Rejected

Impaired paraspinal muscle endurance may be a contributor to persistent low back pain (LBP) and is frequently assessed using a single repetition of the Biering-Sørensen test. The aim of this study was to investigate how Sørensen test duration, and muscle fatigability, are affected by multiple repetitions of the test, and to determine predictors of Sørensen test duration in young, active adults with and without a history of LBP. Sixty-four individuals participated; 41 had a greater than one-year history of LBP symptoms. Participants performed 3 repetitions of the Sørensen test while electromyography (EMG) data were collected from the lumbar and thoracic paraspinals and the hamstrings. Muscle fatigability was quantified as the slope of the change in median frequency of the EMG signal over time. Duration of the test decreased across repetitions for both groups and was significantly less for the 2 and 3 repetitions in individuals with LBP. For all three muscles, fatigability increased across repetitions, but did not differ between groups. In individuals without LBP, fatigability of the lumbar paraspinals was the best predictor of test duration. In individuals with LBP, Sørensen test duration was predicted by fatigability of the thoracic paraspinals and hamstrings. Our findings demonstrate that it is necessary to amplify the difficulty of the Sørensen test to fully elucidate impairments in young adults with LBP. Training or rehabilitation programs aiming to improve lumbar paraspinal endurance in individuals with LBP should account for the endurance of other synergist muscle groups during endurance exercise.

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology which affects the oral mucosa. OLP varies in its clinical features from a reticular form that is, in most cases, asymptomatic, to atrophic-erosive, and is accompanied by symptoms of burning sensation and pain followed by difficulty in eating. Given the fact that OLP is a disease of unknown etiology, the treatment is symptomatic and involves suppressing the signs and symptoms of the disease using various topical and systemic drugs. The first line of therapy for treating symptomatic OLP is topical corticosteroids, whereas systemic corticosteroids are used for treating persistent lesions that do not respond to local treatment. However, the lack of convincing evidence on the efficacy of previous therapies, including topical corticosteroids, and numerous side effects that have appeared over recent years has resulted in the emergence and development of new therapeutic options. Some of the therapies mentioned are tacrolimus, efalizumab, dapson, interferon, retinoic acid, photochemotherapy with psoralen and ultraviolet A rays (PUVA), aloe vera, antimalarials, antibiotics and others. These therapies only partially meet the properties of efficacy and safety of use, thus justifying the continuous search and testing of new treatment methods.

Regional anesthesia (RA) may improve patient-related outcomes, including decreased operative complications, shortened recovery times, and lower hospital readmission rates. More analyses are needed using a diverse set of databases to examine characteristics associated with the receipt of RA.

This study aimed to determine distinguishing predictors and develop a clinical score to differentiate COVID-19 and common viral infections (influenza, respiratory syncytial virus (RSV), dengue, chikungunya (CKV), and zika (ZKV)). This retrospective study enrolled 549 adults (100 COVID-19, 100 dengue, 100 influenza, 100 RSV, 100 CKV, and 49 ZKV) during the period 2017-2020. CKV and ZKV infections had specific clinical features (i.e., arthralgia and rash); therefore, these diseases were excluded. Multiple binary logistic regression models were fitted to identify significant predictors, and two scores were developed differentiating influenza/RSV from COVID-19 (Flu-RSV/COVID) and dengue from COVID-19 (Dengue/COVID). The five independent predictors of influenza/RSV were age > 50 years, the presence of underlying disease, rhinorrhea, productive sputum, and lymphocyte count < 1000 cell/mm. Likewise, the five independent predictors of dengue were headache, myalgia, no cough, platelet count < 150,000/mm, and lymphocyte count < 1000 cell/mm. The Flu-RSV/COVID score (cut-off value of 4) demonstrated 88% sensitivity and specificity for predicting influenza/RSV (AUROC = 0.94). The Dengue/COVID score (cut-off value of 4) achieved 91% sensitivity and 94% specificity for differentiating dengue and COVID-19 (AUROC = 0.98). The Flu-RSV/COVID and Dengue/COVID scores had a high discriminative ability for differentiating influenza/RSV or dengue infection and COVID-19. The further validation of these scores is needed to ensure their utility in clinical practice.

