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Tag: Bone Health

  • 10 Quick Facts about Sarcoma, one of the Rarest Cancers

    10 Quick Facts about Sarcoma, one of the Rarest Cancers

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    Newswise — New Brunswick, N.J. July 1, 2023 – From the top of your head to your toes, sarcoma can grow in bones, muscles, tendons, cartilage, and any connective tissue, which makes it a difficult disease to detect. Understanding more about this disease can help people to identify it early. Adam C. Berger, MD, FACS, chief of Melanoma and Soft Tissue Surgical Oncology and associate director for Shared Resources at Rutgers Cancer Institute of New Jersey shares some facts.

    1. According to the American Cancer Society, sarcoma, often called ‘the forgotten cancer,’ makes up approximately 1 percent of all adult cancer diagnoses.
    2. There are two broad categories for sarcoma. The first category is soft tissue sarcoma, which means that the cancer arises in the soft tissue elements of anywhere in the body (extremity, chest, abdomen, etc), such as muscles, fat, nerves and blood vessels. The second category is bone sarcoma, which are cancers that originate in the bone.
    3. The most common areas sarcoma tumors grow are the legs, ands, arms, neck, chest, shoulders, abdomen, and hips.
    4. These are further classified into more than 70 sarcoma subtypes. Subtypes of sarcoma are named based on the surrounding tissue, the affected area of the bone or the type of cells creating the tumor.
    5. The most common types of sarcoma are soft tissue sarcomas, including angiosarcomas, fibrosarcomas, leiomyosarcomas, rhabdomyosarcomas, liposarcomas and synovial sarcomas.
    6. Osteosarcomas (bone sarcomas) are the second most common type, with the least frequent type being sarcomas that develop in internal organs, such as the lungs.
    7. The symptoms of sarcomas vary because they take multiple forms in multiple locations. For example, in their early stages, soft tissue sarcomas rarely display any symptoms other than a painless lump. As the tumor grows, pain may occur depending on where the tumor is located, or if it presses on nearby nerves.
    8. With sarcoma of the bone, pain is the most common symptom. Treatments for sarcomas are dependent upon the subtype a patient has and will vary widely depending on a variety of other factors such as tumor location and size, the patient’s age and if the tumor is new or recurrent.
    9. There are known inherited disorders, including Li-Fraumeni syndrome, that significantly increase the risk of developing both soft-tissue and bone sarcoma – particularly among children and young adults.
    10. Expertise is critical. With a rare and complex type of cancer such as sarcoma, it is important to seek the best possible care.

    Experts at Rutgers Cancer Institute, New Jersey’s only National Cancer Institute (NCI)-designated Comprehensive Cancer Center together with RWJBarnabas Health are involved in various precision medicine initiatives for sarcomas focusing on personalized treatment for metastatic disease as well as early detection. Clinical trials for sarcomas are also currently being conducted, focusing on both targeted therapy and immunotherapy for treatment of the disease. Learn more: https://www.cinj.org/patient-care/sarcoma-and-soft-tissue-oncology-program.

     

     

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    Rutgers Cancer Institute of New Jersey

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  • Collagen’s Weak Bonds: A Sacrifice for Tissue Protection

    Collagen’s Weak Bonds: A Sacrifice for Tissue Protection

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    Newswise — One of the more unusual ways objects can increase longevity is by sacrificing a part of themselves: From dummy burial chambers used to deceive tomb raiders, to a fuse melting in an electrical circuit to safeguard appliances, to a lizard’s tail breaking off to enable its escape. Sacrificial parts can also be found within collagen, the most abundant protein in our bodies. Scientists at the Heidelberg Institute for Theoretical Studies (HITS) have revealed how the rupture of weak sacrificial bonds within collagen tissue helps to localize damage caused by excessive force, minimize negative impacts on the wider tissue, and promote recovery. Published in Nature Communications, the work shines light on collagen’s rupture mechanisms, which is crucial for understanding tissue degradation, material ageing, and potentially advancing tissue engineering techniques.

    “Collagen’s remarkable crosslink chemistry appears to be perfectly adapted to handling mechanical stress,” says Frauke Gräter, who led the research at HITS. “By using complementary computational and experimental techniques to study collagen in rat tissue, our findings indicate that weak bonds within the crosslinks of collagen have a strong propensity to rupture before other bonds, such as those in the collagen’s backbone. This serves as a protective mechanism, localizes the detrimental chemical and physical effects of radicals caused by ruptures, and likely supports molecular recovery processes.”

    Collagen comprises roughly 30 percent of all proteins in the human body. It provides strength to bones, elasticity to skin, protection to organs, flexibility to tendons, aids in blood clotting, and supports the growth of new cells. Structurally, collagen resembles a triple-braided helix: Three chains of amino acids intertwine to form a strong and rigid backbone. Each collagen fibre contains thousands of individual molecules that are staggered and bound to each other by crosslinks, contributing to collagen’s mechanical stability. It was thought that collagen crosslinks are susceptible to rupture, however little was known about the specific sites of bond ruptures or why ruptures occur where they do.

    Scientists from the Molecular Biomechanics Group at HITS aimed to unravel these puzzles using computer simulations of collagen across multiple biological scales and under different mechanical forces. They validated their findings via gel electrophoresis and mass spectrometry experiments conducted on rat tails, flexors, and Achilles tendons. By subjecting collagen to rigorous testing, the team was able to determine specific breakage points. They observed how force dissipates through the complex hierarchical structure of the tissue and how its chemical bonds bare the load.

    Mature crosslinks in collagen consist of two arms: one of which is weaker than other bonds in collagen tissue. When subjected to excessive force, the weaker arm is typically first to rupture, dissipating the force and localizing detrimental effects. The scientists found that in regions of collagen tissue where weak bonds are present, other bonds – both in the crosslinks and the collagen backbone – are more likely to remain intact, thereby preserving the structural integrity of the collagen tissue.

    Previous work led by HITS scientists revealed that excessive mechanical stress on collagen leads to the generation of radicals, which in turn cause damage and oxidative stress in the body. ”Our latest research shows that sacrificial bonds in collagen serve a vital role in maintaining the overall integrity of the material can help to localize the impacts of this mechanical stress that could otherwise have catastrophic consequences for the tissue”, explains Benedikt Rennekamp, the study’s first author. “As collagen is a major substituent of tissues in our bodies, by uncovering and understanding these rupture sites, researchers can gain valuable insights into the mechanics of collagen and potentially develop strategies to enhance its resilience and mitigate damage.”

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    Heidelberg Institute for Theoretical Studies (HITS)

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  • تنبيه من خبير: كيف سيستفيد المرضى من الجراحات اليقظة للعمود الفقري

    تنبيه من خبير: كيف سيستفيد المرضى من الجراحات اليقظة للعمود الفقري

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    جاكسونفيل، فلوريدا — كانت مايو كلينك من أوائل المراكز على مستوى العالم في تنفيذ عمليات دمج الفقرات بالدعم الروبوتي وباستخدام التخدير النصفي، ما يعني أن المريض مستيقظ خلال العملية. يطلق أيضًا على عملية دمج الفقرات اسم دمج الفقرات القطني عبر الثقوب. هذه العملية هي نوع من دمج الفقرات والذي يساعد على تثبيت العمود الفقري بعد المشكلات التآكلية أو المتعلقة بالسرطان أو بعد الإصابة المتسببة في عدم استقرار الفقرات.

    د. سيلبي شين، دكتور في الطبهو جراح أعصاب فيمايو كلينك فلوريدا. يوضح د. شين أن هذه الجراحات اليقظة للعمود الفقري قد تقلل من وقت العملية وتحد من الألم بعد العملية مقارنةً بالعمليات تحت التخدير الكلي.

    ويقول د. شين “إن النهج الروبوتي واليقظ لعملية الدمج الفقري طفيف التوغل هو نهج فريد من نوعه”. يركز د. شين بشكل أساسي على عمليات العمود الفقري طفيفة التوغل بمساعدة الروبوتات. ويؤمن بأهمية وجود عقلية مبتكِرة.

    يستكمل د. شين “مع التطور التكنولوجي، والمساعدة الروبوتية، وتحسن أساليب التخدير، فقد نتمكن من تحسين نتائج المرضى مقارنةً بذي قبل”. “نحتاج لتهيئة كل السبل التي نتبعها من أجل تقديم أفضل رعاية للمرضى. بالطريقة التي نعلم أنها ستنفعهم.”

    إن إجراء الجراحات اليقظة سيقلل المخاطر المرتبطة بالتخدير الكلي كما يتعافي المريض بعدها بصورة أفضل وأسرع.

    هناك فوائد أخرى من وجهة نظر الجراحين.

    يوضح د. شين “يبدأ التخدير النصفي في العمل بصورة أسرع من التخدير الكلي. بالتالي نستطيع التعامل مع الحالة بشكل أسرع”.

    كما يضع المساعد الروبوتي المسامير الجراحية بشكلٍ أدق، ما يحسن من سلامة المريض.

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    نبذة عن مايو كلينك
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

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    Mayo Clinic

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  • Movement as Medicine: The Many Health Benefits of Dancing

    Movement as Medicine: The Many Health Benefits of Dancing

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    BYLINE: Robin Frank

    Newswise — With physical distancing no longer a concern for most people, dancing for fun, exercise and social connection is back on the agenda for adults of all ages. Its popularity is apparent on Meetup.com, which lists numerous dance events around the country. 

    Kathleen Davenport, MD, a physiatrist at HSS Florida in West Palm Beach, is not surprised. She specializes in the nonsurgical treatment of orthopedic injuries and conditions, with special expertise in dance medicine. HSS Florida is the regional outpatient location of New York’s Hospital for Special Surgery, consistently ranked the number one hospital for orthopedics by U.S. News & World Report and other organizations.

    “I have patients ranging in age from young children to 90-year-old adults who enjoy Latin and other styles of dancing,” says Dr. Davenport, who serves as company physician for the Miami City Ballet and is president-elect of the International Association for Dance Medicine and Science. At HSS Florida, she treats both professional and recreational dancers.

    A competitive ballroom dancer herself, she enthusiastically supports the activity for its physical and psychological benefits. “I like to say that dancing checks a lot of boxes. In social dancing, you interact with different people and can make new friends, which has multiple psychological benefits,” she explains. “On the physical side, you need good balance, you need core strength, you need strength in your lower and upper extremities if you’re doing partner work. Dancing can also be an excellent cardio workout.”

