interactions. We then transition toward the implication of CK2 in musculoskeletal disorders. Through a summary of current strategies for CK2 targeting with a new approach, we discuss the potential aspects that could be addressed in future drug research.

The beautiful and stable posture is essential for ballet. Especially the pirouette which dancers balance themselves on their one leg is one of the most impressive postures. During the pirouette motion, loads from the rotation and the body weight are concentrated to the one leg. Proper ballet shoes can reduce the muscle burden and improve the stability. Four types of shoes; bare feet, running shoes, pointe shoes, and dance sneakers are analyzed. The motion capture system and SIMM are used for the analysis of muscle burden and stability during pirouette. The major 6 muscles in the leg (beceps femoris long head, beceps femoris short head, soleus, rectus femoris, gastrocnemius medialis, and gastrocnemius lateralis) are analyzed, and the effect of rotating velocity is considered. Dance sneakers are outstanding for improving the stability and lessening the muscle burdens in all conditions for beginners. That comes from the design feature of the divided shoe soles and protecting the ankle of the axis leg. With the results and analysis, the direction for design optimization of ballet shoes is suggested. Consequently, this research is about the verification of sports equipment using computer simulation with the musculoskeletal model from a scientific viewpoint of biomechanics.

Due to their close anatomical and spatial relationships with left renal hilum, both superior mesenteric artery and celiac trunk injuries continue to be reported during left radical nephrectomy, either through an open, laparoscopic or robotic approach. The aim of this review, 50 years after the first reported cases, is to highlight anatomical and pathophysiological basis, risk factors, as well as diagnostic and therapeutic strategies for dealing with these injuries.

Opioid use disorder has increased in the world in recent years and Iran ranks first in terms of opium smoking in the world. In fact, opium smoking by traditional methods, in addition to dependence on morphine, is a behavioral addiction in Iran. The body position during opium smoking is usually non-standard and non-ergonomic. Over time, changes in muscle tissue, tendons and ligaments, and the connective tissue go from elasticity to neuromuscular plasticity. This study aims to compare sway back posture and musculoskeletal problems between opium smokers and non-drug users. In this comparative and cross-sectional study, 80 opium smokers were compared with 74 non-drug users in terms of sway angle (sway back posture), and musculoskeletal complaints (NORDIC questionnaire) and the association of possible risk factors was investigated. Data were analyzed by Kolmogorov-Smirnov, Correlation Coefficient and paired-t tests using SPSS version 23. There were significant differences between two groups in terms of sway back posture (P=0.007), and neck (<0.001), upper back (<0.001) and lower back (0.006) musculoskeletal complaints. Homelessness, the lifetime duration of opium smoking (in months), and the duration of daily opium smoking (in minutes) had significant correlation with sway back posture and musculoskeletal complaints. Homelessness was the strongest predictor and had strongest correlation. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to increase in sway angle and sway back posture and increase in musculoskeletal complaints of neck, upper back and lower back due to the non-neutral posture of opium smoking. It seems that plasticity and structural and functional adaptations of the posture occurs due to opium smoking and further studies are recommended.

Background: Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. On the other hand, there are still misconceptions about these adipose-derived regenerative cells (ADRCs) that contain vascular-associated pluripotent stem cells (vaPS cells) in regenerative medicine. Methods: Based on our previous publications on this topic, we have developed a concept to describe the significance of the ADRCs/vaPS cells in the field of orthobiologics as briefly as possible and at the same time as precisely as possible. Results: The ADRCs/vaPS cells belong to the group of orthobiologics that are based on autologous cells. Because the latter can both stimulate a patient’s body's localized self-healing power and provide new cells that can integrate into the host tissue during the healing response when the localized self-healing power is exhausted, this group of orthobiologics appears more advantageous than cell-free orthobiologics and orthobiologics that are based on allogeneic cells. Within the group of orthobiologics that are based on autologous cells, enzymatically isolated, uncultured ADRCs/vaPS cells have several advantages over non-enzymatically isolated cells/microfragmented fat as well as over uncultured bone marrow aspirate concentrate and cultured cells (adipose-derived stem cells, bone marrow-derived mesenchymal stem cells). Conclusions: The use of ADRCs/vaPS cells can be seamlessly integrated into modern orthopedic treatment concepts, which can be understood as the optimization of a process which - albeit less efficiently - also takes place physiologically. Accordingly, this new safe and effective type of treatment is attractive in terms of holistic thinking and personalized medicine.

Tendon injuries, while prevalent, present a significant challenge in fully restoring their structural and functional integrity. Utilizing alpha-smooth muscle actin (α-SMA)-Ai9-scleraxis (Scx)-green fluorescent protein (GFP) transgenic mice, which exhibit both Scx (a tendon cell marker) and α-SMA (a myofibroblast marker), we explored Met's effects on tendon healing and repair and its mechanisms of action. Our findings revealed that intraperitoneal (IP) injections of Met -administered before or after injury, as well as both - effectively prevent the release of HMGB1 into the tendon matrix and reduce circulating levels of HMGB1. Additionally, Met treatment increased and activated AMPK and suppressed TGF-β1 levels within the healing tendon. These interventions also improved tendon healing by blocking the migration of α-SMA+ myofibroblasts, reducing the prevalence of disorganized collagen fibers and collagen type III, and enhancing the presence of collagen type I. These outcomes highlight Met's anti-fibrotic properties on acutely injured tendons and suggest its potential for repurposing as a therapeutic agent to minimize scar tissue formation in tendon injuries, which could have profound implications in clinical practice.

. Sealants and adhesives are used in the repair and preservation of damaged solid organs. This study examines the matrix metalloproteinases (MMP) activity in the healing of liver injuries treated with two biological adhesives (Tachosil® and GelitaSpon®) as well as that of a new elastic cyanoacrylate (Adhflex®). Methods. We induced in 90 male rats hepatic lesions using a Stiefel biopsy punch in the liver. Wound healing was assessed 2, 6, and 18 days after injury by quantifying MMP1, 2, 8, 9, and 13 tissue levels. The histopathological repair was evaluated by hematoxylin-eosin, Masson’s trichrome, and Periodic Acid Schiff (PAS) staining and CD31, CD68 immunohistochemical marker. The three sealants used contributed to the complete healing of hepatic lesions. Both histopathology and MMP findings point to the fact that degradation with Adhflex® is slower and causes a strong inflammatory reaction at the onset of healing. Results. All the MMPs measured showed higher values early in the healing process in animals treated with Adhflex® and Tachosil, expression for MMP2 and MMP9 being significantly higher in the Adhflex-treated group. Animals treated with Tachosil had significant greater values of MMP8 and MPP13 than the Adhflex group. Animals treated with Adhflex® showed a sustained overexpression in all MMPs even at the latest wound healing stages. Conclusion. Notably, the overexpression of the MMPs did not negatively influence the histological healing process of liver injuries. Since all hepatic trauma injuries should be treated as emergencies, any easy-to-use and rapid sealant, like Adhflex®, could be considered an adequate treatment option.

Background. Adhesives and sealants can be used to repair and preserve solid damaged organs. This study explores the activity of different matrix metalloproteinases (MMP) during the healing of liver injuries treated with two biological adhesives (Tachosil and GelitaSpon) and a new synthetic elastic cyanoacrylate (Adhflex®). Methods. Liver traumatic injuries were experimentally induced in 90 male Wistar rats using a Stiefel biopsy punch in the liver. Wound healing was evaluated 2, 6, and 18 days after injury by determining MMP1, 2, 8, 9, and 13 expression. The histopathological repair was assessed by hematoxylin-eosin, Masson’s trichrome, and Periodic Acid Schiff (PAS) staining. The three sealants used supported complete healing of the liver lesions. Both histopathology and MMP findings indicate that the degradation process of Adhflex® is slower and produces a strong initial inflammatory reaction. Results. All the MMPs measured disclosed higher values at early stage of the healing process in animals treated with Adhflex® and Tachosil, being the expression of for MMP2 and MMP9 significantly higher in the Adhflex-treated group. Animals treated with Tachosil had significant higher values of MMP8 and MPP13 than the Adhflex-treated group. Animals treated with Adhflex® showed a maintained overexpression in all the MMPs tested even at the latest wound healing stages. Conclusion. Notably, this MMPs overexpression did not influence negatively the histological healing process of the hepatic injuries. Given that all hepatic trauma injuries should be considered emergencies, any easy-to-use and rapid sealant, such as Adhflex®, could be considered as a suitable treatment option.