A woman in her late 70s with bilateral total hip arthroplasty (THA) presented with left hip pain arising immediately after the last THA procedure, progressively worsening. Clinically, a severe abductor insufficiency with Trendelenburg limp was observed. Moreover, symptomatic leg length discrepancy required a contralateral heel lift of 0.5 cm. She was previously managed conservatively without any clinical benefit. Radiographs showed a well-fixed uncemented straight, sitting proud stem. MRI showed a large abductor tear. A minimally invasive proximal advancement of the greater trochanter was planned to allow direct surgical repair of the abductor lesion. The patient made a good recovery, and 12 months after surgery, wire removal was performed. The patient gained significant improvements in hip function (Harris Hip Score from 52 to 89), full limp recovery and complete pain relief at 13 months follow-up from primary surgery.

Terminally differentiated keratinocytes are critical for epidermal function and surrounded by involucrin (IVL). Increased IVL expression is associated with a near selective sweep in European populations compared to African. This positive selection for increased IVL in the epidermis identifies human adaptation out-of-Africa. The functional significance is unclear. We hypothesize Ivl to modulate the environmentally sensitive Vitamin D receptor (Vdr) in the epidermis. We investigated Vdr activity in Ivl -/- and wild-type (WT) mice using vitamin D agonist (MC903) treatment and comprehensively determined the inflammatory response using single-cell RNA sequencing (scRNA-seq) and associated skin microbiome changes using 16S bacterial phylotyping. Vdr activity and target gene expression were reduced in Ivl -/- mouse skin, with decreased MC903-mediated skin inflammation and significant reductions in CD4+ T cells, basophils, macrophages, monocytes, and type II basal keratinocytes and increase in suprabasal keratinocytes. Coinciding with the dampened MC903-mediated inflammation, skin microbiota of Ivl -/- mice was more stable compared to WT mice, which exhibited a MC903-responsive increase in Bacteroidetes and decrease in Firmicutes. Together, our studies in Ivl -/- mice identify a functional role for Involucrin to positively impact Vdr activity and suggest an emerging IVL/VDR paradigm for adaptation in the human epidermis.

Suspected optic disc swelling is a common presentation in children. The delineation between true optic disc swelling and pseudopapilloedema, its common masquerade, requires careful evaluation. A streamlined pathway is required to avoid unnecessary investigations.

A retrospective analysis of clinical data of 60 patients with primary empty sella (PES) was conducted to further improve the understanding of the disease.

Biologic disease-modifying anti-rheumatic drugs (bDMARDs), including certolizumab pegol (CZP), are effective treatment options for the management of non-radiographic spondyloarthritis (nr-axSpA). In the absence of head-to-head comparisons in nr-axSpA, we conducted a systematic literature review (SLR) and indirect treatment comparison (ITC) to better understand the comparative efficacy of CZP vs. other bDMARDs.

Pleural diseases are common and frequently result in disabling symptoms, impaired health-related quality of life and hospitalisation. Both diagnosis and management often require pleural procedures and despite a variety of pain control strategies available for clinicians to employ, many procedures are still complicated by pain and discomfort. This can interfere with procedure success and can limit patient satisfaction. This review examines the evidence for pain control strategies for people undergoing non-surgical pleural procedures. A systematic literature search was undertaken to identify published studies examining different pain control strategies including pharmacological (sedatives, paravertebral blocks, erector spinae blocks, intrapleural anaesthesia, epidural anaesthesia, local anaesthetic, methoxyflurane, non-steroidal anti-inflammatory drugs [NSAIDs], opioids) and non-pharmacological measures (transcutaneous electric nerve stimulation [TENS], cold application and changes to the intervention or technique). Current literature is limited by heterogeneous study design, small participant numbers and use of different endpoints. Strategies that were more effective than placebo or standard care at improving pain included intrapleural local anaesthesia, paravertebral blocks, NSAIDs, small-bore intercostal catheters (ICC), cold application and TENS. Inhaled methoxyflurane, thoracic epidural anaesthesia and erector spinae blocks may also be useful approaches but require further evaluation to determine their roles in routine non-surgical pleural procedures. Future research should utilise reliable and repeatable study designs and reach consensus in endpoints to allow comparability between findings and thus provide the evidence-base to achieve standardisation of pain management approaches.