Search Results (31)

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Local horse breeds, particularly cold-blood types, are often marginalized in economic and social contexts, primarily due to the neglect of their economic, genetic, and cultural potential, as well as their role in preserving the identity of rural areas, local communities, and ecosystems. The valorization of these breeds is a crucial prerequisite for their economic repositioning. The Croatian Posavina horse is a local breed, well adapted to harsh, extensive production systems. Its sustainability is achieved through pasture-based meat production, primarily targeting foreign European markets. Ensuring the sustainability of conservation programs requires a thorough understanding of growth dynamics, carcass traits, and meat quality. This study assessed growth performance and carcass characteristics in a sample of 30 male foals, with ten animals selected for detailed analysis of fatty acid, amino acid, and volatile aromatic compound profiles. At eleven months of age, the foals reached a live weight of 347 kg and a dressing percentage of 60.62%. Color, tenderness, and water-holding capacity parameters were favorable for consumers. The meat’s high protein content (22.37%) and low intramuscular fat (3.61%) make it suitable for health-conscious or sensitive consumer groups. A high proportion of polyunsaturated fatty acids (28.5%) and a nutritionally balanced ω-6/ω-3 ratio (3.46) highlight the meat’s functional properties. The essential-to-non-essential amino acid ratio (0.81) further supports its nutritional value. Sensory analysis confirmed an attractive appearance, desirable texture and flavor, and a rich aromatic profile. The carcass and meat quality results, when compared with the production traits of other horse breeds, indicate that Croatian Posavina foal meat is a high-quality and nutritionally valuable alternative to conventional red meat. With optimized conservation and production strategies, the Croatian Posavina horse holds strong potential for market repositioning within sustainable and functional meat production systems. Full article

Background/Objectives: Plantar fasciitis is the most common cause of heel pain, affecting 4–7% of the general population. Physiotherapy is a key component of conservative management. However, there is limited evidence on how physiotherapists in Saudi Arabia manage this condition. This study aimed to investigate current physiotherapy practices for plantar fasciitis in Saudi Arabia and assess their alignment with international clinical guidelines. Methods: A cross-sectional survey was conducted among licensed physiotherapists practicing in Saudi Arabia who had treated patients with plantar fasciitis. An online questionnaire, adapted from a validated UK-based survey, gathered data on participant demographics, service characteristics, diagnostic criteria, treatment goals, outcome measures, and intervention strategies. Descriptive statistics were used for analysis. Results: A total of 399 physiotherapists participated. Diagnosis was mainly based on clinical signs such as pain during plantar fascia stretch (72.9%), early morning pain (70.4%), and medial heel tenderness (69.4%). Common goals of intervention included pain reduction (93.4%), functional improvement (69.9%), and patient education (57.3%). Pain scales (74.9%) and functional tests (49.1%) were the most frequently used outcome measures. Interventions such as exercise therapy (92.0%), stretching (89.4%), and strengthening (84.7%) were widely used. More advanced modalities like shockwave therapy and dry needling were less frequently reported. Conclusions: Physiotherapy practices largely align with international guidelines. However, variation in outcome assessments and underuse of advanced modalities indicate the need for national clinical guidelines and targeted training programs. These steps may promote more consistent, evidence-based care and improve patient outcomes in Saudi Arabia. Full article

Introduction: Vertebral Compression Fractures (VCF) are the most common vertebral fractures, usually osteoporotic, with rising incidence. The natural history of VCFs-related pain remains unclear, and treatment protocols are still being evaluated, ranging from conservative to surgical. Patient-reported measures have been proven inaccurate and carry significant biases. This study examines maximal tenderness location (MTL) to palpation and percussion on physical examination during VCF healing and the postoperative period. Methods: A prospective study included 40 patients treated for VCFs per the NICE guidelines (2013) from 2019 to 2021. Treatment was either conservative (n = 12) or surgical (n − 28), Balloon Kyphoplasty (BKP). All patients’ MTL were recorded in EMR (Electronic Medical Record) on every visit. BKP was offered for severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management, progressive fracture collapse, or lack of union. Follow-up was six months. Pain evolution was analyzed using Kaplan–Meier survival curves, Log-Rank tests, Mann–Whitney U tests, t-tests, and logistic regression models. A p-value < 0.05 was considered statistically significant. Results: 12 patients were treated conservatively, and 28 underwent BKP for T12-L2 VCFs, accounting for 75% of fractures, mostly single-level fractures. All initially suffered MTL over the VCF; BKP patients showed local VCF pain resolution after 3.5 weeks following surgery while lasting seven weeks under conservative treatment. Lumbosacral pain was more prevalent following BKP (OR = 4, p = 0.05) and developed earlier. Conclusions: This study is novel in relating physical examination findings to fracture age and treatment provided, suggesting that VCFs-related pain is a time-related shift from local fracture pain to lumbosacral pain. Patient-reported pain scales may not reliably distinguish between these varying pain patterns. These findings suggest that only local VCF pain should be considered for surgical treatment. Future studies evaluating VCF outcomes should address physical examination and not rely solely on patient-reported metrics. Full article