Purpose: To explore the influence of education and other factors on an athlete’s decision to return to sport post-concussion injury, and whether general risk-taking tendencies are related to return to sport post-concussion decisions in these athletes. Participants and Methods: A self-administered electronic survey was designed to examine their decision-making process when faced with scenario-based questions regarding returning to sport post-concussion injury. Students from the Health Sciences and Medicine Faculty at Bond University were invited to participate. Participants were allocated to a concussion education or non-education group prior to commencement of questionnaire via the random generator on Qualtrics software function. The risk propensity scale was used to assess the risk aversion of each participant. Results: Sixteen respondents were randomized evenly to education and non-education groups. Seven (43.8%) had previously received concussion education training prior to completing the questionnaire, with one (14%) choosing to return to sport in the scenario-based questions. The education group reported two (25%) respondents return to sport, while three (75%) respondents out of four returned to sport with no education or previous concussion training. Influential factors that impacted the decision whether to return to sport or not included: game importance, concussion severity and symptoms, and various internal and external factors. Finally, there was a divergence in results from the risk propensity scale when deciding to return to sport and general risk-taking propensities. Conclusion: This study identified several influential factors including game importance, concussion severity and symptoms which play a significant role in the return to sport decisions post-concussion injury.

Introduction; to the best of the authors knowledge no past research has established how illness narrative master plots are expressed initially, and then if, and how they change longitudinally following musculoskeletal trauma. The aim of the current research was able to consider how specific master plots were expressed, interact and change across time following musculoskeletal trauma. Methods; a narrative analysis was undertaken that included individuals who had experienced a musculoskeletal traumatic injury. Individuals were included if they were an inpatient within 4 weeks of the first interview had mental capacity to participate and were able to communicate in English. Three interviews were undertaken (within 4 weeks of injury, 6 and 12 months). A 5-stage categorical form type narrative analysis was performed. Results; Twelve individuals (49.9±17.5 years; 7 male, 5 female) completed interviews at three time points following the trauma event (&lt;4 weeks months, 6 months and 12 months). Three main narratives that appeared to work together to facilitate a positive accommodation of the trauma event into the individual’s life were presented. These included the resumption narrative, the activity narrative and quest narrative. Finally, less often regressive narratives were identified although these narratives were, at times, actively avoided. Discussion; The current results provide important consideration for how narratives are used within clinical practice, in particular the value of how these three narratives could be access and promoted.

Because most of the recognized causes of superior gluteal nerve (SGN) injury are iatrogenic, detailed knowledge of the anatomy of the SGN is crucial to prevent its injury associated with surgical procedures. This study aims to describe the precise location of SGN or its branches at the greater sciatic foramen, measure the distances of these nervous structures to palpable bony landmarks, and evaluate the possible correlation between these parameters and pelvis size. Twenty human cadaveric hemipelvises were studied. After dissection to expose the SGN or its branches at the greater sciatic foramen, the distances from these nervous structures to the greater trochanter (GT), to the anterior superior iliac spine (ASIS), to the posterior superior iliac spine (PSIS), to the ischial tuberosity (IT), and to the greater sciatic notch were measured. We found that at the greater sciatic foramen the SGN emerges as a common trunk in 75% of hemipelvises, and already divided in its superior and inferior branches in 25% of hemipelvises. When the SGN exits the pelvis as a common trunk, it does so, in most cases, in contact with the bone at the apex of the greater sciatic notch or superior to it. The median distance from the SGN at the greater sciatic notch to the PSIS, ASIS, GT and IT is 7.6 cm, 10.9 cm, 7.5 cm and 10.8 cm, respectively. We found a positive correlation between some of the analyzed parameters and the size of the pelvis. The anatomical data of this study may serve as pivotal guides during orthopedic pelvic surgery, contributing to minimize SNG iatrogenic lesions with significant implications in the patient's quality of life.

Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS has been shown to be more sensitive than US for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT. CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and for the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.

There is a significant risk of injury in sports and intense competition due to the demanding physical and psychological requirements. Hamstring strain injuries (HSI) are the most prevalent type of injury among professional soccer players and are the leading cause of missed days in the sport. These injuries stem from a combination of factors, making it challenging to pinpoint the most crucial risk factors and their interactions, let alone find effective prevention strategies. Recently, there has been a growing recognition of the potential of tools provided by artificial intelligence (AI). However, current studies primarily concentrate on enhancing the performance of complex machine learning models, often overlooking their explanatory capabilities. Consequently, medical teams encounter difficulty interpreting these models and are hesitant to trust them fully. In light of this, there is an increasing need for advanced injury detection and prediction models that can aid doctors in diagnosing or detecting injuries earlier and with greater accuracy. Accordingly, this study aims to identify biomarkers of muscle injuries in professional soccer players through a biomechanical analysis, employing several ML algorithms, such as Decision tree (DT) methods, Discriminant methods, Logistic regression, Naive Bayes, Support vector machine (SVM), K-nearest neighbor (KNN), Ensemble methods, Boosted and bagged trees, Artificial Neural Networks (ANN), and XGBoost. In particular, XGBoost was also used to obtain the most important features. The findings highlight that the variables that most effectively differentiate the groups and could serve as reliable predictors for injury prevention are the maximum muscle strength of the hamstrings and the stiffness of the same muscle. With regards to the 35 techniques employed, a precision of up to 78% was achieved with XGBoost, indicating that by considering scientific evidence, suggestions based on various data sources, and expert opinions, it is possible to attain good precision, thus enhancing the reliability of the results for doctors and trainers. Furthermore, the obtained results strongly align with the existing literature, although further specific studies about this sport are necessary to draw a definitive conclusion.

Lower back musculoskeletal disorders (MSD) are an important public health problem and the leading cause of disability worldwide, but with prevalence yet unknown among shellfish gatherers. To investigate the prevalence and work-related factors associated with lower back MSD in a population of female shellfish gatherers, an epidemiological cross-sectional study was carried out in Saubara, Bahia – Brazil, in 2013. The Brazilian version of the Job Content Questionnaire (JCQ) and the Nordic Musculoskeletal Questionnaire (NMQ), in addition to a questionnaire containing the physical demands adapted to the artisanal work, were applied to a random sample of 209 female shellfish gatherers. The prevalence of lower back MSD was 72.7%. Using multivariate logistic regression, the shellfish gatherers who had worked for more than 26 years in the activity showed a prevalence of 1.22 (95% CI: 1.04-1.44) times higher compared to those unexposed. Lower back MSD was 1.24 (95%CI: 1.08-1.42) times higher among those more exposed to work sitting with trunk flexion. Those performed manual handling and muscle force with the arms had a prevalence ratio of 1.18 (95%CI: 1.01-1.39). These results show the need for greater awareness of health and social welfare factors impacting workers in small-scale fisheries and will promote the elaboration of health care policies for this occupational class.

Cartilage degeneration is a characteristic of osteoarthritis (OA) which is often observed in aging populations. This degeneration is due to the breakdown of articular cartilage (AC) mechanical and tribological properties, primarily attributed to lubrication failure. Understanding the reasons behind these failures and identifying potential solutions could have significant economic and societal implications, ultimately enhancing the quality of life. This review provides an overview of developments in the field of AC, focusing on its mechanical and tribological properties. The emphasis is on the role of lubrication in degraded AC, offering insights into its structure and function relationship. Further it explores the fundamental connection between AC mechano-tribological properties and the advancement of its degradation and puts forth recommendations for strategies to boost its lubrication efficiency.

While shoulder injuries represent the musculoskeletal disorders (MSDs) most encountered in physical therapy, there is no consensus on their management. As attempts to provide standardized and personalized treatment, a robot-ic-assisted device combined with EMG biofeedback specifically dedicated to shoulder MSDs has been developed. The aim of this study was to determine the efficacy of an 8-week rehabilitation program (≈3 sessions a week) using a ro-botic-assisted device combined with EMG biofeedback (RA-EMG group) in comparison with a conventional program (CONV group) in patients presenting with shoulder MSDs. This study is a retrospective cohort study including data from 2010 to 2013 on patients initially involved in a physical rehabilitation program in a private clinic of Chicoutimi (Canada) for shoulder MSDs. Shoul-der flexion strength and range of motion were collected before and after the rehabilitation program. Forty-four patients participated in a conventional pro-gram using dumbbell (CONV group) while 72 of them completed a program on robot-assisted device with EMG and visual biofeedback (RA-EMG group), whereby both programs consisted in 2 sets of 20 repetitions at 60% of maximal capacity. Results showed that the RA-EMG had significantly greater benefits than the Conv group for shoulder flexion strength (+103.1% vs 67%, p = 0.016) and range of motion (+14.4% vs 6.1%, p = 0.046). The current retrospective co-hort study showed that a specific and tailored rehabilitation program with constant effort by automatic adjustment of the level of resistance was able to potentiate strength and range of motion shoulder flexion after an 8-week reha-bilitation period in comparison with a conventional approach in patients with shoulder MSDs. This study provides new insight on shoulder MSD rehabilita-tion and future research should be pursued to determine the added potential of this approach for abduction and external rotation with a randomized controlled design.

