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Management of Posterior Shoulder Instability Among Football Players
Full text linkPurpose of Review: Football players are at an increased risk for posterior shoulder instability compared to other sports due to certain sport-specific motions that involve posteriorly directed force on the shoulder in a vulnerable position. Management of posterior instability, both nonoperative and operative, is aimed at preventing recurrent instability. Regardless of treatment, timing of return to play revolves around avoiding reinjury and prioritizing player safety. This article provides a review of the current treatment modalities of posterior shoulder instability and the return to play criteria that must be met prior to releasing the player to competition. Recent Findings: Posterior shoulder instability was traditionally thought to occur predominately in offensive linemen. However, recent literature suggests it can also commonly be found in other players, including defensive linemen and quarterbacks. Current research reports high return to play rates for athletes that undergo arthroscopic posterior capsulolabral repair. Whereas, there is limited literature regarding return to play rates after posterior bony augmentation and management of reverse Hill-Sachs lesions. Rehabilitation and return to play protocols have been recommended but are nonspecific to American football. Summary: Posterior shoulder instability has the potential to sideline young athletes for an extended time and presents a complex challenge to both the athlete and the treating physician. Although the ultimate goal is to facilitate return to play, the physician must balance this with minimizing the risk of re-injury
Multi-Omic Spatially Resolved Analysis of the Neuroinflammatory Response to Intracortical Microelectrode Arrays
No full textIntracortical microelectrode arrays (MEAs) are devices implanted into the brain\u27s cortex with the ability to record or stimulate neuronal activity. Unfortunately, MEAs tend to fail over chronic time points, limiting their clinical utility. Chronic failure has largely been attributed to the brain\u27s neuroinflammatory response. Until recently, most of what was understood about the neuroinflammatory response to MEAs was learned through immunohistochemical analysis of small numbers of proteins. More recently, gene expression studies have sequenced thousands of mRNA molecules that contribute to neuroinflammation, but few studies have performed large-scale proteomic analyses. To expand the knowledge of molecular mechanisms involved, we have previously investigated the activity of 62 proteins within 180 μm of the MEA implant site using a spatial proteomic platform. In the present study, we are the first to apply large-scale genomics and proteomics to MEAs, as we evaluate changes in both the whole protein-encoding mouse transcriptome and our 62-protein proteomic panel. We further examine the spatial distribution of the neuroinflammatory response within three distinct domains adjacent to the MEA: 0–90 μm, 90–180 μm, and 180–270 μm from the implant site. Our analysis directly compares the gene and protein expression and highlights the need for segmentation based on proximal distance from the implant site. We also identify key pathways associated with immune cell activation, neurodegeneration, and metabolism that likely contribute to MEA failure and could be targeted to improve MEA performance in future studies
Association Between Combined Oral Contraceptive Prescription and Cervical Artery Dissection: A Retrospective Cohort Study
No full textBackground: To date, research has identified positive associations between combined oral contraceptives (COCs) and adverse vascular events, however, evidence regarding the possible association with cervical artery dissection (CeAD) remains limited. We tested the hypothesis of a positive association between COCs and CeAD within one year following COC initiation compared to matched controls initiating intrauterine devices (IUDs), as measured by risk ratio (RR). Methods: We queried de-identified United States health records data (TriNetX, Inc.) from 2014 to 2024 for females aged 15–50 years without previous cerebrovascular disease or CeAD, creating mutually exclusive cohorts initiating either COCs or IUDs. We used propensity matching to control for variables associated with CeAD. Our primary outcome included the RR for CeAD within one year follow-up. We secondarily explored cumulative CeAD incidence and RR of stroke, also examining outcomes for females with ≥2 COC prescriptions (COC2). Results: After matching there were 214,020 patients per cohort (mean age 31 years). The incidence and risk of CeAD was greater among those prescribed COCs compared to matched controls with IUDs [95 % CI] (COCs: 0.016 %, IUDs: 0.008 %; RR 1.94 [1.10,3.43]; P = 0.0195). A similar association was observed for stroke (COCs: 0.106 %, IUDs: 0.057 %; RR = 1.86 [1.49,2.32]; P \u3c 0.0001). The secondary COC2 analysis revealed similar findings. Conclusions: The present findings suggest that females prescribed COCs have an increased risk of CeAD and stroke compared to matched controls using IUDs. These observations should be viewed as preliminary, require corroboration by other studies, and in isolation do not replace the broader clinical and shared decision-making regarding contraceptive use
Sustained Release of Antifibrotic Nintedanib from Polymer Microparticles Reduces Dosing Frequency While Reducing Inflammation in Murine Idiopathic Pulmonary Fibrosis
