Citations

Aims Knee osteoarthritis (OA) is a common cause of pain and disability in adults. Intra-articular injections are important components in the management of knee OA symptoms, but there are concerns that these injections may be associated with the progression of OA. Therefore, this study determined how the likelihood of progression to arthroplasty is influenced by intra-articular injection of corticosteroid (CS) and/or hyaluronic acid (HA) in patients with knee OA. Methods This population-based cohort study included patients aged 40 to 60 years receiving an initial intra-articular injection of CS and/or HA from 1 January 2000 through 31 December 2010, who resided in Olmsted County, Minnesota, USA. The primary outcome was the likelihood of joint arthroplasty by number of intra-articular injections received evaluated by Cox proportional hazards regression. Results A total of 1,897 patients (n = 2,336 knees) who received 8,600 injections (n = 5,786 CS; n = 2,814 HA) were included (mean age 51.9 years (SD 5.5); 1,515 females (64.9%); mean BMI 34.8 kg/m 2 (SD 8.0)), and 917 (39.3%) subsequently underwent arthroplasty. Accounting for age, BMI, and Kellgren-Lawrence (KL) grade at initial injection, the number of intra-articular injections was associated with an increased likelihood of arthroplasty (hazard ratio (HR) 1.12 (95% CI 1.08 to 1.17)). For patients with early OA (KL grade 0 to 1), CS injections (HR 1.27 (95% CI 1.17 to 1.37)) were associated with an increased likelihood of arthroplasty versus HA (HR 1.12 (95% CI 1.06 to 1.19)). Conclusion Each intra-articular injection was associated with a 12% increased likelihood of arthroplasty. With subgroup analysis, CS injections in early OA were associated with a 27% increased likelihood of arthroplasty. Cite this article: Bone Jt Open 2026;7(11):1462–1470.

ABSTRACT BACKGROUND Opioids prescribed for acute pain frequently remain unused, creating opportunities for unintended use, accidental ingestion, or diversion. Little is known about counseling patients receive from prescribers or pharmacists on storage and disposal of opioids. OBJECTIVE To characterize clinician counseling on opioid disposal and patient-reported storage, use, and disposal practices among opioid-naïve patients prescribed opioids for acute pain. DESIGN Multicenter prospective cohort study with participant recruitment between September 2020 and March 2023. PARTICIPANTS Opioid-naïve patients prescribed opioids for acute pain in emergency departments, primary care or urgent care clinics, inpatient settings, and dental practices. MAIN MEASURES Patient-reported receipt of counseling on the importance of opioid disposal and appropriate disposal methods; opioid storage practices; use and disposition of prescribed opioids; disposal methods; and reasons for keeping or disposing of leftover opioids. KEY RESULTS Among 1708 participants, the median age was 38 years (IQR, 28-52); most were recruited from emergency departments (n=915; 53.6%) and primary care or urgent care clinics (n=307; 18.0%). Among 1233 participants who answered the question on counseling about the importance of opioid disposal, 811 (65.8%) reported receiving no counseling. Among 1220 participants who answered the question on counseling about appropriate disposal methods, 832 (68.2%) reported receiving no counseling. Among 812 participants who answered the question about storing opioids in a locked location, 610 (75.1%) reported never doing so. Among 929 participants providing information on opioid leftovers and disposition, 618 (66.5%) did not use all prescribed opioids. Among these 618 participants, 258 (42.8%) kept leftover opioids and 345 (57.2%) disposed of them. Among 256 participants who reported reasons for keeping leftover opioids, 159 (62.1%) wanted medication available for the same condition, 70 (27.3%) wanted medication available for a different condition, and 36 (14.1%) did not know how to properly dispose of the medication. CONCLUSIONS Among opioid-naïve patients prescribed opioids for acute pain, counseling about opioid disposal was uncommon, secure storage was infrequent, and leftover opioids were frequent, with many patients keeping leftover opioids for possible future use. These findings suggest opportunities to improve counseling on opioid storage and disposal and encourage safe disposal of unused opioids after acute pain treatment.

Abstract High-frequency oscillations are specific biomarkers of epileptogenic zone, yet their noninvasive localization from scalp electroencephalography (EEG) remains challenging due to their brief duration, low amplitude, and poor signal-to-noise ratio. Here, we introduce TH-DeepSIF, a transformer-based deep learning framework trained on biologically realistic neural mass model simulations for noninvasive high-frequency oscillation source imaging. The model was evaluated in simulated single- and dual-source scenarios, where it recovered both the spatial location and temporal dynamics of high-frequency oscillation generators under increasing spatiotemporal complexity. We further validated TH-DeepSIF in 20 patients with drug-resistant epilepsy by comparing reconstructed high-frequency oscillation sources with surgical resection regions. TH-DeepSIF achieved accurate localization and waveform reconstruction in simulations, demonstrating low localization error and strong temporal correspondence with ground truth. In clinical data, pathological high-frequency oscillations (spike ripples) showed strong agreement with resection regions, with a median localization error of 10.9 mm and specificity of 0.883. In a subset of six patients with intracranial EEG, pathological high-frequency oscillation source estimates were spatially close to the seizure onset zone (median localization error: 2.41 mm). Compared with all detected high-frequency oscillations, imaging based on pathological high-frequency oscillations yielded significantly improved spatial correspondence and performance across multiple metrics. Reconstructed source activity was also temporally aligned with both scalp high-frequency oscillation bursts and associated spike deflections. These results demonstrate that TH-DeepSIF provides a data-driven framework for noninvasive high-frequency oscillation source imaging with improved anatomical specificity and support the use of pathological high-frequency oscillations as informative biomarkers for epileptogenic zone localization.