Heel pain in the “funnel-shaped” space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints may be representative of Sinus Tarsi syndrome. The pain is often characterized by a burning, numbness, or tingling sensation that can stem from strains and tears on the ligaments in that area. Injury treatment typically includes balance training, muscle exercises, bracing, foot orthosis, and non-steroidal anti-inflammatory drugs (NSAIDs). This study presents Wharton Jelly (WJ) tissue allografts as an alternative intervention for patients who fail standard-care treatments. WJ targets tissue defects, unlike other therapies, which aim to reduce swelling and symptomatic pain. This study includes five female patients who have previously failed standard-of-care treatment. Each received extracorporeal pulse-activated therapy (EPAT), WJ, laser therapy, and an orthotic. After an average of 80 days, the cohort had an overall 85.29% improvement in pain. The study's limitations include a small cohort size and a non-blinded design. Given the significant improvement in pain, WJ tissue allograft, combined with other techniques, presents an optimal patient care plan for tissue defects associated with Sinus Tarsi syndrome when standard-of-care treatments fail. These results provide evidence for a more extensive, randomized study to define dosage protocols further and confirm safety and efficacy.

Background and Objectives: Angioembolization has emerged as an effective therapeutic approach for pelvic hemorrhages; however, its exact effect size remains uncertain. Therefore, we conducted this systematic review and meta-analysis to investigate the effect size of embolization-related pelvic complications after nonselective angioembolization compared to that after selective angioembolization in patients with pelvic injury accompanying hemorrhage. Materials and Methods Relevant articles were collected by searching the PubMed, EMBASE, and Cochrane databases until June 24, 2023. Meta-analyses were conducted using odds ratios (ORs) for binary outcomes. Quality assessment was conducted using the risk of bias tool in non-randomized studies of interventions. Results: Five studies examining 357 patients were included in the meta-analysis. Embolization-related pelvic complications did not significantly differ between patients with nonselective and selective angioembolization (OR 1.581, 95% confidence interval [CI] 0.592 to 4.225, I2 = 0%). However, in-hospital mortality was more likely to be higher in the nonselective group (OR 2.232, 95% CI 1.014 to 4.913, I2 = 0%) than in the selective group. In the quality assessment, two studies were found to have a moderate risk of bias, whereas two studies exhibited a serious risk of bias. Conclusions: Despite the favorable outcomes observed with nonselective angioembolization concerning embolization-related pelvic complications, determining the exact effect sizes was limited owing to the significant risk of bias and heterogeneity. Nonetheless, the low incidence of ischemic pelvic complications appears to be a promising result.

As the problem of traction injuries to brachial plexus is a common one and of high socio-economic significance, the analysis of the surgical outcomes in patients with this pathology is significant for neurosurgery, neurology, traumatology-orthopedics, and rehabilitation. The aim of the research is to compare the short-term outcomes of using various surgical methods for managing patients with closed traction injuries of brachial plexus. Material and methods. The research involved 61 patients with closed traction injury of brachial plexus divided into two groups homogeneous in sex, age and severity of their neurological deficit: Group I – 33 patients who underwent microsurgical neurolysis, Group II – 28 patients who underwent microsurgical neurolysis combined with one-level electrostimulation. The dynamic assessment of clinical and functional status of upper limbs was performed using scale methods and electrophysiological monitoring. Results. The research revealed a more evident recovery of the upper limb function in Group II patients suggesting the method of microsurgical neurolysis combined with electrostimulation to be preferable in case of closed traction injuries to brachial plexus. Conclusion. The combination of microsurgical neurolysis with one-level electrostimulation improves the short-term outcomes of surgical treatment in patients with closed traction injuries of brachial plexus due to a sooner decrease in pain in postoperative period, and positive dynamics of clinical and electrophysiological parameters.

Injuries of repetitive efforts constitute one of the prime causes of absenteeism in the workplace, have bear a considerable cost for the public health system and can cast doubt on the sustainability of a company. The objective of this paper is to build, in the researchers, the needed knowledge to choose a set of relevant scientific articles about repetitive strain injuries in the poultry meat industry, aiming identify characteristics in those scientific publications that have the potential to contribute on the topic of this paper. The research is characterized as exploratory-descriptive, draws on primary and secondary data sources. The study involves the application of a method for selection and analysis of the selected articles. To this end, the method utilized was the Knowledge Development Process – Constructivist (Proknow-C) as theoretical intervention instrument. Within the process development, it was obtained a portfolio of 16 articles aligned to the research and scientifically recognized with the main periodicals, papers, authors and keywords. The ProKnow-C process allowed identify opportunities in the literature about injuries in the poultry meat industry and showed opportunities for research future. This paper, under the constructivist perspective, presents a structured process to build, in the researcher, the necessary knowledge to identification, selection and analysis of relevant scientific articles relating to research context and, for these articles, find prominences and opportunities for a research theme without similar publications.

Background: The popularity of climbing via ferratas (VF) in the European Alps has increased a lot. We have analysed the pattern of injuries from accidents, which have occurred on VF, and First Aid (FA) knowledge from the persons on such alpine routes. The aim was to create specific FA courses for those who climb VF. Material and Methods: Incidences and FA knowledge of the alpinists were investigated by a questionnaire. Data included details of the individual’s alpine experience, accidents or any kind of medical emergency they have ever experienced. FA knowledge was evaluated by 18 multiple choice questions with 5 answers each. The questionnaire was based on those of previous studies but was slightly adopted for VF. For this data from rescue operations on VF were used. Finally every participant was asked to judge his FA knowledge by a Likert scale (1 to 5). Results: The collective consisted of 391 participants (28.4% women) with an average age of 41 years. A significant portion did no regular fitness training and in most cases the last FA training was years ago. Nobody had joined a specific FA course for climbers or mountaineers. The most common causes of emergencies were: weather conditions (19%), stumble (18.6%), falls (13.4%), and weariness and deficiency in concentration (13.4%). FA questions most often answered correctly were cardiac emergencies (49.6%), high altitude cerebral edema (HACE) (43.2%), snow blindness (40.9%), injuries of the head (37.1%) and hemorrhagic shock (35.3%). Those most often wrong were injuries of the back (1.0%), injuries of the thorax (2.8%), frostbite (9.0%), acute mountain sickness (AMS) (4.1%) and strategy of rescue (4.1%). VF climbers show significant less FA knowledge than mountaineers in the Western Alps and trekkers. Conclusions: Data support the need of a specific FA training for VF climbers. Their FA knowledge does not fit with the demands in the mountains while some other knowledge they have is negligible on VFs (e.g. HACE). This is in accordance with earlier studies in “classic” alpine mountaineering and in trekking.

This study examines the matrix metalloproteinase (MMP) activity in the healing of liver injuries treated with biological adhesives Tachosil^® and GelitaSpon^® and the elastic cyanoacrylate Adhflex^®. Hepatic lesions were induced in male rats using a Stiefel biopsy punch. Healing was assessed 2, 6, and 18 days after injury by quantifying tissue levels of MMP1, 2, 8, 9, and 13. Histopathological repair was evaluated using hematoxylin-eosin, Masson’s trichrome, and Periodic Acid Schiff (PAS) staining and immunohistochemical markers CD31 and CD68. The sealants contributed to complete healing. Histopathology and MMP findings indicate that Adhflex^® has slower degradation and a strong inflammatory reaction at the onset of healing. Early on, all MMPs showed higher levels in Adhflex^® and Tachosil^®-treated animals, and MMP2 and MMP9 expressions were significantly higher in the Adhflex-treated group at 18 days post-injury (T3). The Adhflex^® group had significantly higher MMP8 and MPP13 levels than other treated groups and showed a sustained overexpression of all MMPs, even in the latest healing stages. Notably, the overexpression did not negatively influence the histological healing process. All hepatic trauma injuries should be treated as emergencies, and any easy-to-use and rapid sealant like Adhflex^® could be considered as an option for treating liver trauma.

Background and objectives: Musculoskeletal (MSK) pain significantly impacts physical activity and quality of life in the elderly, potentially influencing mortality. This study explored the relationship between MSK pain, physical activity, muscle mass, and mortality among older adults. Material and Methods: We studied 1000 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA), a prospective, population-based cohort study of people aged 65 years or older. Survival status was tracked over a 5-year period. Correlations between Low back pain (LBP), knee pain, regular exercise, appendicular skeletal muscle mass (ASM), and other variables were analyzed. Logistic regression analyzes were used to identify independent risk factors for mortality. Results: Of the total participants, 829 (82.9%) survived after a 5-year period. Survivors tended to be younger, had a higher BMI, and were more active in regular exercise. In contrast, non-survivors exhibited a higher prevalence of both LBP and knee pain, along with increased instances of multiple MSK pain. Lower ASM correlated moderately with LBP and knee pain, whereas higher ASM was associated with regular exercise Lower ASM was moderately associated with LBP and knee pain, while higher ASM correlated with engagement in regular exercise. There was a moderate correlation between LBP and knee pain, both of which were associated with a lack of regular exercise. Age, sex, ASM, and regular exercise were significant predictors, even though MSK pain itself did not directly predict all-cause mortality. Conclusions: This study demonstrated the independent association between ASM, regular exercise, and mortality. Although MSK pain did not directly correlate with all-cause mortality, the non-survivor group had higher levels of both single and multiple MSK pain. Recognizing the interplay of MSK pain, physical activity, and muscle mass for older adults, the research underscores the need for holistic strategies to enhance health outcomes in older individuals with MSK pain.