    Some studies show that physical exercise is also good for brain health. “When dancing you need to remember the steps and how to do them. We have found that dancing is beneficial for people of all ages as it can help keep memory active as we go through our years,” Dr. Davenport says.

    Perhaps best of all, dancing just feels good, with many people experiencing a sensation similar to the so-called “runner’s high.” “When you do something enjoyable, particularly physical exercise, endorphins are released, which are our ‘happy’ hormones. By releasing these hormones, our body encourages us to keep engaging in these activities,” she explains.

    As with any athletic activity, good practices help prevent injury. Dr. Davenport offers advice to get the most out of dancing for fun and physical fitness:

    • It’s all about technique. If new to social dancing, take some lessons to learn the correct steps and the proper technique. Many social events start with a group lesson and warm up.
    • Start slowly. Ramp up gradually as you build muscle strength and endurance. Don’t start out by dancing for hours without a time out. This is hard on the body and can lead to injury.
    • Warm up ahead of time. Do a cool down after the dance with some gentle stretching.
    • Listen to your body. If you’re tired, take a rest. It may be advisable to skip an event if you overdid it dancing the day before. This will help you avoid an overuse injury.
    • Stay hydrated. Dancing can provide an excellent workout, so keep water on hand to ensure adequate fluid intake.
    • If you experience pain or a potential injury, however slight, come off the dance floor. Continuing to dance could turn a minor problem into a more serious injury.
    • Choose the right shoe for your style of dance.
    • Take an honest look at your footwear. For Latin dancing, for example, heels are generally recommended, but it’s not the right shoe for all women. Make sure you’re in a shoe that is supporting the activity and not causing pain.
    • Parents are advised to check their children’s dance shoes every year. Adults should check their shoes at least every two years or after recovering from a foot injury to make sure they still fit well.
    • If you’re a former or experienced dance enthusiast who has taken a break, ease back into it. Transition slowly back to your previous level.
    • At some venues, the music is very loud. Consider asking the DJ to lower the volume or wear ear plugs if it becomes uncomfortable.
    • People just starting out may want to learn about dance etiquette. Studios and dance clubs often post helpful information on their websites.

    Dr. Davenport says engaging in good practices can help everyone reap the benefits of dancing now and in the future.

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

     

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    Hospital for Special Surgery

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  • Social isolation linked to reduced bone quality in males, mouse study finds

    Social isolation linked to reduced bone quality in males, mouse study finds

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    Newswise — Social isolation may negatively impact bone health, suggests a study conducted in mice being presented Sunday at ENDO 2023, the Endocrine Society’s annual meeting in Chicago, Ill.

    “Social isolation is a potent form of psychosocial stress and is a growing public health concern, particularly among older adults,” said lead researcher Rebecca Mountain, Ph.D., of MaineHealth Institute for Research in Scarborough, Maine. “Even prior to the onset of the COVID-19 pandemic, which has significantly increased the prevalence of isolation and loneliness, researchers have been concerned about a rising ‘epidemic of loneliness.’”

    Mountain noted that social isolation is associated with increased risk for many health conditions in people, including mental health disorders, as well as higher overall rates of illness and death.

    “Previous clinical research has demonstrated that psychosocial stressors, and subsequent mental health disorders, are major risk factors for osteoporosis and fracture, which disproportionally affect older adults,” Mountain said. “The effects of social isolation on bone, however, have not been thoroughly investigated.”

    In the new study, researchers exposed adult mice to either social isolation (one mouse per cage) or grouped housing (four mice per cage) for four weeks. They found that social isolation caused significant reductions in bone quality, including reduced bone mineral density, in male, but not female mice.

    “Overall, our data suggest that social isolation has a dramatic negative effect on bone in male mice, but it may operate through different mechanisms or in a different time frame in female mice,” Mountain said. “Future research is needed to understand how these findings translate to human populations.”

    In addition to exploring the effects of social isolation in human datasets, her research team will also investigate the mechanisms of how social isolation contributes to bone loss using mouse models.

    “Our work provides critical insight into the effects of isolation on bone and has key clinical implications as we grapple with the long-term health impacts of the rise in social isolation related to the COVID-19 pandemic,” Mountain said

    # # #

    Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

    The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

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    Endocrine Society

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  • Study finds “robotic pill” can safely deliver injectable osteoporosis drug

    Study finds “robotic pill” can safely deliver injectable osteoporosis drug

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    Newswise — A proven and effective medication for osteoporosis, which is currently only available as an injection, can be administered orally using a novel “robotic pill,” according to a study presented Saturday at ENDO 2023, the Endocrine Society’s annual meeting in Chicago, Ill.

    “We believe this study provides the first clinical evidence of safe and successful delivery of the osteoporosis drug teriparatide through an oral robotic pill,” said Arvinder Dhalla, Ph.D., who leads Clinical Development at Rani Therapeutics, the San Jose, Calif.-based company that developed the technology and funded the study. “Data from this study are very encouraging and should give hope to those suffering from chronic conditions that require painful injections, like osteoporosis, that an oral alternative could be on the way.”

    When a person swallows the robotic pill, it moves through the stomach intact. In the intestine the pill releases a self-inflating balloon with a microsyringe, which injects a drug-filled microneedle and delivers the medication.

    “The intestines do not have pain response to needles, so the injection is painless,” Dhalla said. The needle rapidly dissolves, and the medication is absorbed while the delivery mechanism deflates and is safely passed out of the body.

    “The robotic pill, which is essentially a swallowable auto-injector in the form of a pill, is designed to deliver the drug safely and efficiently as a painless intestinal injection,” she said. 

    The Phase I study of 39 healthy women evaluated the safety, tolerability and movement through the body of the robotic pill known as RT-102, containing a dose of the drug teriparatide (PTH 1-34). Teriparatide is a synthetic form of the natural human parathyroid hormone. It has been in clinical use for decades as an injectable medication (under the brand name Forteo®) for rebuilding brittle bones of osteoporosis patients. It is taken as a daily injection for up to two years.

    Study participants were divided into three groups. Two groups received either a lower or higher dose delivered with the robotic pill, and the third group received a standard injection of teriparatide. Fluoroscopic imaging was used to track the robotic pill through and out the body. Drug concentrations were measured in blood samples collected over six hours. The study found the bioavailability (the ability of the drug to be absorbed and used by the body) of the drug delivered by the robotic pill was comparable to or better than the drug given via the injection.

    “This breakthrough technology of converting injections into oral pills is a significant step forward towards ending the burden of painful injections for millions of patients suffering from chronic diseases,” Dhalla said.

    Dhalla is scheduled to present at the Society’s ENDO 2023 hormones and technology news conference at 9 AM Central on Saturday, June 17. Register to view the news conference livestream at endomediastream.com

    # # #

    Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

    The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

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    Endocrine Society

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  • In 2050, over 800 million people globally estimated to be living with back pain

    In 2050, over 800 million people globally estimated to be living with back pain

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    EMBARGOED: 08:30 hrs Australian Eastern Standard Time (AEST) Tuesday 23 May 2023 / 23:30 hrs UK (UK) Monday 22nd May

     

    Study estimates there will be over 800 million cases of low back pain in 2050, a 36 percent increase from 2020. With an ageing population, researchers say we must ‘put the brakes’ on low back pain cases before the burden becomes too great for our healthcare system.  

    Analysis of over 30 years of the GBD data has shown the number of cases of low back pain is growing, with modelling suggesting by 2050, 843 million people will be affected by the condition largely due to population increases and ageing of populations.

    The continued lack of a consistent approach on back pain treatment, and limited treatment options have researchers concerned that this will lead to a healthcare crisis, as low back pain is the leading cause of disability in the world. 

    In Australia, there will be a nearly 50 percent increase in cases by 2050. The landscape of back pain cases is set to shift, with the biggest increases in back pain cases to be in Asia and Africa.  

    The findings are published in Lancet Rheumatology today. 

    “Our analysis paints a picture of growing low back pain cases globally, putting enormous pressure on our healthcare system. We need to establish a national, consistent approach to managing low back pain that is informed by research,” says lead author, Professor Manuela Ferreira from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District and Northern Sydney Local Health District.

    “Currently, how we have been responding to back pain has been reactive. Australia is a global leader in back pain research; we can be proactive and lead by example on back pain prevention”, said Professor Ferreira who is based at Sydney’s Kolling Institute.

    The study reveals several milestones in back pain cases. Since 2017, the number of low back pain cases has ticked over to more than half a billion people. 

    In 2020, there were approximately 619 million cases of back pain.

    At least one third of the disability burden associated with backpain was attributable to occupational factors, smoking and being overweight.

    A widespread misconception is that low back pain mostly affects adults of working age. But researchers say this study has confirmed that low back pain is more common among older people. Low back pain cases were also higher among females compared to males.

    This is the most comprehensive and up-to-date available data that includes for the first time global projections and the contribution of GBD risk factors to low back pain. The work was made possible by the joint efforts of The University of Sydney, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine (healthdata.org), IHME’s international collaborators, and the Global Alliance for Musculoskeletal Health (gmusc.com).

    “We also know that most available data come from high-income countries, making it sometimes hard to interpret these results for low to mid-income countries. We urgently need more population-based back pain and musculoskeletal data from countries of low to mid-income,” said senior author Professor Lyn March from Sydney Musculoskeletal Health and the Kolling Institute.

    The study analysed GBD data from 1990 to 2020 from over 204 countries and territories to map the landscape of back pain cases over time. The GBD is the most comprehensive picture of mortality and disability across countries, time, age, and sex. 

    It is also the first study to be used for modelling the future prevalence of back pain cases. 

    “Health systems need to respond to this enormous and rising burden of low back pain that is affecting people globally.  Much more needs to be done to prevent low back pain and ensure timely access to care, as there are effective ways of helping people in pain” said Prof Anthony Woolf, co-chair of the Global Alliance for Musculoskeletal Health which is calling for priority to be given to addressing the growing burden of musculoskeletal conditions.

    “Ministries of health cannot continue ignoring the high prevalence of musculoskeletal conditions including low back pain. These conditions have important social and economic consequences, especially considering the cost of care. Now is the time to learn about effective strategies to address the high burden and to act” said Dr Alarcos Cieza, Unit Head, World Health Organization, Headquarters, Geneva

     

    National guidelines will form basis of back pain prevention

    In 2018, experts (independent to this study) voiced their concerns in The Lancet and gave recommendations, especially regarding exercise and education, about the need for a change in global policy on the best way to prevent and manage low back pain to stop the rise of inappropriate treatments.

    However, since then, there has been little change. Common treatments recommended for low back pain have been found to have unknown effectiveness or to be ineffective – this includes some surgeries and opioids. 