Objective Glucocorticoids (GCs) remain the primary treatment for polymyalgia rheumatica (PMR) but are associated with substantial long‐term toxicity. Although sex‐based differences in GC‐related adverse effects have been suggested, they have not been well studied in PMR. Methods We conducted a retrospective cohort study of patients with PMR treated between 2017 and 2024 within a multisite health system. Patients ≥50 years of age with at least two PMR International Classification of Diseases, Tenth Revision, codes and documented GC dosing for ≥75% of days during the first six months of treatment were included. Sex‐based differences in GC toxicity outcomes including incident or worsening hypertension, type 2 diabetes mellitus, and incidence of fragility fractures were evaluated using multivariable regression models adjusted for age, body mass index, treatment site, and baseline type 2 diabetes mellitus. Results A total of 1,899 patients met inclusion criteria (915 female patients and 984 male patients; mean age 72.5 years). At one year, the cumulative GC exposure and composite toxicity was not statistically different between sexes. At three years, cumulative GC exposure was higher in female patients (4,419.5 mg prednisone equivalents compared to 4,106.2 mg in male patients, P = 0.042) as well as daily GC dose ( P = 0.037). Female patients had a higher incidence of fractures at three years (8.5% vs 3.2%, P ≤ 0.001) and incidence of giant cell arteritis (GCA; 7.6% vs 3.4%, P < 0.001). Conclusion The median cumulative GC exposure in patients with PMR remains high, with higher exposure in female patients. Female patients were more likely to experience fracture and the development of GCA within the same time frame. image

Background Sudden cardiac death (SCD) is the leading cause of duty‐related death among firefighters. Understanding postmortem cardiovascular abnormalities associated with SCD is critical to guiding fire service cardiovascular disease screening and prevention programs. Methods This study included US firefighters who had a duty‐related death over a 16‐year period (1999–2014) with available postmortem reports (autopsy/medical examiner reports). Cases were systematically reviewed to identify cases of SCD. For each SCD case, the primary etiology of SCD was adjudicated by experts in sports cardiology and cardiovascular pathology. Results Postmortem evaluations were available for 794 of 2100 (37.8%) on‐duty firefighter deaths over the study period (average age, 44±13 years; age range, 17–82 years; 4.0% women). A total of 312 of 794 (39.3%) firefighter deaths were adjudicated as SCD. A total of 255 of 312 (81.8%) SCD events were attributable to coronary artery disease/ischemic heart disease or hypertensive heart disease, which both are associated with traditional cardiovascular risk factors. The leading etiology of SCD among young firefighters (aged <40 years) was also coronary artery disease/ischemic heart disease (24/50 [48.0%]). Of firefighters who had an exertional SCD event thought to be secondary to coronary artery disease (n=97), a total of 62 of 91 (68.1%) had severe fixed coronary stenosis, while 29 of 91 (31.9%) demonstrated acute plaque rupture/thrombosis. Conclusions More than 80% of on‐duty SCD events among US firefighters are due to coronary artery disease and hypertensive heart disease that may be prevented by early disease identification and risk factor modification. Future studies should assess the efficacy of more rigorous firefighter cardiovascular disease screening and management practices.