Background Children often suffer the nonspecific musculosceletal pain as reported in literature. Aim To determine relationship between body weights with development of musculoskeletal pain and to determine whether growing in body height is associated with musculoskeletal pain in schoolchildren. Subjects/ Methods A prospective longitudinal study included 1315 school children aged 7-14 years (652 boys and 663 girls) and was performed in 13 elementary schools in B&H. Child body height and body weight were measured. The survey of perception of musculoskeletal pain in different body regions of subjects was conducted by adjusted Nordic Musculosceletal Questionnaire (NMQ). Results The highest prevalence of an overweight and obesity in the 10th year 35.7% and the lowest frequency 17.8% in the 14th year was. In the age 14th obesity was’nt found. Boys have more prevalence of overweight. Using logistic regression model, we found that school children with normal BMI were protected with increased body height of acute lower back pain (β= -0.089, 95%CI, -9.730- -0.023, P< 0.049), and increased body height was protector of obese school children of acute upper back pain (β= -0.356, 95%CI, -14.077- -3.878, P< 0.001) and chronic lower back pain (β= -0.356, 95%CI, -14.077- -3.878, P< 0.001). Conclusion Schoolchildren with normal weight more often have had musculosceletal pain than those with overweight or obesity. This can be associated with intense physical growth period in height, especially. The assumption is that the increase in height changes the relationship between excessive BMI and musculoskeletal pain in children of school age.

The anterior cruciate ligament (ACL) injury in the knee is one of the most frequent injuries in the biomechanical environment during jumping exercises; however, repeated jumping, like jumping rope, has not been reported to have a significant impact on the ACL injury. Because of this, this study aimed to compare and examine any potential biomechanical risk factors that can arise during various jumping rope activities, including the basic bounce (BB), forward-backward jump (FB), side-to-side jump (SS), and high knee jump (HK). Thirty participants were recruited. A motion capture system was used to obtain synchronized kinematic and kinetic data for four different jumping rope techniques. The OpenSim modeling system was used to determine the biome-chanical knee factors. The paired samples t-test was used to compare the mean difference in each jumping rope technique of initial contact (IC) and maximum knee flexion (MKF), and a one-way ANOVA was used to compare the mean difference between four different jumping rope techniques in the IC-MKF phase. Between IC and MKF, knee flexion angle, moment, joint ground reaction forces (GRF), and muscle forces of four jumping rope techniques were significantly different (p <.05). Also, in the IC-MKF phase, knee flexion angle and knee extension moment; HK was lower than others; vertical GRF; HK and FB were higher than others; anteroposterior, mediolateral GRF, and muscle forces; SS was higher than others (p <.05). Depending on the jumping rope techniques, the lower knee flexion angle in HK, the higher knee vertical GRF in HK and FB, the higher knee extension moment, anteroposterior, mediolateral GRF, and muscle forces on SS could be a pos-sibility of ACL injury risk compared to others. Therefore, it is recommended that SS be used in risk assessment of ACL in future studies, and BB will be suitable for normal people in daily exercises or will be the alternative intervention program for knee rehabilitation with the lowest risk of injury.

Background: Online teaching has resulted in university students adopting a sedentary lifestyle. Prolonged sitting and reduced physical activity due to pandemic restrictions have led to musculoskeletal pain in various body areas, significantly impacting the students’ quality of life. This study aims to investigate the effects of remote learning on Sicilian physiotherapy students during the COVID-19 pandemic, specifically focusing on the occurrence of musculoskeletal pain. Methods: An observational study was conducted using an online survey administered through Google Forms. The survey consisted of 26 multiple-choice questions and was distributed to students enrolled in Physiotherapy programs at the Universities of Catania, Messina, and Palermo. Participants were contacted via social channels or email, and data collection spanned 5 weeks. The collected data were analyzed using R software. Results: A total of 128 questionnaires were collected. More than half of the students (51.6%) reported dedicating 15–22 h per week to distance learning for a duration of 6–12 months (50%). Regarding study location, most students preferred studying at a desk (82.8%), with slightly over half (57.8%) adopting a backrest while studying remotely. Analysis of the students’ posture during study hours revealed common positions, including tilting the head forward by more than 20 degrees (47.8%), leaning the trunk forward by more than 20 degrees (71.9%), both shoulders being hunched forward (57.0%), wrists positioned above the level of the elbows (46.1%), thighs pointing upwards (41.4%), and one or both feet in a downward or dorsiflexed position (69.5%). Conclusion: The questionnaire responses indicate that the lifestyle of university students, influenced by online teaching, has deteriorated, leading to musculoskeletal pain, including myofascial pain. These results are primarily influenced by the adopted posture and the duration of time spent in these positions.

Background: Adolescence is a developmental stage when there is a high risk of engaging in non-suicidal self-injury (NSSI). There is recent interest in the study of thwarted belongingness and perceived burdensome as variables associated with the frequency of NSSI in adolescents. Meaning in life (MIL) could be negatively associated with thwarted belongingness and perceived burdensome. To date, no studies have analyzed whether thwarted belongingness and perceived burdensomeness could be associated with the frequency of NSSI in adolescents. On the other hand, no studies have analyzed the buffering role of MIL in the association between thwarted belongingness and perceived burdensomeness and the frequency of NSSI. Aims: a) to test whether thwarted belongingness and perceived burdensomeness are associated with NSSI frequency; b) to test whether MIL moderates the association between thwarted belongingness and NSSI frequency; and c) to test whether MIL moderates the association between perceived burdensomeness and NSSI frequency. Method: The sample consisted of N = 1531 participants between 12 and 18 years old from Spain. The participants filled out the Inventory of Statements about Self-Injury, Purpose-In-Life Test-Adolescents Version, and Interpersonal Needs Questionnaire. Moderation analysis were performed. Results: Thwarted belongingness and perceived burdensomeness were positively associated with the frequency of NSSI in Spanish adolescents. MIL was a moderating variable between thwarted belongingness and the frequency of NSSI, and between perceived burdensomeness and the frequency of NSSI. Conclusion: Thwarted belongingness and perceived burdensomeness could be a risk factor for NSSI and MIL could be a protective factor against NSSI, and adding these variables to current descriptive theories of NSSI in adolescents would allow us to improve the assessment and treatment protocols for adolescents with NSSI.

People who suffer a mild traumatic brain injury (mTBI) have heterogeneous symptoms and disease trajectories, which make it difficult to precisely diagnose and assess complications long-term. Insufficient information is available regarding how to precisely diagnose and assess mTBI. This study identified and compared deficits in cognitive, psychosocial, visual functions, and balance performance between college students with and without histories of mTBI. Global DNA methylation ratio (5-mC%) in blood was also compared as a peripheral epigenetic marker. Twenty-five volunteers participated in this pilot study, including 11 mTBI cases (27.3% females; mean age of 28.7 years, SD=5.92) and 14 healthy controls (64.3% females; mean age of 22.0, SD=4.13). All the participants were assessed for cognitive (by NIH toolbox—executive function, memory, and processing speed), psychological (by PROMIS—depression, anxiety, and sleep disturbances), visual function (by King-Devick and binocular accommodative tests), postural balance performance (by a force plate), and blood 5-mC% (global methylation) levels. Students with mTBI reported significantly poorer episodic memory, severe anxiety, and more sleep disturbance problems. They also had higher blood 5-mC% level (all p’s<.05). No significant differences were found in visual function and postural balance. These findings validate changes in cognitive, psychosocial, and global DNA methylation long after mTBI.

Background: There is lack of data on types of community first aids use and treatment given post injuries from many low-middle income countries, including India. Materials and Methods: A cross-sectional study was conducted among children up-to 18 years of age, in Ujjain district, India to understand types of first aid given and health seeking post injury. Results: A total of 1087 injuries, in 1049 children were identified in last one year, 729 (67%) received, first aid and 758 (72%) sought some healthcare. Children with burns received most (86%) first aid, while most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought healthcare from a private health set-up; most (65%) being transported within the golden hour; motorbikes being the most preferred (50%) mode of transport. Only 1% injured used ambulance services. Commonly reported first aid included: use of coconut oil on wounds from falls (38%) and burns (44%); antiseptic cream on wounds from RTA (31%), turmeric in falls (16%), and rubbing of metal on a bitten site (47%). Potentially harmful substances applied included lime, toothpaste, clay and mud. Conclusion: In most injuries, appropriate locally available substances, were used by the community. Our findings will help design community interventions to increase appropriate first aid in childhood injuries.