No full textPurpose: Idiopathic pulmonary fibrosis (IPF) is a life-threatening, progressive lung disease with limited therapeutic options, often resulting in poor patient outcomes. Current treatments, such as Nintedanib (NTB) and Pirfenidone (PFD), require frequent administration, leading to adverse effects and low patient adherence. The purpose of this study was to investigate a sustained-release drug delivery system utilizing microparticles (MPs) composed of insoluble beta-cyclodextrin (β-CD) polymers to enhance the bioavailability and extend the release of NTB and PFD. Methods: A multidisciplinary approach, including in silico modeling, in vitro assays, and in vivo studies, was employed to assess the efficacy of β-CD-polymer MPs as drug carriers. Results: Molecular docking simulations and surface plasmon resonance studies demonstrated a stronger binding affinity of NTB to β-CD-polymer MPs compared to PFD, suggesting an extended delivery profile for NTB over PFD. Pharmacokinetic analysis in healthy mice confirmed sustained-release profiles for both drugs, with NTB maintaining therapeutic plasma concentrations for over 70 h. In a bleomycin-induced IPF mouse model, NTB-loaded β-CD-polymer MPs significantly reduced pro-inflammatory markers and required fewer injections than the standard daily NTB regimen. Conclusion: These findings indicate that β-CD-polymer MPs may serve as a promising platform for reducing dosing frequency of NTB and enhancing therapeutic outcomes in the treatment of IPF
A Toda Bracket Convergence Theorem for Multiplicative Spectral Sequences
No full textMoss’ theorem, which relates Massey products in the -page of the classical Adams spectral sequence to Toda brackets of homotopy groups, is one of the main tools for calculating Adams differentials. Working in an arbitrary symmetric monoidal stable simplicial model category, we prove a general version of Moss’ theorem which applies to spectral sequences that arise from filtrations compatible with the monoidal structure. This involves the study of Massey products and Toda brackets in a non-strictly associative context. The theorem has broad applications, e.g., to the computation of the motivic slice spectral sequence and other colocalization towers
Current Standards and Future Directions of Duchenne Muscular Dystrophy Respiratory Care: The PPMD Italy Meeting Report
No full textObjective: This report summarizes key discussions from the meeting “Current Standards and Future Directions of Respiratory Assessment and Management of Duchenne Muscular Dystrophy (DMD),” organized by Parent Project Muscular Dystrophy (PPMD) Italy and the United States to address current challenges and opportunities in DMD respiratory care. Methods: The meeting brought together researchers, clinicians, and patient advocates who shared experiences, discussed advancements in DMD respiratory management, and identified areas of debate that require further research. Results: The speakers emphasized routine assessment of pulmonary function and of breathing during sleep to achieve timely diagnosis of respiratory complications. Therapeutic discussions focused on airway clearance and assisted ventilation, highlighting noninvasive ventilation (NIV) as the preferred modality, even for advanced respiratory failure. The respiratory implications of new pharmacological therapies were discussed. The speakers endorsed the importance of cardiorespiratory outcomes in assessments of drug efficacy. To assess a drug\u27s clinical impact and to define current respiratory phenotypes, the trajectory of the absolute value of forced vital capacity (FVC) was proposed as a potentially better parameter than FVC percent predicted, which is favored in current drug studies. In regard to management of acute respiratory failure and perioperative situations, standards of care and areas needing future research were identified. Conclusion: In this meeting, many points of consensus emerged, as well as areas requiring further research. The necessity to involve patients and their families in all aspects of respiratory care was emphasized, as well as the need for patient centered outcomes in medical decision making and research
Novel Biomarkers of Fetal and Neonatal Environmental Exposure, Effect and Susceptibility
No full textAbstract: Rapid advancements in science and technology have allowed medical providers to treat wider ranges of diseases with safer and more effective therapies than ever before. One of the areas of health that has been consistently understudied, however, is one that affects us all: environmental health or the effects that the chemicals we are exposed to every day have on our acute and chronic health. This effect can be exacerbated during and shortly after pregnancy, as an individual exposure is often shared by both the mother and the fetus/neonate. The diagnosis and monitoring of chemical exposure can be quite challenging, and improving our understanding of the effects of exposure will therefore require effective use of an expanding set of biomarker tests and biological matrices. This review covers the background and history of neonatal biomarkers of exposure, effect, and susceptibility, focusing on the potential uses for the non-invasive matrix of exhaled breath for the detection and monitoring of chemical exposures. Impact: Provides a brief overview of Food and Drug Administration and National Institutes of Health Joint Leadership Council BEST (Biomarkers, EndpointS, and other Tools) Resource. Summarizes new and potential biomarkers for fetal exposure. Collates studies using breath as a matrix for environmental exposures
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