    Professor Ferreira says there is a lack of consistency in how health professionals manage back pain cases and how the healthcare system needs to adapt. 

    “It may come as a surprise to some that current clinical guidelines for back pain treatment and management do not provide specific recommendations for older people.” 

    “Older people have more complex medical histories and are more likely to be prescribed strong medication, including opioids for back pain management, compared to younger adults. But this is not ideal and can have a negative impact on their function and quality of life, especially as these analgesics may interfere with their other existing medications. This is just one example of why we need to update clinical guidelines to support our health professionals.”

    Co-author Dr Katie de Luca, from CQUniversity, said if the right action is not taken, low back pain can become a precursor to chronic health conditions such as diabetes, cardiovascular disease and mental health conditions, invasive medical procedures, and significant disability.

    “Low back pain continues to be the greatest cause of disability burden worldwide. There are substantial socio-economic consequences of this condition, and the physical and personal impact directly threatens healthy ageing.”

    -ENDS-

    Declaration: The authors declare no conflicts of interest.

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    University of Sydney

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  • During Osteoporosis Awareness Month, Those at Risk Urged to Bone Up on Silent Disease

    During Osteoporosis Awareness Month, Those at Risk Urged to Bone Up on Silent Disease

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    BYLINE: Robin Frank

    Newswise — Osteoporosis is often called a “silent” disease because people typically have no symptoms and often don’t know they have it until they break a bone in an unexpected way, according to experts at Hospital for Special Surgery (HSS). Osteoporosis develops when bone mineral density and bone mass decrease, leading to weakened bones and an increased risk of a fracture. The hips, spine and wrist are most susceptible.

    The chance of developing the disease increases as you get older, and women are at greater risk. Osteoporosis or its precursor, osteopenia, affects more than half of adults ages 50 and older in the United States. Osteopenia is a loss of bone density that is not as advanced as osteoporosis.  

    National Osteoporosis Awareness Month in May is an opportune time to discuss ways to promote good bone health and take action if at risk, say HSS experts.

    Bones As Living Tissue

    We often think of our bones as if they were Legos that support our body, but they are much more than that. A bone is living tissue that is affected by our hormones and by the nutrients, vitamins and minerals we consume. Peak bone mass occurs at the time of puberty and into our 20s and early 30s. However, even as we age, our body constantly creates new bone.

    It’s normal for women to start experiencing a decrease in bone density when they enter menopause, according to Jessica Starr, MD, an endocrinologist at HSS. This happens due to hormonal changes and is generally a slow process. “Breaking a bone after falling while in a standing position could be a sign of osteoporosis,” she says. “Any fracture should prompt a discussion of bone health with one’s doctor.”

    Osteoporosis is diagnosed with a bone density test, a quick and painless type of x-ray that provides information about bone strength and the risk of a future fracture. Recommended screenings and appropriate treatment are important, Dr. Starr says. Healthy women are advised to have an initial bone density screening at age 65. For men, it’s age 70.

    Earlier screening is recommended for women with certain risk factors for bone loss, such as a family history of fractures or the use of certain medications such as steroids. Those who consumed very little calcium in younger years, had an eating disorder, smoke or consume excessive amounts of alcohol may also be vulnerable to accelerated bone loss, Dr. Starr notes.

    Anyone with a diagnosis of either osteoporosis or osteopenia should talk to her doctor to develop a strategy to prevent further bone loss, she says. The plan may include lifestyle changes and possibly medication. “There’s no one-size-fits-all approach to treating osteoporosis,” Dr. Starr explains. “Different medications are available, and treatment should be tailored to the needs of each individual.”

    Lifestyle Changes to Promote Bone Health

    A healthy lifestyle is important to maintain good bone health or prevent further bone loss if one has osteoporosis or osteopenia, Dr. Starr explains. Getting adequate calcium and vitamin D; consuming a nutrient-rich diet that includes all the major food groups; not smoking; and engaging in weight-bearing and resistance exercises can help build and preserve bone mass. Excessive alcohol consumption can also lead to decreased bone density.  

    “It’s best to get calcium and vitamin D from our diet. Individuals should try to get at least half of their daily calcium from foods such as dairy products, dark, green leafy vegetables and high-calcium fish like salmon and sardines,” Dr. Starr says. For information on recommendations for daily calcium and vitamin D intake, visit bones.nih.gov.

    Weight-bearing exercises, such as walking and dancing, are excellent. Muscle strength training is also important for bone health and balance. It’s not only important to exercise, but to move safely when lifting a package or engaging in other activities.  

    Prevent a Fall, Prevent a Fracture

    Taking measures for fall prevention is good for everyone, and even more so in a household of older adults, HSS experts note. This includes securing rugs to the floor; making sure there’s good lighting; having a nonslip surface in the bathtub or shower and installing a grab bar, if needed. Adults should wear supportive shoes with nonslip soles and be careful to keep floors clear of objects that could cause a tripping hazard. 

    It may take some effort, but it’s important to lead a healthy lifestyle today to maintain bone health in the future.

    #     #     #

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Strong link between bone biomarkers and prostate cancer survival

    Strong link between bone biomarkers and prostate cancer survival

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    Newswise — Prostate cancer is the second leading cause of death in American men. Understanding the factors that influence patient outcomes is critical for improving treatment and survival rates.

    Research led by UC Davis Comprehensive Cancer Center reveals a link between bone metabolism biomarkers and survival in men with newly diagnosed hormone-sensitive prostate cancer (HSPC) who received androgen deprivation therapy (ADT). The work was published in European Urology.

    The study analyzed results from a SWOG Cancer Research Network Phase 3 trial of nearly 1,000 patients on ADT, including some who were also on the novel hormonal therapy Orteronel. Patients participating in the trial came from 248 academic and community centers throughout the country.

    Bone biomarkers for both bone loss and bone formation were measured in HSPC patients enrolled in the trial.

    The researchers found that elevated bone biomarkers were associated with an increased risk of death. Bone biomarkers have been found to influence overall survival in men with castration-resistant prostate cancer (CRPC), but have not been fully established for HSPC. CRPC is a prostate cancer that continues to grow even when testosterone levels are greatly reduced.

    “Our findings show that high levels of bone turnover biomarkers are associated with a shorter lifespan in men newly diagnosed with metastatic HSPC,” said UC Davis Comprehensive Cancer Center Director Primo “Lucky” Lara Jr. “In the future, knowing one’s bone biomarker status could improve how we predict patient outcomes and enhance treatment considerations for men with HSPC.”

    Managing bone health during prostate cancer treatment

    A finely balanced interaction between cells that rebuild bone and cells that destroy bone is common in men with advanced prostate cancer. These men often present with skeletal metastasis, a common source of bone pain and fracture that can affect their survival.

    In addition, men with metastatic HSPC are typically treated with ADT, which disrupts bone turnover and contributes to the development of bone diseases such as osteopenia and osteoporosis. Previous studies have shown that elevated levels of blood-based biomarkers of bone turnover predict survival in men with CRPC and bone targeted therapy may help patients with highly elevated markers.

    “This study takes a similar look at bone turnover biomarkers in men with advanced or metastatic HSPC who are initiating ADT as part of a large phase 3 clinical trial,” said co-author and UC Davis Comprehensive Cancer Center clinical scientist Mamta Parikh. She is also the cancer center’s director of genitourinary malignancies. “Ultimately, our findings add to the growing understanding of the complex interplay between cancer and bone metabolism, which will also help us design of future clinical trials.”

    Co-authors

    Other contributors to the study included Edward Mayerson, Catherine Tangen and Michael LeBlanc from the SWOG Statistical Center, Seattle; Erik Gertz and Marta van Loan from the U.S. Department of Agriculture, Western Human Nutrition Research Center, Davis; Amir Goldkorn and David I. Quinn from the USC Norris Comprehensive Cancer Center, Los Angeles; Maha Hussain with the Northwestern University, Chicago; Shilpa Gupta with the Cleveland Clinic, Cleveland; Jingsong Zhang with Moffit Cancer Institute, Tampa Bay; Przemyslaw Twardowski with St. John’s Cancer Institute, Providence Health, Santa Monica; Nicholas J. Vogelzang with Comprehensive Cancer Centers of Nevada, Las Vegas; Ian Thompson with Christus Santa Rosa Health System, TX Health, San Antonio and Neeraj Agarwal with Huntsman Cancer Institute, Salt Lake City.

     

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  • ما هي مسببات الإصبع الزنادي؟

    ما هي مسببات الإصبع الزنادي؟

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    Newswise — فيرمونت، ولاية مينيسوتا — إن يداك أعجوبة ميكانيكية، ذات بكرات على هيئة أوتار تنثني وتتمدد لفتح وإغلاق قبضة اليد، وفرد وثني الأصابع. وكل وتر مُغلَّف بغمد يثبته في مكانه.

    قد يلتهب الوتر ويتورم في بعض الأحيان، مما يمنع انزلاقه بسلاسة أسفل هذا الغمد. وعند حدوث ذلك، قد يعلق الإصبع أو الإبهام في وضع منحني أو وضع مستقيم ويُطلق على هذه الحالة الإصبع الزنادي.

    من هم المعرضون للإصابة بالإصبع الزنادي؟

    عادة ما يكون الأشخاص البالغون 45 عامًا أو أكثر، والمصابون بالسكري أو التهاب المفاصل الروماتويدي عُرضة للإصابة بالإصبع الزنادي. ونادرًا ما يُصاب به الأطفال. يلتهب غمد الوتر عادةً بسبب التحميل الزائد عليه أو التعرض لإصابة، لذلك قد يكون لدى الأشخاص الذي يؤدون حركات متكررة أو الذين يتطلب عملهم الإمساك بالأشياء الثقيلة أو رفعها قابلية للإصابة بهذه الحالة. وقد تحدث الحالة في أي وقت وهي أكثر شيوعًا مما يظنه الأشخاص.

    كيف تُعالج؟

    إذا ظهرت عليك أعراضًا خفيفة، مثل كتلة صغيرة ومؤلمة في قاعدة الإصبع أو الإبهام على جانب راحة اليد، لكن لا يزال بإمكانك فرد أو ثني الإصبع دون أن يَعلق، فتناول أدوية مضادة للالتهاب المتاحة دون وصفة طبية، مثل الأيبوبروفين، كل يوم لمدة أسبوعين. إذا كان الإصبع أو الإبهام عالقًا، فيمكنك الضغط عليه برفق لجعله ينفرد أو ينثني.