The demand for dietary supplements containing collagen has been growing for years. The speciality and uniqueness of the dietary supplement (DS) examined in our study is the presence of L-arginine and hyaluronic acid alongside collagen and vitamin C. The individual mechanisms of action and physiological role of these compounds are understood, but they have not yet been tested in the combination and amounts of the dietary supplement used in this study. In this study, we investigated the effectiveness of the DS in elderly patients with musculoskeletal complaints. Somatometric, body composition, physiotherapy and laboratory tests were performed at the beginning and at the end of the study. The two-month study involved 30 people, randomly divided into two groups: a control group (CG) and an experimental group (EG). All subjects consumed 25 ml DS per day and EG members also participated in physiotherapy 3 times a week. Alongside the DS, blood lipid levels changed: LDL decreased, HDL increased, LDL/HDL ratio significantly decreased in both groups. For EG, the results improved more markedly. In 3 items of the body composition test, there was a significant improvement in both groups, which was attributed to the use of the dietary supplement. For the EG, there were significant changes in 5 additional test items, which we attribute to the addition of regular physical activity. Knee and hip joint range of motion (ROM) showed significant improvements in the study group, while in the CG the DS can cause significant improvements in joint range of motion in a passive condition as well.

Keywords: Occupational injuries; stress; injury types

Background: One of the most common occupational health hazard and serious health concern, now a days, recognized is Musculoskeletal disorders (MSDs). The high prevalence among students and teachers is a major cause of decline in their health related quality of life and work performance. This study aimed to identify the prevalence of musculoskeletal disorders among teachers and students during online education. Methods: A cross-sectional survey was conducted among university faculty members and students who were involved in online education during COVID-19. Data collection was carried out electronically through a validated Arabic version of the Nordic Musculoskeletal Questionnaire (NMQ) which is self reported. A total of 175 respondents responded to the questionnaire (response 60%). Results: The prevalence of any part of the body was 90.3%. The commonest site of MSDs for past 12 months was the low back (65.7%), the neck (58.3%), and shoulders (57.7%). Females (80%) suffered more than males (20%). The students reported slightly higher MSDs as compared to teachers (93.1% vs 90.3). Binominal regression analysis showed association of females with low back pain “OR: 2.24 (95% CI): 1.04-4.83; p = 0.03” and neck pain “OR: 2.7 (95% CI): 1.24–5.84; p = 0.012)” while bad posture was associated with pain in upper back “OR: 3.46 (95% CI): 1.73-6.93; p = 0.001”. Conclusion: The faculty members and students are prone to high MSDs during online classes and significant measures should be taken to reduce the prevalence by addressing associated risk factors.

The clinical neurophysiological tests allow determine the type, extent, and nature of brachial plexus damage. They are crucial in decision-making regarding surgical procedures or conservative treatment. This report aimed to present an algorithm for rehabilitation procedures in patients with brachial plexus injury of various origins based on the results of neurophysiology findings for the selection of procedures supporting the process of nerve and muscle regeneration. The research group consisted of patients whose medical documentation was analyzed concerning the reason, level, and localization of damage to the brachial plexus structures, surgical and or rehabilitative treatment as well as the MRI results. Among the group of ten patients, the clinical studies showed the greatest incidence of brachial plexus injuries of the mixed (both pre- and postganglionic), all trunks, and cervical root injuries, respectively. Results of the motor evoked potentials (MEP) and electroneurography (ENG) recordings induced at levels of spinal roots and Erb's point showed a decrease of more than 40% in amplitudes on the symptomatic side in comparison to the asymptomatic side. This difference was recorded for the axillary and radial innervation and the C5, C6, and C7 root domains, ranging from 56% to 71%; the lowest decrease was recorded following electrical stimulation at Erb's point for the ulnar nerve (41.5%). The latency prolongation on the symptomatic side in CMAP and MEP tests ranged from 0.2 to 1.9 ms, the most following magnetic stimulation of the C5 cervical root for the axillary innervation. All results indicated the axonotmesis and neuropraxia type of injury in motor fibers (40%) confirmed by EMG results. The sensory conduction studies (SNCS) in distal nerve branches did not confirm the severe advancement of the brachial plexus injury (22%). The proposed algorithm of the physiotherapeutic procedures should be mainly targeted for recovery of motor dysfunction as the consequence of brachial plexus injury. Rehabilitation should incorporate the treatment supporting nerve regeneration, muscle strengthening, and maintaining functional ranges of motion of the injured extremities. The rehabilitation treatment for patients with brachial plexus injuries is an individualized process, and the selection of procedures and the effectiveness of the treatment undertaken should be confronted with results of neurophysiological tests verifying the motor neural transmission from the level of the cervical motor center to the effector, peripheral nerve function, and muscle’s motor unit activity.

Older adults in low-and middle-income countries experience a disproportionate burden of non-communicable diseases (NCDs). Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths worldwide, including in Thailand. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI in primary care via trained community health workers (CHWs) and care managers (CMs). STEADI takes a coordinated care approach that consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk in 20 community-dwelling older adults using three key questions and found that all of them had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed balance, vision, footwear, postural hypotension, medications, and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications,75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions to mitigate their specific fall risk factors. CHWs and CMs indicated high acceptability (19.20±.1.31 of 20 total), appropriateness (18.80± 1.79 of 20 total), and feasibility (18.60±1.67 of 20 total) of the Thai-STEADI intervention. Our study showed that the community-based multifactorial Thai-STEADI delivered by CHWs and CMs is feasible and acceptable to prevent falls in older adults with limited access to health care.

Background and Objectives: The COVID-19 pandemic influenced the management of patients with immune mediated rheumatic and musculoskeletal diseases (imRMDs) in various ways. The goal of our systematic review was to determine the influence of the first period of the COVID-19 pandemic on the management of imRMDs. Materials and Methods: Systematic literature search of PubMed, Cochrane and Embase databases, including studies with adult patients on the influence of the COVID-19 pandemic on management of imRMDs. There were no restrictions regarding to study-design except for systematic reviews and case reports that were excluded as well as articles on the disease outcomes in case of SARS-CoV-2 infection. Two reviewers screened the studies for inclusion, and, in case of disagreement, consensus was reached after discussion. Results: A total of 5969 potentially relevant studies were found, and, after title, abstract and full-text screening, 35 studies were included with data from 182’746 patients and 2018 rheumatologists. Non-availability of drugs, e.g., hydroxychloroquine and tocilizuab, was frequent (16–69% of patients). Further, medication non-adherence was reported among patients with different RMDs and between different drugs in 4–46% of patients. Changes to preexisting medication were reported in up to 33% of patients (e.g. reducing dose of steroids or cessation of biological disease-modifying antirheumatic drugs). Physical in-office consultations and laboratory testing decreased and as a consequence newly implemented remote consultations increased greatly with an increase of up to 80%. Conclusion: The COVID-19 pandemic influenced the management of imRMDs, especially at the beginning. Influences were wide-ranging, affecting availability of pharmacies, adherence to medication or medication changes, doctor visits and laboratory testing. New systems of care were set up, including virtual clinics and video consultations. These new forms of health care delivery should be spread and implemented worldwide to routine clinical practice to be ready for future pandemics.

This study examined the effects of group art therapy on depression, burden, and self-efficacy in primary family caregivers of patients with brain injuries. This was a quasi-experimental, nonequivalent control group and a pre- and post-test design. This study was carried out in one national rehabilitation hospital targeting 41 primary family caregivers of patients with brain injuries. Group art therapy intervention was carried out three days per week for 12 times over four consecutive weeks. The experimental group (n = 20) received group art therapy, whereas the control group (n = 21) did not. We used a time difference method to minimize the risk of contaminating the control group by sampling sequentially. The experimental group showed a significantly greater decrease in burden (t = 2.462, p = 0.020) and significantly greater improvement in self-efficacy (t = −6.270, p &lt; 0.001) than the control group. Group art therapy may be an effective nursing intervention for primary family caregivers of patients with brain injuries.

We describe an interesting case report about a patient with hemophilia A with severe chronic elbow arthropathy who underwent multiple surgical because of his condition. We collected all the clinical and imaging findings, and we compared the decision-making flow chart and the surgery performed with the most recent indications, treatments and complications reported in the literature. The aim of this case report is to show how usually the hemophilic patient even if young usually comes to our attention from the beginning with complex and advance musculoskeletal disease. Elbow hemophilic arthropathy is a complex disease and the management in these patients could be more difficult than others because of the higher risk of complications rate after all surgical procedures, for this reason it’s very important to treat these patients in hub centers with expertise in well-coordinated multidisciplinary teams. The path from diagnosis to surgical treatment of hemophilic elbow arthropathy can be a risky one, as it happened in this case.

Background: Shoulder pain is the third most common musculoskeletal issue in primary care, affecting up to 50% of patients six months post-consultation, leading to significant functional impairments and societal costs, especially due to sick leave. Shoulder injuries are particularly prevalent among 'overhead athletes' in sports like swimming, volleyball, and handball, with high injury rates reported annually. Screening tools like the Arm Care Screen (ACS) have been used to identify athletes at risk of shoulder injuries effectively. However, their applicability to the general population is less understood. This study aimed to assess the discriminant validity of a modified ACS (MACS) in detecting musculoskeletal risk factors among non-athletes. Methods: A prospective cross-sectional study was conducted with 30 asymptomatic subjects over 18, excluding those with a history of shoulder injuries or surgeries. The MACS, comprising four tests, was administered, and its diagnostic performance was evaluated through sensitivity, specificity, predictive values, and likelihood ratios. Results: Results indicated low sensitivity (0%-47.62%) and variable specificity (55.56%-100%), suggesting that MACS may not effectively identify risk factors in the general population. Positive and negative predictive values were inconsistent, highlighting the need for non-athlete-specific screening tools. Conclusion: While the MACS showed promise in athletes, its application in the general population requires further refinement. The study underscores the necessity for tailored screening methods to enhance early detection and prevention of musculoskeletal issues in diverse populations.