Abstract Tumors of neuroendocrine origin are a heterogenous group of related neoplasms which can arise from anywhere in the body. Neuroendocrine neoplasms (NENs) are categorized by site of origin, differentiation status and grade (Ki‐67 expression and/or mitotic rate), with significant prognostic variability accordingly. Historically, the prevalence of bone metastasis is reported to be 6%–12% based on “first generation” (i.e., 111 Indium pentetreotide [Octreoscan®]) somatostatin receptor imaging (SSRI). We conducted a retrospective cohort study including patients with well‐differentiated NENs to determine the clinical and imaging characteristics of osseous metastases when evaluated with higher‐sensitivity 68 Gallium‐DOTATATE positron emission tomography (PET) scans, as well as determining fracture prevalence in selected sub‐cohorts. We also developed a risk score analysis to assess risk of fracture in this cohort. Four hundred twenty‐four patients were identified for inclusion. The median age was 61 years. Most patients were asymptomatic (64%), had sclerotic lesions (77%), Krenning 4 (71%), and had >3 sites (69%) of osseous disease. A high proportion of patients had osseous metastases at sites with high risk for fracture, including vertebra (82%), pelvis (63%), and peri‐trochanteric femur (34%). Fifty‐seven patients (13%) in the entire cohort suffered a fracture. Fracture prevalence was significantly lower in small bowel neuroendocrine tumors (NETs, 7%) and Grades 1 and 2 disease (8% and 9%, respectively), with higher prevalence in pancreatic NETs, paragangliomas/pheochromocytomas, lung carcinoid, and Grade 3 disease (≥20% for each; p ‐values <.05). Our study showed that the rate of osseous metastatic disease approximates 20% in well‐differentiated NENs. Most bone metastases are asymptomatic and the risk of fracture is variable based on the primary site of disease and tumor grade. Our novel risk score analysis for fracture was designed to assist clinician decision making as to management of bone metastasis in this patient population.

The Congenital Heart Surgeons’ Society (CHSS) is viewed by many as one of the most prestigious professional societies dedicated to pediatric and congenital cardiac surgery. The CHSS Center for Research and Quality (CRQ) Fall 2025 Work Weekend was held in Chicago on Saturday, October 25, 2025. The purpose of this article is to summarize the proceedings of the CHSS CRQ Fall 2025 Work Weekend and to provide a 2025 Annual Report of the CHSS CRQ. At the CHSS CRQ Fall 2025 Work Weekend, multiple topics were discussed related to ongoing CHSS research and quality initiatives. The CHSS CRQ is evolving to keep pace with the rapid evolution of medical informatics and the ever-evolving regulatory issues of clinical research. This 2025 Annual Report of the CHSS CRQ summarizes some of the ongoing initiatives at CHSS CRQ designed to assure that the CHSS CRQ continues to lead innovative and collaborative clinical research to improve pediatric and congenital cardiac care.

Abstract Background Lower extremity compression therapy has been proposed as an adjunct to mitigate diuretic resistance during acute decompensation of heart failure (ADHF). We evaluated the effect of lower leg compression with elastic bandages on diuretic efficiency in patients with diuretic-resistant ADHF. Methods Historical cohort study enrolling adult cardiac intensive care unit admissions with ADHF who used elastic bandages (EBs) at Mayo Clinic in Minnesota from 2007 to 2017. The diuretic efficiency before and after applying EB was the primary outcome. Results A total of 176 patients with heart failure who received elastic bandages were included. The in-hospital mortality rate, the median hospital length of stay, and 30-day hospital readmission were 9.7%, 11.4 days (interquartile range 7.1–19.0), and 11%, respectively. When EB was applied, the average daily loop diuretic dosage was decreased by a mean difference of 1.19 mg per 40 mg furosemide equivalent [95% confidence interval (CI): 0.22–2.2; P = .016]. The average post-EB diuretic efficiency was 1355 mL (interquartile range 1119–1590) per 40 mg furosemide, which was significantly higher than before EB application, with a mean difference of 340 mL per 40 mg furosemide equivalent (95% CI: −554 to −125; P = .002). A higher diuretic efficiency led to lower diuretic doses. Average daily urine output before and after EB application was not different (2642 pre-EB vs 2792 post-EB mL/day; 95% CI: −455 to 154; P = .33). Conclusion EB use enhances diuretic efficacy during ADHF. Further studies are needed to determine the potential clinical benefits and risks of applying EB compression treatment in ADHF.

Purpose: This study examined whether phoneme-level posterior probabilities generated by an articulatory-informed deep learning model (Phonet) can serve as interpretable and sensitive markers of articulatory impairment in motor speech disorders (MSDs). The goal was to determine whether these features distinguish individuals with and without MSDs and reflect varying severity levels of articulatory impairment. Method: A total of 676 participants (199 with MSDs, 477 without MSDs) completed a remotely captured word repetition task. Speech recordings were phonetically aligned, and posterior probabilities were extracted using a retrained version of the Phonet model, which estimates frame-level probabilities for 23 phonological classes. Segment-level posterior values were computed and compared across groups and severity levels using linear mixed-effects regression models. Results: Posterior probabilities were significantly reduced in the MSD group across all phoneme types. Within the MSD group, posterior probabilities decreased progressively with greater clinical severity, as measured by both perceptual sound distortion ratings and a cumulative articulation error score. Segment-specific analyses revealed systematic differences across phoneme classes, indicating that posterior probabilities capture distinct patterns of articulatory degradation associated with motor speech impairment. Conclusions: Phoneme-level posterior probabilities serve as interpretable, segment-specific indicators of articulatory impairment in MSDs. These features differentiate clinical status and reflect gradations of severity, making them promising tools for augmenting traditional perceptual speech assessments. Their linguistic transparency and scalability support future clinical applications in diagnosis, monitoring, and targeted intervention.