    إذا كان الإصبع أو الإبهام عالقًا، ولم يفلح الضغط في فرده أو ثنيه، وإذا كنت تشعر بطقطقة أو تصلب، سيكون المستوى الثاني من العلاج هو الحقن بالستيرويد لتهدئة الالتهاب والتورم. ويُجرى الحقن في العيادة ويكون موضعه راحة اليد. حيث يُرش سائل بارد لتخدير المنطقة.

    قد يخفف الحقن من المشكلة، ولكن يُحتمل أن تعود الحالة مجددًا. وإذا حدث ذلك، قد يُعاد الحقن بعد مضي ثلاثة أشهر.

    والعلاج غير الجراحي الآخر الأقل شيوعًا هو ارتداء جَبيرة. سترتدي الجَبيرة في الليل لإبقاء الإصبع أو الإبهام المصاب مفرودًا.

    هل الجراحة خيارًا مطروحًا؟

    عندما لا تنجح الأدوية المتاحة دون وصفة طبية والحُقن الستيرويدية، فقد تحتاج إلى جراحة، وهي عبارة عن إجراء طبي سريع يتم في نفس اليوم. حيث يُعمل شق صغير في راحة اليد، عادة على طول ثنية الإصبع حتى يكون موضع الشق أقل وضوحًا. يُدخِل الجراح المسبار تحت الجلد لفك الالتصاق.

    ويمكنك العودة إلى المنزل في نفس اليوم، ولكن سيكون استخدامك محدودًا لليد التي أجُريت عليها الجراحة لمدة 10 إلى 14 يومًا حتى تتماثل للشفاء. سيكون بإمكانك ارتداء ملابسك والقيادة والأكل وعمل بعض الأنشطة الخفيفة الأخرى، ولكن احرص على عدم حمل أي شيء يزن أكثر من 15 رطلًا (7 كغم).

    ستعود إلى العيادة بعد حوالي 10 إلى 14 يومًا لإزالة الضمادات والغرز الجراحية. يمكن لأغلب الأشخاص العودة للعمل دون أي محاذير ونادرًا ما يحتاجون إلى الخضوع للعلاج الطبيعي بعدها.

    هل يمكن الوقاية من الإصبع الزنادي؟

    الوعي هو خط الوقاية الأول. إذا لاحظت وجود كتلة صغيرة مؤلمة في قاعدة الإبهام أو الإصبع، أو طقطقة أو تصلب، فيجب استشارة اختصاصي عظام.

    سارة سنايدر ممرضة ممارسة في قسم جراحة العظام في نظام مايو كلينك الصحي.

    ###.

    نبذة عن مايو كلينك
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

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  • Mid-Calf Nerve Block May Enable Early Rehabilitation After Foot and Ankle Surgery, Preventing Pain While Allowing Foot Movement

    Mid-Calf Nerve Block May Enable Early Rehabilitation After Foot and Ankle Surgery, Preventing Pain While Allowing Foot Movement

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    Newswise — A pilot study conducted at Hospital for Special Surgery (HSS) shows evidence that a mid-calf nerve block is a safe and effective regional anesthetic option for foot and ankle surgeries and may enable faster recovery of motor function of the ankle joint compared with a popliteal block. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.1

    “This new block provides excellent anesthesia and analgesia to foot and ankle surgeries and preserves motor function of the ankle joint. The results are very promising,” said Enrique A. Goytizolo, MD, an anesthesiologist at HSS and senior author of the study. “New protocols of early rehabilitation of foot surgeries can be instituted, since patients have no pain with movement of the foot.”

    An ultrasound-guided popliteal block is the current standard anesthetic technique for foot and ankle surgeries, but the study findings show that using an ultrasound-guided mid-calf block could enable earlier rehabilitation protocols and an overall faster recovery from surgery.

    A popliteal block numbs the sciatic nerve at the level of the popliteal fossa, which is a diamond-shaped space behind the knee joint. A mid-calf block is placed farther down the leg, between the popliteal fossa and the ankle, and numbs the posterior tibial nerve, superficial and deep peroneal nerves, sural, and saphenous nerves. A mid-calf block provides prolonged analgesia for any foot or ankle surgery while preserving motor function of the ankle joint.

    Twenty patients who were scheduled to receive foot or ankle surgery at HSS were recruited for the study. The procedures included total ankle replacement, ankle arthroscopy, bunionectomy, cheilectomy, and Achilles tendon repair. Participants were assessed in the post-anesthesia care unit (PACU) and again before discharge to record the time when the mid-calf block ended, presence of paresthesia, and any other side effects. On postoperative days 1, 2, and 7, participants were asked about their pain on a numerical rating score (NRS), their medication use, and other symptoms.

    The researchers found that the median duration of analgesia from the mid-calf block was 18.2 hours, with an interquartile range of 4.5-24.0 hours. All 20 patients were able to flex their toes in the PACU.

    The average pain score in the PACU was 0.8 +/- 2.1 at rest, and 1.1 +/- 2.3 with movement. Three participants were excluded for sensitivity analysis because they received additional surgery in surgical areas not covered by the mid-calf block. Among the 17 patients in the sensitivity analysis group, these scores were both 0.3 +/- 1.2 at rest and with movement.

    “The mid-calf block provides reliable, consistent, and excellent anesthesia and analgesia for foot and ankle surgeries,” said Dr. Goytizolo. “Follow-up research and patient treatments following this study should include a fast-track rehabilitation program for patients who have total ankle replacement surgeries with a mid-calf block.”

    The findings of this study will also inform future randomized control trials on the mid-calf block.

    References

    1. Marko Popovic BS, Alex Illescas MPH, Pa Thor PhD, Jacques YaDeau MD PhD, Constantine Demetracopoulos MD, Scott Ellis MD, Vincent LaSala MD, Matthew Roberts MD, Anne H. Johnson MD, Mark Drakos MD, Enrique Goytizolo MD. “Mid-Calf Block for foot and ankle surgery: A pilot study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL. 

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities

    Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities

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    Newswise — Hollywood, Florida, April 22, 2023 — In a study conducted at Hospital for Special Surgery (HSS), researchers found that the use of peripheral nerve blocks in total knee and total hip arthroplasty were associated with a consistent reduction in risk for postoperative complications in patients with a lower comorbidity burden. In particular, the most consistent reduction in risk of complications and use of hospital resources was in older patients with no comorbidity burden. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting and were acknowledged as one of the President’s Choice Abstracts.1

    “The utility of interventions in a general population of patients might be difficult to show, but might differ by subgroups, with certain patients deriving benefit when others do not,” said Stavros G. Memtsoudis, MD, PhD MBA FCCP, an anesthesiologist at HSS and lead author of the study. “In this study, we tried to identify which subgroups might benefit most from peripheral nerve blocks in terms of a reduction in complications after joint arthroplasty.”

    These findings demonstrate that comorbidities may be a factor with a greater effect on complication risk than other factors, such as age, and that peripheral nerve blocks alone may not be sufficient to consistently influence outcomes in patients with comorbidities.

    These findings may also demonstrate that there may be a specific optimal baseline patient population for whom peripheral nerve blocks have the greatest impact on improving surgical outcomes: patients who are older but do not have many comorbidities. This study could help clinicians determine which surgical patients may benefit most from peripheral nerve blocks and which candidates may need additional measures to improve their outcomes.

    Many total joint arthroplasty (TJA) patients are at risk for poorly controlled pain and complications. The number of these surgeries performed increases each year, underscoring the importance of finding solutions. To find out how uniformly peripheral nerve blocks can improve perioperative outcomes and pain relief in TJA patients, the researchers conducted a population-based analysis using data from TJA surgeries in the United States from January 2006 to December 2019.

    Patients were divided into nine groups based on age and number of comorbidities. Age was broken down as follows: Young (Y) = younger than 65 years; Middle (M) = 65 to 75 years; and Old (O) = older than 75 years. Comorbidities were categorized as: no pre-existing comorbidity (Group 1); 1 or 2 comorbidities (Group 2); and 3 or more comorbidities (Group 3). This led to a breakdown of nine groups total: Y1, Y2, Y3, M1, M2, M3, O1, O2, and O3.

    The sample included more than 2.8 million TJA cases performed in 887 hospitals. Of those, 15.5% received a peripheral nerve block. The overall rate of peripheral nerve blocks increased from 9.5% in 2006 to 18.9% in 2019. Peripheral nerve blocks were used least often in young patients with more than 3 comorbidities (13.9%) and used most often in middle-aged patients with no comorbidities (16.3%). Peripheral nerve blocks were associated with a significant reduction in the odds of respiratory complication, acute renal failure, delirium, ICU admission, high opioid consumption during hospitalization, and prolonged length of stay.

    The results showed reduced odds of respiratory complications for the O1 and Y2 groups, reduced odds of acute renal failure in the Y1, O1, and M2 groups, and reduced odds of delirium in O1. The risk for ICU admission was reduced in those who received peripheral nerve blocks in all ages with no comorbidities, as well as in the Y2 and O2 groups, compared with those who did not receive a peripheral nerve block. Peripheral nerve blocks also reduced the odds of a prolonged length of stay in the Y1, M1, Y2, M2, and Y3 groups. Odds of high opioid use in patients who received a peripheral nerve block versus no peripheral nerve block were significantly reduced in all groups except for Y3 and O3.

    “While peripheral nerve blocks might have the advantage of providing superior pain control versus systemic modalities as well as reducing opioid consumption, a reduction in complications might be expected in those without comorbidities,” Dr. Memtsoudis said. “However, given that peripheral nerve blocks still provide better pain control and reduce opioid use, all patients should be considered for peripheral nerve blocks.”

    “Older patients without major comorbidities might represent a subgroup in which the beneficial effects of peripheral nerve blocks are most likely to be expected,” he noted. “This might be the case because major comorbidities are a bigger determinant of complications, with peripheral nerve blocks being less likely to be able to exert a substantial effect.”

    Future research should include further examination of the benefits of peripheral nerve blocks. “Many questions remain unanswered, including quantification of attributable risk reduction of peripheral nerve blocks and which peripheral nerve blocks provide the biggest effect,” Dr. Memtsoudis concluded.

     

    References

    1. Haoyan Zhong MPA, Marko Popovic BS, Jashvant Poeran MD PhD, Crispiana Cozowicz MD, Alex Illescas MPH, Jiabin Liu MD PhD, Stavros G Memtsoudis MD PhD MBA FCCP. “Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population based study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.

     

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Por que tenho dores no ombro?

    Por que tenho dores no ombro?