Introduction. Musculoskeletal disorders related to work might follow with a cumulative effect during working life. We aimed to develop a new model to allow to compare the accuracy of duration of work and intensity/frequency associations in application to severe knee pain. Methods. The CONSTANCES cohort is used with data from n=66553 subjects who were working at inclusion and coded. From a biomechanical job exposure matrix “JEM Constances”, intensity/frequency of heavy lifting and kneeling/squatting were used and applied to the work history in comparison to severe knee pain. An innovative model was developed and evaluated, allowing to compare the accuracy of duration of work and intensity/frequency associations. Results. The mean age is 49 years at inception with 46 percent of women. The G model developed was slightly better than regular models. In men, odds ratios of the highest quartile for the duration and low intensity were not significant for both exposures, whereas intensity/duration were for every duration. Results in women were less interpretable. Conclusion. Though increased duration increased strength of association with severe knee pain, intensity/frequency were important predictors among men. Exposure estimation along working history should have emphasis on such parameters, though other outcomes should be studied such as women.

The use of e-scooters and e-bicycles has been on the rise with an increased medical and financial burden. Our purpose was to identify risk factors for increased medical charges and recommend appropriate steps. We studied a retrospective cohort presenting to a level 1 urban trauma center from January 2018 through July 2019 due to micro-mobility platforms. The primary outcome for comparison was total billing cost and a regression analysis was performed to identify variables associated with higher cost. A total of 4073 patients were identified. The majority of which were males (67%), aged 20-30 years (41%). Helmet use reported in only 39.8%. Radiologic studies were performed more often in the e-bicycle group. Total billing charges amounted to 28.3 million New Israeli Shekels ($7.9 million). Average total cost was higher for e-bicycle injuries and in non-helmet users. Other factors associated with higher cost were age, and time of day 12:00-18:00. We recommend that urban cities invest in infrastructure in advance to micro-mobility introduction, regulate the use of e-platforms, designate resources for education on personal protective equipment and prepare medical centers in advance.

Introduction Pedestrian road injuries are a significant public health issue in Georgia, Syria, and Tajikistan. This study investigates the trends in mortality, Years of Life Lost (YLLs), and incidence rates of pedestrian road injuries from 1990 to 2021, with a focus on sex-specific differences, using age-standardized data from the Global Burden of Disease (GBD) database. Methods The data for this analysis were obtained from the GBD database, emphasizing age-standardized rates of mortality, YLLs, and incidence of pedestrian-related road injuries in Georgia, Syria, and Tajikistan. The population was divided into male and female cohorts for comparison. Statistical methods included descriptive statistics, independent samples t-tests, and effect size calculations to evaluate the differences between sexes. Temporal trends were analyzed to observe changes over the study period. Results Mortality The analysis revealed that males had a significantly higher mean mortality rate (7.18, SD = 2.94) compared to females (2.26, SD = 0.78). The independent samples t-test confirmed a significant difference (t(62) = 9.141, p < 0.001). The effect sizes were substantial, with Cohen's d at 2.285, Hedges' g at 2.257, and Glass's Δ at 6.281. Over time, the mortality rates exhibited peaks in the early 1990s and mid-2000s, with a general decline afterward. Males consistently showed higher mortality rates than females throughout the period. YLLs (Years of Life Lost) For YLLs, males had a significantly higher mean rate (332.59, SD = 132.31) compared to females (103.35, SD = 32.57), with the t-test indicating a significant difference (t(62) = 9.515, p < 0.001). Effect sizes supported the significance of this difference, with Cohen's d at 2.379, Hedges' g at 2.350, and Glass's Δ at 7.308. The YLL rates showed notable peaks in the early 1990s and mid-2000s, followed by a decline, with males maintaining higher rates than females. Incidence Regarding incidence, males had a higher mean rate (235.90, SD = 36.09) compared to females (89.53, SD = 15.29). The t-test results (t(62) = 21.125, p < 0.001) and effect sizes (Cohen's d = 5.281, Hedges' g = 5.217, and Glass's Δ = 9.574) confirmed a significant difference between the sexes. Incidence rates demonstrated a significant decline from 1990 to 2000, followed by fluctuations, with males consistently experiencing higher rates than females. Conclusion This study underscores significant sex differences in mortality, YLLs, and incidence rates due to pedestrian road injuries in Georgia from 1990 to 2021, with males consistently showing higher rates. These findings emphasize the need for targeted interventions to address the specific vulnerabilities of male pedestrians in Georgia. The data and analysis were facilitated through collaboration with the Global Burden of Disease Study, whose contributions were invaluable.

There is increasing interest in the application of near-infrared (NIR) laser light for the treatment of various musculoskeletal disorders. The present study thoroughly examined the physical characteristics of laser beams from two different laser therapy devices that are commercially available for the treatment of musculoskeletal disorders. Then, these laser beams were used to measure the penetration depth in various biological tissues from different animal species. The key result of the present study was the finding that for all investigated tissues, most of the initial light energy was lost in the first one to two millimeters, more than 90% of the light energy was absorbed within the first ten millimeters, and there was hardly any light energy left after 15 – 20 mm of tissue. Furthermore, the investigated laser therapy devices fundamentally differed in several laser beam parameters that can have an influence on how light is transmitted through tissue. Overall, the present study showed that a laser therapy device that is supposed to reach deep layers of tissue for treatments of musculoskeletal disorders should operate with a wavelength between 800 nm and 905 nm, a top-hat beam profile, and it should emit very short pulses with a large peak power.

Background: Early diagnosis of postoperative complications is an urgent task, allowing timely prescribing of appropriate therapy and reducing the cost of patient treatment. Prognostic models based on various data could help in the early diagnosis of postoperative complications after cardiac surgery. Objectives: The purpose of the study was to determine whether an integrated approach based on clinical data along with metabolites and biomarkers had greater predictive value than the models built on less data. Methods: The study included patients (n=62) admitted for planned cardiac surgery (coronary artery bypass grafting with cardiopulmonary bypass), who were retrospectively divided into two groups depending on the presence (n=26) or absence (n=36) of postoperative complications of all types. Clinical and laboratory data on the first day after surgery were analyzed. Additionally, patients' blood samples were collected before and on the first day after surgery to determine biomarkers (interleukin-6, procalcitonin, NT-proBNP, high-sensitivity troponin T) and metabolites (8 aromatic and 2 dicarboxylic acids were detected using gas chromatography-mass spectrometry). Results: Patients before surgery, compared with healthy donors, differed in the concentration of metabolites (p &lt; 0.05), and had concentrations of a number of biomarkers exceeding the corresponding reference values. Multivariate PLS-DA models, predicting the presence or absence of postoperative complications, were built using clinical data (ROC-AUC=0.71), concentrations of metabolites and biomarkers (ROC-AUC=0.60), and the entire data set (ROC-AUC=0.75). For comparison we built univariate models using the EuroScore2 (ROC-AUC=0.59) and SOFA (ROC-AUC=0.76) scales; concentrations of lactate (ROC-AUC=0.71), the dynamic changes of 4-hydroxyphenyllactic acid (ROC-AUC=0.69), and the sum of three sepsis-associated metabolites (ROC-AUC=0.70). The proposed complex model using entire data set was comparable to the SOFA scale, which confirms the expediency of searching for new predictive models based on a variety of factors.

Milk serves as a crucial source of natural bioactive compounds essential for human nutrition and health. The gastrointestinal digestion of milk proteins releases various biologically active peptides that positively impact human health and enhance physiological performance. With the growing production of cheese, Greek yogurt, and other dairy products, the volume of unutilized acid whey is significantly increasing. Acid whey, containing almost all whey proteins and approximately one-quarter of casein, presents a valuable raw material for generating peptides with potential health benefits. These peptides exhibit properties such as antioxidant, antimicrobial, anti-inflammatory, anticarcinogenic, antihypertensive, antithrombotic, opioid, mineral-binding, and growth-stimulating activities, contributing to improved human immunity and the treatment of chronic diseases. Enzymatic hydrolysis of milk proteins has been developed as a method to produce these peptides, facilitating their use in food fortification. To incorporate whey into functional beverages, it undergoes fermentation by lactic acid bacteria with proteolytic activity. To specifically enrich these beverages with peptides exhibiting targeted bioactivities, it is essential to select lactic acid bacteria strains possessing the requisite protease profiles. Additionally, the sensory properties of the final product can be enhanced using starter cultures with diverse metabolic capabilities, even in the absence of added flavoring agents. Given the imperative to develop waste-free technologies and enhance the profitability of the dairy industry, there is a growing need to efficiently utilize and transform acid whey into a broad spectrum of valuable products and food additives. This approach is justified not only by the nutritional benefits of the bioactive components in whey but also by the commercial potential of safe and health-enhancing products.