Bamboo is a member of the Poaceae family and serves as an important economic resource with various applications, including reforestation, food production, and environmental conservation, due to its rapid growth and renewable nature. Among its various uses, bamboo shoots stand out for their tender texture and delicate flavor, making them a highly sought-after culinary delicacy in many cultures and a key ingredient in global food industries. Despite extensive research on the development of monopodial bamboos, studies focused on the developmental processes of sympodial bamboos, especially regarding their culinary potential, remain limited. This study conducted a comprehensive transcriptomic analysis of sympodial bamboo (Bambusa sp.) across six developmental stages (S1–S6) to uncover the molecular regulatory networks governing early bamboo shoot development. The results revealed that 1603 common differentially expressed genes (DEGs) across S1–S6 were enriched in multiple key pathways, with the most significant being plant hormone signaling, MAPK signaling, and Glycolysis/Gluconeogenesis pathways. Co-expression clustering analysis indicated that the Glycolysis/Gluconeogenesis pathway plays a crucial role during the later stages of bamboo shoot development (S5–S6), impacting its texture and flavor—two critical factors determining its culinary quality. Further Weighted Gene Co-expression Network Analysis (WGCNA) highlighted the significant role of the MAPK signaling pathway during early bamboo shoot development and identified key hub genes (MKK, MPK, MEKK) within this pathway, emphasizing their importance in cell division and hormonal coordination. This study provides valuable insights into the molecular mechanisms underlying the rapid growth and exceptional flavor of bamboo shoots and lays the foundation for the genetic improvement of bamboo as a sustainable and nutritious food source, enhancing its value as a premium food ingredient in the global market. Full article

Background and Objectives: Osteoporosis is becoming more prevalent with the rise in the aging population, leading to the increased use of bisphosphonates for treatment. While these medications are effective in preventing osteoporotic fractures, long-term use has been associated with atypical insufficiency fractures, primarily in the femur. However, atypical fractures in other weight-bearing bones, such as the tibia, have rarely been reported. This study aims to present a case of an atypical insufficiency fracture of the tibia in an elderly female who has been on long-term bisphosphonate therapy and to review treatment outcomes within the context of the current literature. Patient concerns: A 76-year-old female presented with pain in the proximal right tibia, developing two months prior without trauma. She had been receiving long-term bisphosphonate therapy for osteoporosis, initially taking sodium risedronate orally for 4 years, followed by intravenous ibandronate for 10 years. Physical examination revealed localized tenderness, and radiographs showed cortical thickening and a horizontal fracture line in the proximal right tibia. MRI confirmed these findings, along with surrounding edema. The laboratory results were mostly normal, but the bone formation marker osteocalcin was significantly reduced. The patient had a history of insufficiency fractures in the ipsilateral tibia and contralateral femur, previously treated conservatively with teriparatide. A similar conservative approach was attempted but failed, leading to surgical intervention with intramedullary nailing and supplementary plating. At the 8-month follow-up, the patient showed successful fracture union and resolution of symptoms. Conclusion: Long-term use of bisphosphonates, though effective for osteoporosis, can lead to atypical insufficiency fractures, primarily in the femur but also occasionally in the tibia. Clinicians should consider this possibility when patients present with pain in weight-bearing bones without a history of trauma. Prompt diagnosis through thorough history-taking, physical examination, and appropriate imaging is essential to ensure timely management. Full article