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    Newswise — FAIRMONT, Minnesota — Se sentir dores no ombro após movimentar o braço, talvez você tenha um problema nele. A dor no ombro pode ser um sinal de artrite, tendiniteruptura do manguito rotador ou instabilidade no ombro. 

    Independentemente da causa, o paciente deve procurar um profissional da área de ortopedia. A primeira consulta incluirá uma análise do histórico de saúde, exame físico e possivelmente um raio X para determinar a causa subjacente e extensão do problema no ombro. Em alguns casos, um exame adicional de imagem, como uma ressonância magnética (RM), pode ser necessário. 

    O profissional da área de ortopedia indicará as opções de tratamento e ajudará a decidir o que é melhor para você. A primeira linha de tratamento pode incluir: 

    • Tomar anti-inflamatórios que não necessitam de receita médica. 
    • Fazer repouso do ombro/braço afetado. 
    • Colocar gelo no ombro. 
    • Modificar as atividades para evitar complicações. 
    • Receber aplicação de injeção de esteroides. 
    • Fazer fisioterapia para fortalecer os músculos do ombro e braço. 

    Muitos estudos demonstram que as pessoas com dores no ombro respondem bem a esses tratamentos e são capazes de se restabelecer para fazer as atividades cotidianas. Porém, caso o paciente esteja sentindo dor e fraqueza, o profissional da área de ortopedia poderá recomendar uma cirurgia. 

    Uma das causas de dor e fraqueza é a ruptura do manguito rotador. O manguito rotador é um grupo de músculos e tendões. Ele mantém a articulação do ombro posicionada e auxilia na movimentação e força do braço. Caso o exame de ressonância magnética (RM) revele uma ruptura no manguito rotador, poderá ser necessário fazer uma cirurgia, ainda que isso não seja necessário para a maioria dos pacientes. 

    Normalmente, a cirurgia é ambulatorial, e o paciente pode ir para casa no mesmo dia. Neste procedimento, o cirurgião insere uma câmera minúscula (artroscópio) e ferramentas através de pequenas incisões para recolocar o tendão rasgado no osso. O paciente poderá necessitar de uma tipoia por seis semanas após a cirurgia para cicatrizar o ombro. 

    Após quatro a seis semanas, o paciente ainda poderá ter algumas restrições para trabalhar e talvez tenha que mudar as atividades. O profissional da área de ortopedia também poderá recomendar fisioterapia. 

    Independentemente de o paciente responder aos tratamentos não invasivos ou necessitar de uma cirurgia, o objetivo do profissional da área de ortopedia é aliviar a dor no ombro para que o paciente possa retomar as atividades cotidianas sem dor ou restrições. 

    Dr. Mark Wikenheiser, médico ortopedista no Sistema de Saúde da Mayo Clinic.   

    ### 

    Sobre a Mayo Clinic 
    Mayo Clinic é uma organização sem fins lucrativos comprometida com a inovação na prática clínica, educação e pesquisa, fornecendo compaixão, conhecimento e respostas para todos que precisam de cura. Visite a Rede de Notícias da Mayo Clinic para obter outras notícias da Mayo Clinic. 

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  • خبراء السرطان في مايو كلينك يسلطون الضوء على التقدم المحرز في علاج الورم النقوي المتعدد

    خبراء السرطان في مايو كلينك يسلطون الضوء على التقدم المحرز في علاج الورم النقوي المتعدد

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    Newswise — مدينة روتشستر، ولاية مينيسوتا— يشارك دكتور سكندر العوضي، دكتور في الطب، اختصاصي الدَّمَويات والأورام في مركز مايو كلينك الشامل لعلاج للسرطان تفاصيل حول تطورات جديدة توصلت إليها الأبحاث ستفضي إلى نتائج أفضل لمرضى الورم النقوي المتعدد.  

    الورم النقوي المتعدد هو نوع غير شائع نسبيًا من أنواع سرطان الدم التي تصيب نخاع العظم. رغم أنه لا يوجد علاج نهائيًا للمرض، إلا إنه يمكن التعامل معه بالعلاجات المتاحة مثل الأدوية، والعلاج الكيميائي، والإشعاع، أو حتى بزراعة نخاع العظم للمساعدة في إطالة جودة حياة المرضى.  

    يشارك دكتور العوضي في قيادة فريق من الباحثين في مايو كلينك لتجربةعلاج مستقبلات المستضد الخيمرية، والتي تسمى أيضًا علاج الخلايا التائية ذات مستقبلات المستضد الخيمرية (CAR-T cell)، لعلاج المرضى المصابين بالورم النقوي المتعدد، وتطوير أدوية جديدة لاستهداف الواسِمات السرطانية المختلفة مثل مستضد نضج الخلايا البائية وغيره.  

    يقول دكتور العوضي “التطورات في الأدوية والعلاجات الجديدة لعلاج الورم النقوي في حالة تطور وتغير مستمرين. وإنه لوقت باعث على الحماسة لإجراء أبحاث على أدوية السرطان لاكتشاف علاجات جديدة ستمنح الأمل لمرضى السرطان.”  

    إن علاج مستقبلات المستضد الخيمرية هو أحدث علاج مناعي للسرطان يحتوي على خلايا تائية مُعدّلة وراثيًا لاستهداف واسِمات الخلايا السرطانية تحديدًا، ولتنشيط الجهاز المناعي للتعرف على الخلايا السرطانية والقضاء عليها.  

    في دراسة نُشرت مؤخرًا في في مجلة نيو إنجلاند الطبية، والتي شاركت فيها مايو كلينك، قارن الباحثون نتائج علاج مستقبلات المستضد الخيمرية بنتائج نُظُم العلاج القياسية المتوفرة حاليًا لدى المرضى الذين عولجوا سابقًا من الورم النقوي المتعدد والذين عاودهم المرض بعد الشفاء منه. وقاس الباحثون معدلات البقاء على قيد الحياة التي خلت من تقدّم المرض، وهي الفترة التي يتعايش فيها المريض مع المرض خلال العلاج وبعده، ولكن دون أن يتفاقم المرض.  

    وأشارت الدراسة أنه بإجراء متابعة تفقدية بمتوسط 18.6 شهرًا، بلغ متوسط البقاء على قيد الحياة دون تقدّم المرض لدى المجموعة التي تلقت علاج مستقبلات المستضد الخيمرية 13.3 شهرًا، مقارنة بمتوسط بلغ 4.4 شهور فقط لدى المجموعة التي عولجت بنُظُم العلاج القياسية.  

    يضيف دكتور العوضي قائلاً: “تشير هذه النتائج إلى أننا نمضي في الطريق البحثي الصحيح الذي سيحدث تغييرًا في الممارسة العلاجية والتي ستقدم علاج مستقبلات المستضد الخيمرية في مرحلة مبكرة من علاج المرضى الذين عاودتهم الإصابة بالورم النقوي المتعدد — والذي أتمنى أن يصبح معيار الرعاية في المستقبل.”  

    يواصل باحثو مايو كلينك اختبار أدوية جديدة تستهدف الورم النقوي المتعدد حيث تقود فرق متخصصة التجارب السريرية مستخدمين طرق علاج مستقبلات المستضد الخيمرية الحديثة. يشمل ذلك استخدام العلاجات الجاهزة وعلاج مستقبلات المستضد الخيمرية في وقت مبكر من رحلة العلاج المرضى.  

    يوجد حاليًا ما يزيد عن 40 تجربة سريرية متاحة في مايو كلينك لمرضى الورم النقوي المتعدد. 

    ### 

    نبذة عن مايو كلينك 
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.  

    جهة الاتصال الإعلامية: 

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    Mayo Clinic

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  • Genes that form specific bones in the womb heal them later in life

    Genes that form specific bones in the womb heal them later in life

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    Newswise — Genes long known to control the formation of bones before birth also control bone healing later in life, a new study found.  

    Led by researchers at NYU Langone Health, a new study pinpointed key Hox genes, specific to each location in the body, as the controllers of stem cells involved in both forming and repairing bone. HOX proteins act like the body’s “zip code,” specifying the position of limbs in the fetus by encoding instructions for transcription factors, which attach to DNA and influence the action of genes.

    Such adjustments guide immature stem cells as they multiply and mature in the womb, say the study authors, to become heart muscle, nerves, bones, etc., and in the right places. Bone is among the tissues that keep pools of stem cells on hand into adulthood, ready to mature into needed replacement cells that maintain healthy tissue and heal broken bones.

    Published online recently in the journal Development, the new work found that Hox genetic programs in adulthood control a bone stem cell type called periosteal stem and progenitors cells or PSCPs. These cells play a central role in healing bones according to the womb-determined positions in which they first formed. Already known to encode the spatial code that sets the body’s formation plan, HOX genes were shown in the study to give adult stem cells from different locations the properties needed to regenerate the particular bone in which they reside.

    During aging, such stem cells become depleted, the researchers say, resulting in weaker bones that are more likely to fracture and slower to heal. In an effort to counter this loss in healing, the research team demonstrated that increasing the activity of the gene that directs the building of the Hoxa10 transcription factor in the tibia, the larger of the two “shin bones,” in aging mice caused a 32.5% restoration of fracture repair capacity.

    “Our data revealed a previously unknown function for Homeobox or Hox genes as essential location-specific regulators of stem cell maturity in adulthood, with short-term local increases in their expression able to drive healing,” said corresponding study author Philipp Leucht, MD, PhD, the Raj-Sobti-Menon Associate Professor in the Department of Orthopedic Surgery at NYU Langone Health. “The therapeutic promise of adult stem cells as a source of bone-making cells in healing-compromised people is massive.”

    Bone Requires Attention

    A fundamental question in the field has been whether bone healing is driven more by stem cells in the marrow in a bone’s center, or by those known to pool in the nearby periosteum, the outer bone layer made of up tough connective tissue and cell-filled areas. Both stem cell types have the capacity to mature into osteoblasts, the cells that lay down new bone in response to a fracture, but the current study argues that stem cells in the periosteum, the PSPCs, are the important contributors to bone repair.

    The study result builds on the understanding that, to keep stem cells pools on hand, they must get signals to continually divide and multiply without maturing, maintaining their “stemness” until needed. The body regulates bone repair by controlling the degree to which stem cells stay immature, with the most primitive cells playing the largest role in healing due to their flexibility and ability to quickly multiply.

    In the current study, the researchers found that Hox deficiency leads to an increase in the stem cells’ propensity to differentiate into mature bone cell types. Conversely, when the team increased Hoxa10 expression in tibia stem and progenitor cells, it reprogrammed them into a more stem-cell-like state, a needed step if they are to become new bone-making cells as part of healing.

