Citations

Aims Arthrofibrosis affects a notable percentage of patients after total knee arthroplasty (TKA). Elevated serum mast cell tryptase (SMCT) levels have been linked to fibrosis, suggesting that SMCT could serve as a biomarker for arthrofibrosis. As such, the aims of this study were to assess SMCT levels in TKA patients, and their possible association with arthrofibrosis and clinical outcomes in a prospective clinical trial. Methods We conducted a prospective study involving 219 patients undergoing primary TKA at a single academic medical centre between January 2018 and December 2022. SMCT levels were measured preoperatively, immediately postoperatively, and at six weeks, three months, and one year postoperatively. Secondary outcomes included revision rates, complications, and Knee Society Scores (KSSs). Allergic and inflammatory conditions were assessed for their influence on SMCT levels. Results At one year postoperatively, eight patients had developed arthrofibrosis (4%), and three (1.5%) had undergone manipulation under anaesthesia. The mean preoperative SMCT level was 5.6 µg/L (SD 3.4), which decreased significantly to 4.1 µg/L (SD 2.7) immediately postoperatively (p < 0.001). At six weeks the mean SMCT level was 6.4 µg/l (SD 4.1), and was 6.1 µg/l at both three months (SD 4.1) and one year (SD 4.0). Elevated preoperative SMCT levels were not significantly associated with the risk of arthrofibrosis development (OR 3; p = 0.370), nor were immediate postoperative levels (OR 2; p = 0.754) or those at six weeks (OR 1; p = 0.989). Of note, elevated SMCT levels at three months (OR 5; 95% CI 0.4 to 64; p = 0.191) and one year (OR 13; 95% CI 1 to 232; p = 0.077) trended toward an increased risk of arthrofibrosis development, without reaching significance. Conclusion In patients undergoing TKA, with the numbers included in this study, there was no significant difference in SMCT levels between patients who did and did not develop arthrofibrosis at any timepoint. However, there was a trend towards elevated SMCT levels at three months and one year in those who developed arthrofibrosis, which merits further study. Cite this article: Bone Joint Res 2025;14(11):1045–1052.

Purpose: The purpose of this study was to compare the height of velopharyngeal (VP) closure in relation to the palatal plane between individuals with velopharyngeal insufficiency (VPI) with or without cleft palate and individuals without cleft palate and with normal speech, considering the effects of age and sex. Method: Magnetic resonance imaging was used to analyze the height of VP closure in the midsagittal view during phonation of /i/ and /s/ sounds among 105 individuals with VPI and 45 individuals without cleft palate and normal speech. Results: Independent-samples t tests demonstrated that individuals with VPI display a significantly lower mean height of VP closure (3.7 mm) compared to individuals without cleft palate and normal speech during phonation of /i/ and /s/ sounds ( p < .001). Analysis of variance was used to evaluate the impact of age and sex on the height of VP closure. Significant differences were observed between the height of VP closure in individuals with VPI and those without cleft palate and normal speech across the age span during the production of /i/ and /s/ sounds. However, nonsignificant differences were found between the height of VP closure in males and females of the VPI group and those without cleft palate and normal speech during the production of these sounds. Conclusions: The results revealed the variations of the height of VP closure in relation to the palatal plane. These findings provide insights into the presurgical planning for individuals with VPI undergoing palatal surgeries, especially the location of pharyngeal flap insertion.

Abstract Uterine leiomyosarcoma (ULMS) is an orphan disease that frequently recurs and metastasizes, with patients undergoing multiple lines of chemotherapy due to lack of effective therapeutic targets. To address this gap, we used single-cell RNA sequencing and spatial transcriptomic analysis to comprehensively profile ULMS. We uncovered multiple states of tumor cells, including tumor cells with mesenchyme-like features, ischemic tumor cells defined by a MYC program, inflammatory tumor cells with active interferon signaling, and stem cell-like hormone receptor-positive cells. The inferred spatial correlates of these tumor cell states demonstrated unique localization patterns. By correlating these signatures to bulk RNA sequencing data, we demonstrate the relevance of these findings to clinical outcomes. Finally, using the single-cell integration and drug response prediction algorithm (scIDUC), we propose drug predictions that may target specific tumor states. Our findings suggest new avenues for further exploration of individualized and multifaceted therapeutic strategies to treat ULMS.