Quasipaa spinosa, commonly known as the spiny frog, is an economically valued amphibian in China prized for its tender meat and nutritional value. This species exhibits marked sexual dimorphism, most notably the prominent spiny structures on males that are pivotal for mating success and species identification. The spines of Q. spinosa exhibit strong seasonal variation, changing significantly with the reproductive cycle, which typically spans from April to October. Sexually mature males develop densely packed, irregularly arranged round papillae with black spines on their chests during the breeding season, which may then reduce or disappear afterward, while females have smooth chest skin. Despite their ecological importance, the developmental mechanisms and biological functions of these spines have been inadequately explored. This study integrates morphological, transcriptomic, and metabolomic analyses to elucidate the mechanisms underlying the seasonal variation in spine characteristics of Q. spinosa. Our results demonstrate that spine density inversely correlates with body size and that spine development is accompanied by significant changes in epidermal thickness and keratinization during the breeding season. Comparative transcriptomic analysis across different breeding stages revealed significant gene expression alterations in pathways related to extracellular matrix interactions, tyrosine metabolism, Wnt signaling, and melanogenesis. Metabolomic analysis further identified significant seasonal shifts in metabolites essential for energy metabolism and melanin synthesis, including notable increases in citric acid and β-alanine. These molecular changes are consistent with the observed morphological adaptations, suggesting a complex regulatory mechanism supporting spine development and functionality. This study provides novel insights into the molecular basis of spine morphogenesis and its seasonal dynamics in Q. spinosa, contributing valuable information for the species’ conservation and aquaculture. Full article

The Homeodomain leucine zipper (HD-Zip) family of transcription factors is crucial in helping plants adapt to environmental changes and promoting their growth and development. Despite research on the HD-Zip family in various plants, studies in Lagerstroemia (crape myrtle) have not been reported. This study aimed to address this gap by comprehensively analyzing the HD-Zip gene family in crape myrtle. This study identified 52 HD-Zip genes in the genome of Lagerstroemia indica, designated as LinHDZ1-LinHDZ52. These genes were distributed across 22 chromosomes and grouped into 4 clusters (HD-Zip I-IV) based on their phylogenetic relationships. Most gene structures and motifs within each cluster were conserved. Analysis of protein properties, gene structure, conserved motifs, and cis-acting regulatory elements revealed diverse roles of LinHDZs in various biological contexts. Examining the expression patterns of these 52 genes in 6 tissues (shoot apical meristem, tender shoot, and mature shoot) of non-dwarf and dwarf crape myrtles revealed that 2 LinHDZs (LinHDZ24 and LinHDZ14) and 2 LinHDZs (LinHDZ9 and LinHDZ35) were respectively upregulated in tender shoot of non-dwarf crape myrtles and tender and mature shoots of dwarf crape myrtles, which suggested the important roles of these genes in regulate the shoot development of Lagerstroemia. In addition, the expression levels of 2 LinHDZs (LinHDZ23 and LinHDZ34) were significantly upregulated in the shoot apical meristem of non-dwarf crape myrtle. These genes were identified as key candidates for regulating Lagerstroemia plant height. This study enhanced the understanding of the functions of HD-Zip family members in the growth and development processes of woody plants and provided a theoretical basis for further studies on the molecular mechanisms underlying Lagerstroemia plant height. Full article

Delayed hypersensitivity reactions (DHRs) have been reported in association with COVID-19 vaccines, particularly those that are mRNA-based. Classic DHRs result in induration, erythema, tenderness, and urticaria. However, soft tissue mass is an uncommon complication of a COVID-19 vaccination-associated DHR and is rarely reported in the literature. We present a case of a 49-year-old male who recognized a mildly painful, firm soft tissue mass within the biceps mimicking neoplasm six months after receiving the booster dose of the Moderna vaccine. Non-operative conservative treatment modalities, including heating pads, ice packs, acetaminophen, and ibuprofen, failed to improve the patient’s mass. The mass, which proved histologically to be an inflammatory pseudo-tumor, did not recur after complete excision. While there have been many reported cases of DHRs following COVID-19 vaccinations, we present this case to raise awareness of the development of pseudo-tumors as a possible, yet rare, clinical manifestation of DHRs following vaccination. Full article

Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco’s zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure. Full article

Background and Objectives: Schmorl’s nodes (SNs), formed by the herniation of intervertebral discs into adjacent vertebral bodies, are generally asymptomatic and do not require treatment. However, certain types of SNs can cause intractable back pain. Case Presentation: A 63-year-old man presented to our hospital with back pain after a fall 1 month prior. Physical examination revealed back pain that worsened with movement and paraspinal tenderness. Magnetic resonance imaging (MRI) performed immediately after presentation revealed subacute to chronic compression fractures with SNs at the upper endplates of the 11th and 12th thoracic and 1st lumbar vertebrae. Pain (numeric rating scale (NRS), 7–8/10) persisted despite 6 months of conservative treatment and MRI revealed increased signal intensity in T2-weighted images in the regions around the SNs. Based on these findings, an epidural nerve block was performed, and then repeated; however, no significant improvement was observed. Percutaneous vertebroplasty (PVP) was performed at the 11th and 12th thoracic and 1st lumbar vertebrae. Pain levels decreased substantially 1 week after PVP (NRS, 3–4/10). Subsequent treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids for two weeks further reduced pain levels (NRS, 1–2/10), following which steroid use was discontinued and NSAID use became intermittent. At the six-month follow-up, pain levels remained low and the patient reported an improvement in activity levels of 90% or more. Conclusions: This case report demonstrates that PVP safely and effectively improved symptoms in a patient with multiple SNs and intractable back pain. Nevertheless, further research, particularly large-scale randomized prospective studies, is necessary to validate the long-term efficacy and safety of this intervention. Full article