    Specifically, say the authors, PSPCs exist as a mixed stem cell population that includes those with the most stemness, naïve periosteal stem cells (PSCs), alongside more mature periosteal progenitor 1 (PP1s) and periosteal progenitor 2 (PP2s) cells. The current study authors found that Hoxa10 expression was most abundant in PSCs and was significantly reduced as cells progressed along the lineage hierarchy to PP1 and PP2. Experiments that increased the activity of the Hox genes in these more mature progenitors brought about a 3-fold increase of PSCs as cells were reprogrammed into a more primitive stem cell identity.  

    “PSPCs have distinguishing characteristics that form the basis for future cell-based therapies, including their greater tendency to naturally regenerate bone than many related stem cell groups,” said co-corresponding lead author Kevin Leclerc, a post-doctoral scholar in Leucht’s lab. “By modifying Hox activity in these cells, we can help them regenerate bone more effectively in individuals with deficient bone-healing capacity.”     

    Along with Leucht and Leclerc, study authors from the Department of Orthopedic Surgery are Lindsey Remark, Malissa Ramsukh, Anne Marie Josephson, Laura Palma, Paulo EL Parente, Margaux Sambon, Sooyeon Lee, Emma Muiños Lopez, and co-senior author Sophie Morgani. The study was funded by National Institutes of Health grants R01AG056169, K08AR069099, S10OD010751, 5P30CA016087 642, and P41 EB017183, as well as by Perlmutter Cancer Center support grant P30CA016087, the Patricia and Frank Zarb Family, and the CTSI TL1 post-doctoral scholarship of the New York Stem Cell Foundation.

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    NYU Langone Health

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  • Older Men More at Risk as Dangerous Falls Rise for All Seniors

    Older Men More at Risk as Dangerous Falls Rise for All Seniors

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    March 17, 2023 — When Senate Minority Leader Mitch McConnell (R-KY) fell recently at a dinner event in Washington, D.C., he unfortunately joined a large group of his senior citizen peers. 

    This wasn’t the first tumble the 81-year-old has taken. In 2019, he fell in his home, fracturing his shoulder. This time, he got a concussion and was recently released to an in-patient rehabilitation facility. While McConnell didn’t fracture his skull, in falling and hitting his head, McConnell became part of an emerging statistic: one that reveals falls are more dangerous for senior men than senior women. 

    This new research, which appeared in the American Journal of Emergency Medicine, came as a surprise to lead researcher Scott Alter, MD, associate professor of emergency medicine at the Florida Atlantic University College of Medicine. 

    “We always hear about lower bone density rates among females, so we didn’t expect to see males with more skull fractures,” he said. 

    Alter said that as a clinician in a southern Florida facility, his ER department was the perfect study grounds to evaluate incoming geriatric patients due to falls. Older “patients are at higher risk of skull fractures and intercranial bleeding, and we wanted to look at any patient presenting with a head injury. Some 80% were fall related, however.” 

    The statistics bear out the fact that falls of all types are incredibly common among the elderly: some 800,000 seniors wind up in the hospital each year due to falls.

    The numbers show death rates from falls are on the rise in the senior citizen age group, too, up 30% from 2007 to 2016. Falls account for 70% of accidental deaths in people 75 and older. They are the leading cause of injury-related visits to emergency departments in the country, too. 

    Jennifer Stevens, MD, a gerontologist and executive director at Florida-based Abbey Delray South, is aware of the dire numbers and sees their consequences regularly. “The reasons seniors are at a high fall risk are many,” she said. “They include balance issues, declining strength, diseases like Parkinson’s and Alzheimer’s, side effects of their medications, and more.”

    In addition, many seniors live in spaces that are not necessarily equipped for their limitations, and hazards exist all over their homes. Put together, and the risks for falls are everywhere. But there are steps seniors, their families, and even middle-aged people can take to mitigate and hopefully prevent dangerous falls.  

    Staring Early

    While in many cases the journey to lessen fall risks begins after a fall, the time to begin addressing the issue is long before you hit your senior years. Mary Therese Cole, a physical therapist and certified dementia practitioner at Manual Edge Physical Therapy in Colorado Springs, CO, says that age 50 is a good time to start paying attention and addressing physical declines. 

    “This is an age where your vision might begin deteriorating,” she said. “It’s a big reason why elderly people trip and fall.” 

    Additionally, as our brains begin to age in our middle years, the neural pathways from brain to extremities start to decline, too. The result is that many people stop picking up their feet as well as they used to do, making them more likely to trip. 

    “You’re not elderly yet, but you’re not a spring chicken, either,” Cole said. “Any issues you have now will only get worse if you’re not working on them.” 

    A good starting point in middle age, then, is to work on both strength training and balance exercises. A certified personal trainer or physical therapist can help get you on a program to ward off many of these declines.

    If you’ve reached your later years, however, and are experiencing physical declines, it’s smart to check in with your primary care doctor for an assessment. “He or she can get your started on regular PT to evaluate any shortcomings and then address them,” Cole said. 

    Cole said when she’s working with a senior patient, she’ll test their strength getting into and out of a chair, do a manual strength test to check on lower extremities, check their walking stride, and ask about conditions like diabetes, former surgeries, and other conditions. 

    From there, Cole said she can write up a plan for the patient. Likewise, Stevens uses a program called Be Active that allows her to test seniors on a variety of measurements, including flexibility, balance, hand strength, and more. 

    “Then we match them with classes to address their shortcomings,” she said. “It’s critical that seniors have the ability to recover and not fall if they get knocked off balance.”

    Beyond working on your physical limitations, taking a good look at your home is essential, too. “You can have an occupational therapist come to your home and do an evaluation,” Stevens said. “They can help you rearrange and reorganize for a safer environment.” 

    Big, common household fall hazards include throw rugs, lack of nightlights for middle-of-the-night visits to the bathroom, a lack of grab bars in the shower/bathtub, and furniture that blocks pathways. 

    For his part, Alter likes to point seniors and their doctors to the CDC’s STEADI program, which is aimed at stopping elderly accidents, deaths, and injuries. 

    “It includes screening for fall risk, assessing factors you can modify or improve, and more tools,” he said. 

    Alter also recommended seniors talk to their doctor about medications, particularly blood thinners. 

    “At a certain point, you need to weigh the benefits of disease prevention with the risk of injury if you fall,” he said. “The bleeding risk might be too high if the patient is at a high risk of falls.” 

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  • HSS Study Shows MISB, a Minimally Invasive Procedure for Treating Bunions, Does Not Affect Flatfoot

    HSS Study Shows MISB, a Minimally Invasive Procedure for Treating Bunions, Does Not Affect Flatfoot

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    Newswise — Existing thought in the orthopedic world is that treating a bunion with the minimally invasive procedure MISB may make a person’s flatfoot worse. A new study by researchers at Hospital for Special Surgery (HSS) in New York City shows that this procedure does not make flatfoot worse in people with asymptomatic flatfoot and may even improve the condition. The findings were presented today at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

    “Because of the way the bunion correction is performed with MISB, there is a thought that it may not help stabilize the foot in the same way that the more extensive, open procedures performed at the midfoot do,” said study senior author Anne Holland Johnson, MD, a foot and ankle surgeon at HSS. “When someone has a flatfoot deformity, which is essentially a fallen arch, the idea is that fixing the bunion through this minimally invasive technique could make the flatfoot worse because we cut the bones closer to the toe. What we found is that it was quite the opposite—that fixing the bunion in a minimally invasive way caused no changes in the overall flatfoot dimensions.”

    “Bunion” is an umbrella term describing a variety of painful deformities at the base of the big toe. In the most common type of bunion, called hallux valgus, the big toe turns inward from its normal position and angles toward the second toe. Hallux valgus often presents with secondary structural deformities such as flatfoot, which can be symptomatic or asymptomatic (causing no symptoms).

    All techniques for treating bunions involve cutting the bones and repositioning them with metal screws. The minimally invasive chevron and akin bunionectomy (MISB) fixes the bunion by cutting the bones through tiny incisions in the skin. “The advantages of doing the surgery through small incisions include minimal to no pain after the surgery; immediate weight bearing, so you can walk normally on the foot; and faster return to day-to-day activities and sports,” said Dr. Johnson.

    The researchers conducted a retrospective study using a patient registry at HSS. In the registry, they identified patients who were over 18 years of age and were diagnosed with a bunion deformity between 2016 and 2021. Of this cohort, patients were included in the study if they underwent a MISB procedure to correct a hallux valgus deformity; reported their outcomes for at least one year and up to two years, as recorded by a patient-reported outcomes tool known as PROMIS; and had x-rays before and three months after surgery, at minimum. Using preoperative x-rays, the team identified individuals who had evidence of flatfoot; using a chart review, they also identified those with an asymptomatic flatfoot. These reviews yielded a study group of 35 patients with asymptomatic flatfoot and 47 patients without flatfoot.

    “We collected PROMIS surveys on all our patients. These are a series of questionnaires that have been validated for use in foot and ankle research and ask the patient about their function, pain, and mental health,” said Rami Mizher, lead author of the study and a research assistant in the Department of Foot and Ankle Surgery at HSS. The researchers found that MISB resulted in similar improvements in the two groups in physical function, pain interference (how often the pain interferes with daily life), pain intensity, and global physical health (overall patient health), as measured by the PROMIS survey. There were no significant preoperative to postoperative changes in PROMIS global mental health and depression measures in either group.

    A chart review showed there was no difference in complications in the two study groups.

    The researchers also examined pre- and post-operative x-rays to clinically assess how well the surgery corrected the bunion deformity and if it changed any of the flatfoot-related measurements. In both groups, there was a similar correction of the bunion deformity. In terms of the flatfoot outcomes, the researchers looked at three different parameters: calcaneal pitch, or the height of the foot arch; Meary’s angle, which measures how much a foot sags; and talonavicular coverage angle, which measures how much the foot turns outward. The first two measures didn’t have any significant changes, while the talonavicular coverage angle improved in the flatfoot group.

    “Our research shows that you can fix the bunion with this comparatively easier procedure and not make the flatfoot worse,” said Dr. Johnson. “It proves that minimally invasive bunion correction is a viable option for patients with flatfoot.”