Background: Emerging neuromodulation approaches, including epidural electrical stimulation (EES), offer hope for restoration of function following chronic spinal cord injury (SCI). However, integrating neuromodulation therapies into clinical procedures is challenging due to the unique needs of the SCI population. Objectives: The purpose of this study was to understand the experiences of participants during a first-in-human trial of perilesional EES aimed at restoring sensorimotor function. Methods: We report participants’ experiences by describing their clinical care, experiences during experimental neuromodulation sessions, and perspectives on the utility of a perilesional EES system. Three participants with chronic thoracic SCI participated in semistructured interviews after completing a 14-day inpatient experimental protocol, which included stimulation mapping, lower extremity motor control experiments, and treadmill stepping. Interview data were analyzed using an applied thematic analysis approach. Nine key themes addressed 4 major topic areas: clinical experiences, experiences during laboratory experiments, experiences as a research participant, and perceived value of perilesional EES. Results: All participants noted the potential for EES to enhance functional recovery, though their postoperative experiences related to clinical care, postoperative pain, and disruptions to routine care differed. Insights gained from qualitative analyses highlighted challenges and opportunities for improving postsurgical care and refining application of EES technology. Further, these results inform recommendations for neuromodulation trials in the SCI community to help mitigate postoperative complications and improve study participant experiences. Conclusion: Key recommendations include being proactive regarding potential postsurgical complications, educating clinical staff regarding common SCI comorbidities, and customizing experimental protocols to align with the priorities and clinical needs of each participant.

Unilateral yellow discoloration of the eye, commonly referred to as scleral icterus, is an uncommon clinical finding; there are only 14 cases of persistent unilateral scleral icterus documented in the literature. Here, the authors describe a patient with Gilbert’s syndrome who presented with left-sided conjunctival and scleral icterus presumed secondary to poor vascular outflow following surgical and radiation treatment of squamous cell carcinoma of the left ear with parotid and cervical lymph node involvement. The current case describes a unique physical finding, reviews the pathophysiology of conjunctival and scleral icterus, and reviews the current literature on this topic.

Foundation models can streamline imaging workflows, improve diagnostic accuracy, enable personalized treatment, and, via integrated generative artificial intelligence, create synthetic images to augment scarce real-world data; however, successful adoption requires explainability, trust, and workflow integration.

ABSTRACT Background While radiofrequency ablation (RFA) and cryoablation (CBA) are established treatments for atrial fibrillation (AF), pulsed field ablation (PFA) offers potential benefits. This study compares PFA's procedural outcomes with RFA and CBA. Methods A PRISMA‐guided systematic review searched PubMed, Cochrane, Embase, and Scopus through September 2024. Studies comparing PFA to RFA or CBA in paroxysmal and persistent AF were included. Results From 1413 titles, 28 studies (7944 patients, 4–13 months follow‐up) met inclusion criteria. PFA showed lower recurrence versus RFA (RR = 0.85, p < 0.05) and CBA (RR = 0.81, p < 0.01). Procedure times were shorter versus RFA (‐46.39 min, p < 0.01) and CBA (‐9.26 min, p < 0.01). PFA had fewer complications than CBA (RR = 0.45, p < 0.01) and thermal ablation (RR = 0.55, p < 0.01), with similar rates to RFA (RR = 0.81, p = 0.25). Fluoroscopy times were higher. Conclusion Promising results with PFA suggest it as a viable alternative to thermal ablation.

ABSTRACT The genomic sequences of seven phages isolated from municipal sewage in Rochester, Minnesota, USA, using Klebsiella pneumoniae strains ( bla KPC carriers) as hosts are reported. These phages are lytic and belong to the Ackermannviridae, Drexlerviridae , and Zobellviridae families. No known antimicrobial resistance or virulence genes were found within their genomes.