The paper focuses on the application of a multilevel, integrative and territorial approach to the protection of cultural heritage through planning instruments in Serbia. It points out the problems of the sectoral approach and discusses international recommendations that can be integrated into the planning methodology. The case study is the area of Djerdap National Park, which has an already established international and national importance. The research suggests that the cultural heritage in the area, with the exception of the Roman limes, is still recognized at the level of individual localities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The interna-tional and national importance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the inte-gration of local values and local communities into development programs and projects.

The impact of interaction SS with MJO on rainfall along Java Island to East Nusa Tenggara has been studied using daily rainfall observation data from 2140 weather observation stations, which are also equipped with GSMaP, OLR, and ERA5 data. There were 61 SS events found, 17 during active MJO and 44 in inactive MJO. Rainfall increases more in the western study area when the active MJO and more in the eastern study area when the inactive MJO is due to SS. SS reduces rainfall in the Jakarta region, regardless of the activity or inactivity of the MJO. SS causes extreme rainfall to only occur in a small part of certain areas, so it tends to significantly reduce the possibility of extreme rainfall. In the southern part of the IMC, SS predominates over MJO in supporting increased water vapor transport. Large-scale synoptic circulations like the monsoon, SS, and MJO can interact with local land-sea wind circulation to produce spatiotemporal variability in rainfall on Java Island. Rainfall mostly increases in the afternoon and decreases in the morning when SS occurs, whether there is MJO or not. Convective instability analysis indicates that SS increases precipitation, most likely by lowering CIN and raising VIMFC.

In order to shorten the detection time and improve the average precision on embedded devices, A lightweight and high accuracy model is proposed for passion fruit in complex environments (backlight, occlusion, overlap, sunny, cloudy, rainy). Firstly, replacing the backbone network of YOLOv5 with a lightweight GhostNet model reduces the number of parameters and computation while improving detection speed. Secondly, a new feature branch is added to the GhostNet network, and the feature fusion layer in the neck network is reconstructed to effectively combine the lower-level and higher-level features, which not only improves the accuracy of the model but also maintains its lightweight. Finally, the knowledge distillation methods are used to transfer the knowledge from the more capable teacher model to the less capable student model, which significantly improving the detection accuracy. The improved model is denoted as G-YOLO-NK. The average accuracy of the G-YOLO-NK network is 96.00%, which is 1.00% higher than the original YOLOv5s model. Furthermore, the improved model size is 7.14MB, reduced to half of the original model, and the real-time detection frame rate is 11.25 FPS on the Jetson Nano. Compared to the state-of-the-art model, the proposed model outperforms them in terms of average precision and detection performance. The present work provides an effective model for real-time detection of passion fruits in complex orchard scenes, which can provide valuable technical support for the development of orchard picking robots and greatly improve the intelligence level of orchards.

The Simultaneous Localization And Mapping (SLAM) scanner is an easy and portable Light Detection And Ranging (LiDAR) data acquisition device. Its main output is a 3D point cloud covering the scanned scene. Regarding the importance of accuracy in the survey domain, this paper aims to assess the accuracy of two SLAM scanners: the NavVis VLX and the BLK2GO Scanner. This assessment is conducted for both outdoor and indoor environments. In this context, two types of reference data are used: the Total Station (TS) and the static scanner Z+F Imager 5016. To carry out the assessment, four comparisons are tested: cloud to cloud, cloud to mesh, mesh to mesh, and edge detection board assessment. However, the results of the assessments confirm that the accuracy of indoor SLAM scanner measurements (5 mm) is greater than that of outdoor ones (between 10 mm and 60 mm). Moreover, the comparison of cloud to cloud provides the best accuracy regarding direct accuracy measurement without manipulations. Finally, based on the high accuracy, scanning speed, flexibility, and the accuracy differences between tested cases, it is confirmed that SLAM scanners are effective tools for data acquisition.

In recent years, electroencephalogram (EEG) emotion recognition has emerged as a research hotspot in the field of artificial intelligence (AI). Despite advancements in EEG-based emotion recognition, room for enhancing performance persists due to EEG signal redundancy and limitations in feature extraction, leading to inefficient models and emotional information loss. To fully utilize EEG's emotional information and improve recognition accuracy while reducing computational costs, this paper proposes a Convolutional-Recurrent Hybrid Network with a dual-stream adaptive approach and an attention mechanism (CSA-SA-CRTNN). Firstly, the model utilizes a CSAM module to assign corresponding weights to EEG channels. Then, an adaptive dual-stream convolutional-recurrent network (SA-CRNN and MHSA-CRNN) is applied to extract local spatial-temporal features. After that, the extracted local features are concatenated and fed into a temporal convolutional network with a multi-head self-attention mechanism (MHSA-TCN) to capture global information. Finally, the extracted EEG information is used for emotion classification. We conducted binary and ternary classification experiments on the DEAP dataset, achieving 99.26% and 99.15% accuracy for arousal and valence in binary classification, and 97.69% and 98.05% in ternary classification, surpassing relevant algorithms. Additionally, the model's efficiency is significantly higher than other models, achieving better accuracy with lower resource consumption.

Glycosidic linkage analysis was conducted on the unfractionated polysaccharides in the alcohol-insoluble residues (AIRs) prepared from six red seaweeds (Gracilariopsis sp., Prionitis sp., Mastocarpus papillatus, Callophyllis sp., Mazzaella splendens, and Palmaria palmata) using GC-MS/FID analysis of partially methylated alditol acetates (PMAAs). The cell walls of P. palmata primarily contained mixed-linkage xylans and small amounts of sulfated galactans and cellulose. In contrast, the unfractionated polysaccharides of the other five species were rich in galactans displaying diverse 3,6-anhydro-galactose and galactose linkages with varied sulfation patterns. Different levels of cellulose were also observed. This glycosidic linkage method offers advantages for cellulose analysis over traditional monosaccharide analysis that is known for underrepresenting glucose in crystalline cellulose. Relative linkage compositions calculated from GC-MS and GC-FID measurements showed that anhydro sugar linkages generated more response in the latter detection method. This improved linkage workflow presents a useful tool for studying polysaccharide structural variations across red seaweed species. Furthermore, for the first time, relative linkage compositions from GC-MS and GC-FID measurements, along with normalized FID and total ion current (TIC) chromatograms without peak assignments, were analyzed using principal component analysis (PCA) as a proof-of-concept demonstration of the technique's potential to differentiate various red seaweed species.

Background: Educating college students about the importance of good sleep habits could lead to the adoption of healthier sleep routines, including sufficient sleep duration and sleep quality. The current pre-post study examines the impact of completing a sleep education program called “Sleep 101” on (1) sleep hygiene practices, (2) sleep quality, and (3) weekday and weekend sleep behaviors among college students. “Sleep 101” is an interactive online course developed to educate college students about the importance of sleep by addressing basic sleep physiology, the impact of sleep on mood, academic and physical performance, the interactions between sleep and various substances, and common sleep disorders. Methods: 338 college students were recruited from a midsized public university in the US and invited to participate in “Sleep 101”, of which 25 participants completed the baseline and post-intervention questionnaire. The Sleep Hygiene Index (SHI) was utilized to evaluate sleep hygiene practices, while standard questions were employed to assess weekday and weekend sleep behaviors and overall sleep quality. Results: Those who completed the study demonstrated a significant increase in weekday sleep duration and were less likely to engage in negative prior bedtime activities. In addition, 40% of those who completed baseline and post-intervention assessments noticed improvements in their sleep quality. Conclusion: These findings suggest that a brief online program is beneficial in improving sleep behaviors among college and could be a scalable approach to addressing current sleep issues and preventing future sleep problems in college students.

The profile of secondary metabolites occurring in apple cuticular layer is not only characteristic for particular apple cultivar, but also dynamically reflects various external factors in growing environment. In this study, the possibility to authenticate apple samples based on analysis of their cuticular layer extracts was investigated. Ultra-high-performance liquid chromatography coupled to high resolution tandem mass spectrometry (UHPLC-HRMS/MS) was employed for obtaining metabolomic fingerprints. In total, 274 authentic apple samples, four cultivars harvested within the seasons 2020 to 2022 in the Czech Republic and Poland were analysed. The generated complex data processed by univariate and multivariate statistical methods enabled to build classification models for discrimination of apple cultivars as well as their geographical origin. The models showed very good performance in differentiation of Czech and Polish samples for three of four cultivars: ‘Gala’, ‘Golden Delicious’ and ‘Idared’, moreover, the validity of the models was verified over harvest seasons. The diagnostic markers, besides metabolites of triterpene biosynthetic pathway, mainly represented wax esters. ‘Jonagold’, which is known to be susceptible to mutations, was the only cultivar for which the unambiguous classification of geographical origin was not possible.