    Authors: Rami Mizher, BS; Lavan Rajan, BA; Jaeyoung Kim, MD; Syian Srikumar, BS; Elizabeth Cody, MD; Anne Holland Johnson, MD; Scott Ellis, MD (HSS)

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Doctor learns how to walk again after biking accident

    Doctor learns how to walk again after biking accident

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    BYLINE: Valerie Goodwin

    Newswise — Like many during the early stages of the COVID-19 pandemic, Joseph Kolars, M.D., professor of medicine in the Division of Gastroenterology and Hepatology at the University of Michigan and his wife, Candace Kolars would take nice weather days as an opportunity to get outside and be active.

    In December 2020, the Kolars were taking one of their usual bike rides through Gallup Park in Ann Arbor when they noticed a runner had fallen on a slippery bridge. The pair quickly hit their brakes but proceeded to fall off their bikes. While Candace Kolars was unharmed, Joseph Kolars was in a lot of pain and couldn’t stand up.

    After calling 911, EMS arrived to find that not only could Joseph Kolars not stand, but his helmet was cracked. He was quickly whisked away to the University of Michigan Health System Emergency Department for evaluation.

    Joseph Kolars had numerous tests run on both his head and his legs. The results revealed that while his helmet had protected his head, his pelvis and femur absorbed the full brunt of the fall.

    A series of x-rays and CT scans showed that Joseph Kolars’s right femur had broken through the joint capsule, gone up through his pelvis, which shattered in the process. The staff at the ED quickly started trying to control Kolars’ pain while putting him into traction to pull his femur out of his pelvic area.

    “I don’t remember much from the ED, but I do remember them doing everything they could to make me feel comfortable,” said Joseph Kolars. “Everyone who helped me was very efficient.”

    After all the ED tests were run, Jaimo Ahn, M.D., an orthopaedic surgeon at Michigan Medicine, assessed the damage of the injury and started working on a plan of operation for Joseph Kolars.

    While his injury was severe, Ahn was able to quickly identify the injury as a “high energy” acetabular fracture, a type of fracture that has been researched for decades. Within 24 hours of arriving to the ED, Ahn was able to start working with Joseph Kolars on a plan of action for surgery.

    Fixing an injury like this requires a lot of surgical trauma to the body. Almost all surgeries require cutting through muscles and tissues to get to the desired location. The larger the incision, the more trauma, blood loss, risk of infection, and more difficult recovery.

    “Surgery is just controlled trauma to the body,” said Ahn. “The less trauma we can cause, the easier it is for the patient to recover.” 

    Ahn proposed a hybrid procedure that would have a smaller incision and less risk and an easier recovery.

    “Dr. Ahn presented this alternative method with lots of confidence,” said Joseph Kolars. “His confidence in the procedure is what convinced me this was the right choice and that it would pan out well.”

    This procedure used more indirect methods to bring the pieces back together. Pins were used during the procedure to help steady the bones so they could be put back in place and guide the fixation metal to where it needs to go. The plates and screws were left in the pelvis to help hold the bone where it needs to be and steady the area so Joseph Kolars could start walking again during recovery.

    The CT scan that was done before surgery allowed Ahn to see every fracture in full detail down to the millimeter. This allowed for more precise placements of the surgical hardware when it came to the procedure and piecing the pelvic bone back together.

    “Some people would describe fracture care as a mix of carpentry and gardening,” said Ahn. “The carpentry aspect is using a hard material that we need to be able to position and fix into place. We are still working with a living organism and need to make sure there is ample blood flow to support what is being done, that is the gardening.

    Getting back on the bike

    After surgery, Joseph Kolars spent six days in the hospital before being discharged. Even though his wife could not visit due to COVID-related restrictions, she felt kept in the loop about what was going on.

    “Dr. Ahn kept good communication with Candace Kolars and was able to inspire confidence in her that this procedure was the right choice,” said Joseph Kolars. “We were both very impressed with the communication from all the staff. Candace Kolars felt like she was being kept in the loop on everything as if she was there.”

    Candace Kolars would receive regular phone calls and facetimes from Ahn, the staff, and Joseph Kolars himself to be kept up to date with the care that he was receiving.

    Ahn and Joseph Kolars both mentioned that it is not always easy for doctors to be good patients.

    “We have a tendency as doctors to feel like we should be leading the critical treatment decisions,” said Ahn. “Joseph Kolars did a great job of being an engaged patient rather than directing care and that engagement can make a real positive difference.”

    Before being discharged from the hospital, physical therapy and occupational therapy teams created a specialized plan for Joseph Kolars’s recovery at home. Due to the nature of the injury, Joseph Kolars couldn’t ride in a car, so the therapists were sent to his house one to three times per week help with rehabilitation.

    Joseph Kolars was unsure if he would be able to walk again or make a full recovery due to the severity of the injury. Thanks to his care teams, he was able to walk again by April of 2021.  Today, Joseph Kolars and his wife still enjoy riding their bikes for as far as 40 miles.

    “The care I received from everyone during my stay in the hospital and after was phenomenal,” said Joseph Kolars. “I’m extremely grateful for everyone who worked on my case.”

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    Michigan Medicine – University of Michigan

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  • The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Presents the 2023 Spine Summit

    The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Presents the 2023 Spine Summit

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    Newswise — The 2023 Spine Summit, presented by the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves, will pack in plenty of intriguing educational opportunities, exciting networking events and thrilling entertainment over the four-day meeting at the Fontainebleau Miami Beach, March 16-19. At the new Spine Summit, keynote speakers, presenters and entertainment will revolve around the theme of “Excellence Requires Change – MVP: Mastery, Vision, Purpose.”

    The 39th Annual Spine Summit, which has preemptively been coined a massive success, has a record-breaking 826 medical registrants to date, a 67% increase from last year. The Spine Summit Exhibit Hall will be packed with 70 diverse exhibitors from established industry giants to nimble startup companies; a healthy 11% increase from the 2022 event. With access to industry experts, neurosurgeons and thought leaders, the floor will serve as the destination to explore advanced technology, attend hot topic presentations and network with colleagues. Throughout the summit, there will be a plethora of learning opportunities including educational courses, special sessions, 357 oral abstract presentations and 254 I-Poster presentations.

    The 2023 Spine Summit kicks off at the Opening Reception Thursday night at the Fontainebleau’s Ocean Lawn where L.A.vation: The World’s Greatest Tribute to U2, sets the backdrop for networking and socializing. Other opportunities to get to know your fellow neurosurgeons include the WINS Reception and the Young Spine Surgeon Reception and Dinner.

    Corresponding with the meeting’s  MVP theme, the Spine Section will celebrate athletic MVPs at its inaugural Sport & Spine Session as pro football Hall of Famer and Super Bowl champion Ronnie Lott of the San Francisco 49ers discusses being an MVP on the gridiron and in life. Lott will take the stage with former teammate and friend, Jeffrey Fuller, who sustained a career-ending spinal cord injury on the field.

    Visionary speakers will kick off every Plenary Session with TEDx-style talks and each will be capped off with an impartial take on the session’s theme by tech leaders. Courses have been revamped, debates and controversies reinvigorated and scientific sessions reimagined.

    In addition to Lott and Fuller, the 2023 Spine Summit will feature inspirational remarks from Michael T. Modic, MD; Michael Brant-Zawadzki, MD, FACR; Sasha Strauss; Liam Duffy and C. Philip O’Carroll, MD.

    Michael T. Modic, MD

    Michael Modic, MD, joined Vanderbilt University Medical Center in 2018 as senior vice president, population health and professor of radiology and radiological sciences. He worked with the population health team integrating clinical activities and establishing and enabling evidence-based clinical standards across diverse network-based ambulatory and inpatient settings. In addition to his administrative efforts, he continued to engage in clinical research and care, committing time to clinical service and the teaching and mentoring of residents, fellows and junior staff as a member of the neuroradiology section.

    Michael Brant-Zawadzki, MD, FACR

    Brant-Zawadzki, MD, FACR, is the senior physician executive at Hoag Hospital and the Ron & Sandi Simon Executive Medical Director Endowed Chair of Hoag’s Pickup Family Neurosciences Institute. In these roles, he facilitates business and strategic relationships with specialist clinicians, and oversees a platform for programmatic care that integrates specialized services with population health. He helps Hoag transform health care strategy, focusing it on specific health conditions using a program-driven, physician-led, multi-disciplinary team approach measured by patient-focused outcomes. He also oversees the Hoag Center for Research and Education.

    Sasha Strauss

    Sasha Strauss shares two decades of experience in brand development, building brands for corporations, philanthropies and universities while working at top advertising, PR, marketing and branding firms worldwide. His unique and proven perspective on how brands are built and communicated laid the foundation for his brand strategy consulting firm, Innovation Protocol. The 10-year-old company has a team of 25, with staff in Los Angeles, San Francisco and New York. His team’s ability to inculcate brand truth is the reason brands like ADP, Amgen, Disney, Google, Notre Dame, PayPal, Nestle and Korn Ferry enlist their consult and keynotes on brand strategy.

    Liam Duffy

    Liam Duffy is a dynamic, high-motor trial lawyer who has significant experience in high-stakes cases. At Yarborough Applegate, Duffy has handled numerous catastrophic injury and wrongful death cases involving issues of workplace safety, over-service of alcohol, product liability, tractor-trailer collisions, premises liability, electric shock and electrocution and more. Liam’s creativeness and forward-thinking approach to trial work has helped his clients achieve numerous seven-figure recoveries, as well as an eight-figure jury verdict in 2019.

    Jeffrey Fuller

    Jeffrey Fuller was recruited to Texas A&M in 1980 and was later drafted by the San Francisco 49ers in 1984 where he played in two Super Bowls and went on to win Super Bowls XIX and XXIII.

    As the result of damage caused to Candlestick Stadium by the 1989 Loma Pierta earthquake, Fuller played his last professional game at Stanford Stadium on October 22, 1989. In the second play of the game, he was partially paralyzed after a helmet-to-helmet hit on New England running back John Stephens.

    Ronnie Lott

    Considered by many to be the greatest defensive back to put on a uniform, Ronnie Lott’s influence reinvented how the position was played, and whose influence can still be seen on the field today. In 14 professional seasons and 192 career games, Lott had 63 interceptions, 1,146 tackles and five touchdowns. He is a 10-time Pro Bowler, made the All-Pro team six times, the All-NFC six times, the All-AFC once and was named to the NFL’s 75th anniversary team in 1994. In 2000, Lott was inducted into the Pro Football Hall of Fame in his first year of eligibility.