Local and typical agri-food products (TAP) are receiving increasing interest from consumers, since they are perceived as genuine, healthy and tasty because they are produced under environmentally friendly farming systems. This has aroused a renewed interest among breeders from the inner regions of Italy and Greece toward autochthonous animal populations, such as Greek Katerini and Italian Podolian cattle. Twenty animals were used, divided into two homogeneous groups of ten subjects per each genotype. Animals were fed only on natural pasture and were slaughtered at 18 months of age. Meat from the Katerini young bulls showed a lower a* value, higher moisture and was leaner, and its fat was richer in n-3 fatty acids and had a better n-6/n-3 ratio. Meat from Podolian young bulls was more tender and showed a higher redness value and a significantly greater MUFA concentration. This preliminary study provides a contribution to the local actors and relevant authorities to develop a conservation program for the endangered Katerini breed based on the nutritional and sensorial characterization of its products. Full article

Background and objectives: An accessory navicular (AN) bone is often classified into types 1–3 according to the Veitch classification, and symptomatic type 1 patients usually receive non-surgical treatment. However, there are cases in which AN cannot be classified into one of these three types using this classification system, and the small ossicle of type 1 AN may not be the cause of foot pain. This report aimed to present a case of symptomatic type 1 AN that required surgical treatment without the excision of the small ossicle after long-term conservative treatment had failed. Case presentation: A 15-year-old girl who was diagnosed with symptomatic type 1 AN was referred to our department. Medial-side foot pain had prevented her from playing soccer well. She had been treated conservatively for type 1 AN for more than 12 months at several orthopedic clinics. Tenderness of the prominent navicular tubercle was identified, and computed tomography and magnetic resonance imaging findings suggested that the cause of her foot pain was derived from the prominent navicular tubercle not the small ossicle itself. Osteotomy of the prominent navicular tubercle with the advancement of the tibialis posterior tendon, without excision of the ossicle, was performed. At the 12-month follow-up examination, she was completely free from foot pain, and the patient-reported outcome measures were excellent. She now plays soccer at the pre-injury level. Conclusions: We report the case of a patient with symptomatic type 1 AN who underwent osteotomy of the prominent navicular tubercle with advancement of the tibialis posterior tendon, without excision of the ossicle, and who showed favorable short-term clinical outcomes. The evaluation of symptomatic patients with AN based on the Veitch classification alone may lead to inappropriate management. The small ossicle of type 1 AN was not the cause of foot pain in the present case. Full article

Conservation duck flocks are of significant importance to science. Over a number of years, many experiments have been carried out to gain a better understanding of individual duck populations. However, the knowledge obtained is still incomplete. The aim of the present study was to compare three duck strains maintained in Poland and included in the Genetic Resources Protection Programme in terms of the fatty acid profile, health lipid indices, and sensory traits of breast and leg meat. The experimental material consisted of 180 sexed Pekin ducks, 60 ducks each (including 30 males and 30 females) from strain P33 (Pekin of Polish origin), P8 (Pekin of Danish origin), and P9 (Pekin of French origin). During 49 days of rearing, the ducks were kept in an enclosed building with six pens on straw. The duck genotype had a significant effect on the myristic (C14:0), palmitic (C16:0), oleic (C18:1n9), linolenic (C18:2n6), arachidonic (C20:4n6), monounsaturated fatty acid (MUFA), PUFAn6 content, and Peroxidisability Index (PI) values of breast muscle. Ducks from the compared strains differed significantly in C16:0 content and the proportion of unsaturated fatty acids (UFAs), including MUFAs, Nutritive Value Index, and Health-Promoting Index in leg muscles. Ducks from the compared strains also differed significantly in the aroma and juiciness of the heat-treated breast muscles and the tenderness of the leg muscles. The sex of the birds had a significant effect on the C18:1, C22:6n3, MUFA, PUFAn6, PUFAn3, PI, and aroma and taste desirability of the breast muscles, as well as the aroma intensity of the leg muscles. Full article