Superior fiber quality is one of the most important objectives in cotton breeding. To detect the genetic basis underlying fiber quality, an F2 population containing 413 plants was constructed by crossing Jifeng 914 and Jifeng 173, both of which have superior fiber quality, with Jifeng 173 being better. Five fiber quality traits were investigated in the F2, F2:3, F2:4, and F2:5 populations. Quantitative trait loci (QTL) mapping was conducted based on a high-density genetic map containing 11,488 single nucleotide polymorphisms (SNPs) and spanning 4,202.12 cM in length. Transgressive segregation patterns and complex correlations in the five tested traits were observed. A total of 108 QTLs were found, including 27 for fiber length (FL), 16 for fiber strength (FS), 24 for micronaire (MC), 17 for fiber uniformity (FU), and 24 for fiber elongation rate (FE). Chromosome A7 contained 12 QTL, ranking the first. No QTL was found on chromosome D1 and D11. Each QTL contributed 1.98%–21.45% to the phenotypic variation (PV), including 13 major effect QTLs that contributed more than 10% toward PV. Two QTLs could be repeatedly detected in three populations, including qFL-D3-2 in F2, F2:4, and F2:5 with 9.18%–21.45% of PV, qFS-A11-1 in F2:3, F2:4 and F2:5 with 6.05%–10.41% of PV. Another seven stable QTLs could be detected in two populations, including four major effect QTLs: qFL-A12-3, qFS-D10-2, qMC-D6-2, and qMC-D8-1. Fourteen QTL-overlapping regions were found, which might explain the complex correlations among the five phenotypic traits. Four regions on chromosome A11, D3, D6, and D10 covered by both stable and major effect QTLs are promising for further fine mapping. The genomic regions of the two QTLs detected in three populations and the four major effect QTLs contain 810 genes. Gene functional analysis revealed that the annotated genes are mainly involved in protein binding and metabolic pathways. Fifteen candidate genes in the qFL-D3-2 region are highly expressed in fiber or ovules during fiber initiation, elongation, secondary cell wall thickening, or maturation stages. qRT-PCR revealed that Ghir_D03G005440.1 and Ghir_D03G011310.1 may play a role in promoting fiber initiation, Ghir_D03G006470.1 may be beneficial for promoting fiber elongation. This study provides more information for revealing the molecular genetic basis underlying cotton fiber quality.

Currently there are fewer depth models applied to pepper picking detection, while the existing generalized neural networks have problems such as large model parameters, long training time, and low model accuracy.In order to solve the above problems, this paper proposes a Yolo-chili target detection algorithm for chili pepper detection. First, the classical target detection algorithm yolov5 is used as a benchmark model, and an adaptive spatial feature pyramid structure combining the attention mechanism and the idea of multi-scale prediction is introduced to improve the model's detection effect on occluded peppers and small target peppers. Secondly, a three-channel attention mechanism module is introduced to improve the algorithm's long-distance recognition ability and reduce the interference of redundant testers. Finally, the quantized pruning method is used to reduce the model parameters and realize the lightweight processing of the model. Applying the method to the homemade chili pepper dataset, the AP value of chili pepper reaches 93.11%; the accuracy rate is 93.51% and the recall rate is 92.55%.The experimental results show that yolo-chili is able to achieve accurate and real-time pepper detection under complex orchards.

The temporary immersion system bioreactor named GreenTray®[2], [3]presents advantages over the existing ones. Firstly, there is no need to use forceps to move the shoots or plantlets in or out of the recipient, neither the use of scalpel to divide them. Secondly, the basis of the shoot can remain in the GreenTray® and can sprout again in several cycles of growth. These two characteristics reduce the costs in the process of micropropagation. Besides, shoots or plantlets development is enhanced by the aeration of the recipient, thus enriching with CO2 the recipient atmosphere. The chapter describes and provides images and values of interest in (1) the micropropagation process of some commercial Prunus or Pyrus rootstocks; (2) the plantlet growth under autotrophic conditions; and (2) the inoculation of plants with pathogens that reproduce in vitro the symptoms observed in vivo, using the GreenTray® bioreactor.

The aim of this retrospective study was to compare the clinical outcomes of treating isolated surgical neck fractures of the humerus using either the intramedullary nail or the MIROS (Minimally Invasive Reduction and Osteosynthesis System®) system. The study included 42 patients who underwent surgical treatment at the Polyclinic from January 2014 to June 2020. The results indicated that both treatments were effective; however, the MIROS system exhibited a higher complication rate. Intramedullary nailing was more reliable, thus recommended as the primary treatment method. This study underscores the importance of selecting the appropriate fixation technique to minimize complications and enhance patient outcomes.

Aiming at the problems of inaccurate segmentation of long object and information loss of small object in real-time semantic segmentation algorithm, this paper proposes a lightweight multi-branch real-time semantic segmentation network based on BiseNetV2. The new auxiliary branch makes full use of spatial details and context information to cover the long object in the field of view. Meanwhile, in order to ensure the inference speed of the model, the asymmetric convolution is used in each stage of the auxiliary branch to design a structure with low computational complexity. In the multi-branch fusion stage, the alignment and fusion module is designed to provide guidance information for deep and shallow feature mapping, so as to make up for the problem of feature misalignment in the fusion of information at different scales, and thus reduce the loss of small target information. In order to further improve the model’s awareness of key information, a global context module is designed to capture the most important features in the input data. The proposed network uses NVIDIA GeForce RTX 3080 Laptop GPU experiment, on the road street view data set Cityscapes and CamVid average occurring simultaneously ratio reached 77.1% and 78.4% respectively, with running speed of 127 frames/s respectively and 112 frames/s. The experimental results show that the proposed algorithm can achieve real-time segmentation and improve the accuracy significantly, showing good semantic segmentation performance

Excess nitrogen in agricultural drainage poses a serious threat to the water quality safety of the Yellow River basin. Utilizing aquatic plants to modify the rhizosphere microbial community structure and facilitate nitrogen transformation is a crucial strategy for mitigating regional water eutrophication. Our results revealed that the denitrification rate (DR), dissimilatory nitrate reduction to ammonium rate (DNRAR) and nitrogen fixation rate (NFR) of rhizosphere sediments exhibited a significant increase in artificially cultivated ditch. Compared with those in natural ditches, the richness of the bacterial community and the relative abundances of Bacteroidota, Verrucomicrobiota, Firmicutes, Anaeromyxobacter and Geobacter, which are involved mainly in the nitrogen cycle, in the rhizosphere sediments of artificially cultivated ditch were significantly greater due to improvements in environmental conditions. In artificially cultivated ditch, the dominant functional genes affecting DRNARs in the rhizosphere sediments of P. australis were nrfC and nrfA, while DRs were driven mainly by norB and napA, which were influenced by the nitrogen and carbon levels; and the dominant functional genes affecting NFRs in the rhizosphere sediments of T. orientalis were nifD, nifK and nifH. Our results provide a scientific basis for the use of aquatic plants for mitigating excess nitrogen levels in agricultural drainage.

Strawberry root rot caused by Neopestalotiopsis clavispora is one of the main diseases of strawberry and significantly impacts the yield and quality of strawberry fruit. There are now no effective control techniques available except for fungicide sprays, which may directly impact consumers. Biological control is becoming an alternative method for the control of plant diseases to replace or decrease the application of traditional synthetic chemical fungicides. Trichoderma is widely used as a biological agent for controlling strawberry root rot. In order to provide resources for screening the highly effective biocontrol fungus for controlling strawberry root rot caused by Neopestalotiopsis clavispora, the biocontrol mechanism,the control effects of Trichoderma asperellum CMT10 against strawberry root rot and growth-promoting effects on strawberry seedlings were investigated by plate culture, microscopy observation and root drenching methods.The results showed that CMT10 had obvious competitive, antibiotic and hyperparasitism effects on Neopestalotiopsis clavispora CMGF3. The CMT10 could quickly occupy nutritional space, and the inhibition rates of CMT10 against CMGF3 in confrontation culture on 7 d was 65.49%. The inhibition rates of volatile metabolite and fermentation metabolite produced by CMT10 against CMGF3 were 79.67% and 69.84%, respectively. The mycelium of strain CMT10 can act as hyperparasites by making contacting, winding and penetrating hyphae of CMGF3. Pot experiment showed that the biocontrol efficacy of CMT10 on strawberry root rot caused by Neopestalotiopsis clavispora was 63.00%. CMT10 had obvious promotion effect on strawberry growth, the plant height, root length, total fresh weight, root fresh weight, stem fresh weight and root dry weight, with the promotion rates were 20.09%, 22.39%, 87.11%, 101.58%, 79.82% and 72.33%, respectively. Overall, this study showed the ability of Trichoderma asperellum CMT10 to control strawberry root rot and their potential to develop as novel biocontrol agents to replace chemical fungicides for eco-friendly, sustainable agriculture.