    Philip O’Carroll, MD

    Philip O’Carroll, MD, is an expert in mind-body interactions. A native of Ireland and a graduate of University College Dublin Medical School, he completed a three-year residency in internal medicine in Canada, followed by a residency in neurology at Massachusetts General Hospital. Dr. O’Carroll completed a fellowship in neurophysiology at the Mayo Clinic in Rochester, Minnesota. He is a co-founder of the Pickup Family Neurosciences Institute at Hoag Hospital.

     

    The 2023 Spine Summit is being brought to attendees by Adam Kanter, MD, FAANS, AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Chair; Scott Meyer, MD, FAANS, Annual Meeting Chair and Charles Sansur, MD, FAANS, Scientific Program Chair.

    Adam Kanter, MD, FAANS, Section Chair

    Adam Kanter, MD, FAANS, Section chair, graduated with cum laude honors from the University of Massachusetts in Amherst. He performed research for NASA while obtaining a master’s degree at Boston University and then on to medical school at the University of Vermont. He completed neurosurgery residency at the University of Virginia, including a year abroad in Auckland, New Zealand, followed by fellowship training in minimally invasive spine surgery at the University of California, San Francisco. He then joined the University of Pittsburgh Medical Center (UPMC) as director of the minimally invasive spine program. Dr. Kanter launched UPMC’s complex spine fellowship in 2012, was appointed chief of spine in 2014 and performed more than 6,000 operations as he ascended the ranks to tenured professor of neurological surgery. Dr. Kanter has authored more than 150 journal publications, numerous books and chapters, and given more than 200 lectures across the globe.

    After 15 years in Pittsburgh, Dr. Kanter sought new adventures and leadership opportunities, relocating his family and practice to Newport Beach, California, where he joined Hoag Hospital as Associate Executive Medical Director, Pickup Family Neurosciences Institute and Chief of Neurosurgery, Hoag Specialty Clinic.  He is actively obtaining his executive MBA from the University of California, Los Angeles, following which he will assume the executive directorship of the Pickup Family Neurosciences Institute.

    Scott Meyer, MD, FAANS, Annual Meeting Chair

    Scott Meyer, MD, FAANS, Annual Meeting chair, is a top neurosurgeon in New Jersey specializing in degenerative spine disease, minimally invasive spine surgery, cervical disc replacement, spinal deformity (scoliosis), spinal tumors and spinal trauma. In New Jersey, Dr. Meyer has served as chairman and a member of the Spine Technology Committee at Atlantic Health System. He is president of the New Jersey Neurosurgical Society, and also a member of the Executive Board for the New Jersey Spine Society. Dr. Meyer is a member of the Spine Steering Committee at both Morristown Medical Center and Overlook Medical Center.

    Charles Sansur, MD, FAANS, Scientific Program Chair

    Charles Sansur, MD, FAANS, Scientific Program Chair, is a professor and director of spine surgery for the Department of Neurosurgery at the University of Maryland in Baltimore. He is also the current program director and vice-chair of neurosurgery at the University of Maryland. He is a member of the editorial board for the Journal of Neurosurgery, Spine. He has served on the Spine Section Executive Committee since 2010. He holds several patents and is actively engaged in product development in spine surgery. He is frequently invited to teach other spine surgeons throughout the country at various national meetings.

     

    About the 2023 Spine Summit:

    From March 16-19, 2023, in Miami Beach, Florida, neurosurgeons, orthopaedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers will join for the 2023 Spine Summit for educational advancement, networking opportunities and riveting entertainment. This annual meeting is the

     

    About the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves:

    The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves brings together neurosurgeons, orthopedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers focused on spinal surgery. The Spine Section advances spine surgeon’s interests, represents them in national advocacy and disseminates science.

     

    For more information, visit www.spinesection.org

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    American Association of Neurological Surgeons (AANS)

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  • Protein droplets may cause many types of genetic disease

    Protein droplets may cause many types of genetic disease

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    Newswise — Most proteins localize to distinct protein-rich droplets in cells, also known as “cellular condensates”. Such proteins contain sequence features that function as address labels, telling the protein which condensate to move into. When the labels get screwed up, proteins may end up in the wrong condensate. According to an international team of researchers from clinical medicine and basic biology, this could be the cause of many unresolved diseases. The findings appeared in the journal Nature.

    Patients with BPTA syndrome have characteristically malformed limbs featuring short fingers and additional toes, missing tibia bones in their legs and reduced brain size. As the researchers found out, BPTAS is caused by a special genetic change that causes an essential protein to migrate to the nucleolus, a large proteinaceous droplet in the cell nucleus. As a result, the function of the nucleolar condensate is inhibited and developmental disease develops.

    “What we discovered in this one disease might apply to many more disorders. It is likely not a rare unicorn that exists only once. We just could not see the phenomenon until now because we did not know how to look for it,” says Denise Horn, a clinical geneticist at the Institute of Medical and Human Genetics at Charité – Universitätsmedizin Berlin.

    In collaboration with scientists at the Max Planck Institute for Molecular Genetics (MPIMG) in Berlin, the University Hospital Schleswig-Holstein (UKSH), and contributors from all around the world, the team is pushing open a door to new diagnoses that could lead to the elucidation of numerous other diseases as well as possible future therapies.

    “We discovered a new mechanism that could be at play in a wide range of diseases, including hereditary diseases and cancer,” says Denes Hnisz, Research Group Leader at the MPIMG. “In fact, we have discovered over 600 similar mutations, 101 of which are known to be associated with different disorders.”

    “The actual work is just starting now,” adds human geneticist Malte Spielmann of UKSH in Lübeck and Kiel. “We will find many more genes with such disease-causing mutations and can now test their mode of action.”

    An unusual mutation

    Affected individuals have complex and striking malformations of the limbs, face, and nervous and bone systems, only partially described by the already-long disease name “brachyphalangy-polydactyly-tibial aplasia/hypoplasia syndrome” (BPTAS).

    “With fewer than ten documented cases worldwide, the disease is not only rare, but ultra-rare,” says Martin Mensah, clinical geneticist at the Institute of Medical and Human Genetics at Charité. To track down the cause, he and his colleagues decoded the genome of five affected individuals and found that the gene for the protein HMGB1 was altered in all patients.

    This protein has the task of organizing the genetic material in the cell nucleus and facilitates the interaction of other molecules with the DNA, for example to read genes.

    In mice, a complete loss of the gene on both chromosomes is catastrophic and leads to death of the embryo. In some patients with only one copy mutated, however, the cells are using the intact copy on the other chromosome, resulting only in mild neurodevelopmental delay. But the newly discovered cases did not fit this scheme.

    “All five unrelated individuals featured the same ultra-rare disorder and had virtually the same mutation”, says Mensah, who is a fellow of the Clinician Scientist Program operated by the Berlin Institute of Health at Charité (BIH) and Charité. “This is why we are sure that the HMGB1 mutation is the cause of the disease. However, at that point, we had no clue how the gene product functionally caused disease, especially given that loss-of-function mutations were reported to result in other phenotypes.”

    Charged protein extensions

    A closer look revealed that different mutations of HMGB1 have different consequences. The sequencing data showed that in the affected individuals with the severe malformations, the reading frame for the final third of the HMGB1 gene is shifted.

    After translation to protein, the corresponding region is now no longer equipped with negative but with positively charged amino acid building blocks. This can happen if a number of genetic letters not divisible by three is missing in the sequence, because exactly three consecutive letters always code for one building block of the protein.

    However, the tail part of the protein does not have a defined structure. Instead, this section hangs out of the molecule like a loose rubber band. The purposes of such protein tails (also called “intrinsically disordered regions”) are difficult to study because they often become effective only in conjunction with other molecules. So how might their mutation lead to the observed disease?

    Protein droplets in the cell

    To answer this question, the medical researchers approached biochemists Denes Hnisz and Henri Niskanen at the MPIMG, who work with cellular condensates that control important genes. These droplet-like structures behave much like the oil and vinegar droplets in a salad dressing. Composed of a large number of different molecules, they are separated from their surroundings and can undergo dynamic changes.

    “We think condensates are formed in the cell for practical reasons,” Niskanen explains. Molecules for a specific task are grouped together in this way, say to read a gene. For this task alone, he says, several hundred proteins need to somehow make their way to the right place.

    “Intrinsically disordered regions, which tend not to have an obvious biochemical role, are thought to be responsible for forming condensates,” Niskanen says, giving an example to describe how important the physical properties of the protein extensions are in this regard. “I can easily make a ball from many loose rubber bands that holds together relatively tightly and that can be taken apart with little effort. A ball of smooth fishing line or sticky tape, on the other hand, would behave quite differently.”

    Solidifying droplets

    The nucleolus within the cell nucleus is also a condensate, which appears as a diffuse dark speck under the microscope. This is where many proteins with positively charged tails like to linger. Many of these provide the machinery required for protein synthesis, making this condensate essential for cellular functions.

    The mutant protein HMGB1 with its positively charged molecular tail is attracted to the nucleolus as well, as the team observed from experiments with isolated protein and with cell cultures.

    But since the mutated protein region has also gained an oily, sticky part, it tends to clump. The nucleolus loses its fluid-like properties and increasingly solidifies, which Niskanen was able to observe under the microscope. This impaired the vital functions of the cells – with the mutated protein, more cells in a culture died compared to a culture of cells without the mutation.

    Combing through databases

    The research team then searched databases of genomic data from thousands of individuals looking for similar incidents. In fact, the scientists were able to identify more than six hundred similar mutations in 66 proteins, in which the reading frame had been shifted by a mutation in the protein tail, making it both more positively charged and more “greasy”. Of the mutations, 101 had previously been linked to several different disorders.

    For a cell culture assay, the team selected 13 mutant genes. In 12 out of 13 cases, the mutant proteins had a preference to localize into the nucleolus. About half of the tested proteins impaired the function of the nucleolus, resembling the disease mechanism of BPTA syndrome.

    New explanations for existing diseases

    “For clinical research, our study could have an eye-opening effect,” says Malte Spielmann, who led the research together with Denes Hnisz and Denise Horn. “In the future, we can certainly elucidate the causes of some genetic diseases and hopefully one day treat them.”

    However, “congenital genetic diseases such as BPTAS are almost impossible to cure even with our new knowledge”, says Horn. “Because the malformations already develop in the womb, they would have to be treated with drugs before they develop. This would be very difficult to do.”

    But tumor diseases are also predominantly genetically determined, adds Hnisz: “Cellular condensates and the associated phase separation are a fundamental mechanism of the cell that also plays a role in cancer. The chances of developing targeted therapies for this are much better.”

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    Max Planck Society (Max-Planck-Gesellschaft)

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