Search Results (8,748)

Background/Objectives: Healthy longevity depends on not only lifespan but also the maintenance of physiological, metabolic, physical, and cognitive functions throughout aging. Identifying early determinants of health is crucial for preventing age-related decline. This narrative review aims to synthesize current evidence on how diet and specific nutrients relate to these early risk factors and indicators of healthy longevity. Methods: A review was performed to identify the links between dietary factors, energy balance, and gut microbiota composition and normal body weight; blood cholesterol, pressure, and glucose; healthy sleep; an active lifestyle; and normal physical function and cognitive performance. Particular attention was given to Mediterranean and other plant-based dietary models as sources of key nutrients. Evidence from observational studies, randomized controlled trials, and meta-analyses was considered. Results: Across all markers, dietary quality and nutrient adequacy emerged as consistent determinants of health outcomes. Key nutrients were associated with favorable cardiometabolic, cognitive, and musculoskeletal functions, such as omega-3 fatty acids, fiber, vitamins D and B, minerals like magnesium and potassium, and polyphenols. Common nutrition gaps included insufficient intake of fiber, unsaturated fats, and micronutrients, which was often linked to a shift toward less plant-based diets. Gut microbiota diversity may mediate several of these associations, influencing metabolism, inflammation, sleep quality, and cognitive performance, although inter-individual variability and causal pathways remain incompletely understood. Conclusions: An integrated dietary approach emphasizing the consumption of whole and plant-rich foods, with moderate amounts of animal foods, supports multiple early markers, risk factors, and indicators of healthy longevity. The modulation of the gut microbiota through plant-based diets and fermented foods represents a promising strategy for maintaining health across aging trajectories. Full article

Multiple myeloma (MM) develops through asymptomatic precursor stages characterized by progressive remodeling of the bone marrow (BM) immune microenvironment and disruption of bone homeostasis. To delineate changes in natural killer (NK) cell states during disease evolution, we investigated coordinated immune-tumor remodeling by integrating NK cell functional states with plasma cell-intrinsic susceptibility programs derived from CRISPR-based screens across healthy donors (HD), monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM), and newly diagnosed MM patients. The integration of NK cell state-associated gene signatures with plasma cell transcriptional programs revealed stage-specific co-variation between immune and tumor compartments. Public single-cell RNA sequencing datasets were interrogated to resolve NK cell heterogeneity, identifying cytotoxic CD56^dim and regulatory CD56^bright subsets. NK cell dynamics displayed stage-dependent changes, with early expansion followed by the contraction of CD56^dim cells in BM, whereas CD56^bright cells showed predominantly compositional remodeling. Within the CD56^bright subset, transcriptional changes included an increased expression of KLRC1 (encoding NKG2A), subsequently validated by multiparametric flow cytometry. In parallel, plasma cell programs associated with NK sensitivity progressively decreased along disease stages, supporting tumor adaptation to immune pressure. The NKG2A ligand HLA-E displayed selective expression within CD16⁺ monocytes and followed a distinct variable pattern across disease stages, highlighting a microenvironmental contribution to NK cell regulation. Collectively, these findings indicate a coordinated process of immune-tumor co-evolution, characterized by dynamic remodeling of NK cell states and plasma cell susceptibility, with the NKG2A–HLA-E axis emerging as a central interface during MM progression. Full article

Accurate assessment of the A1 pulley is essential for the diagnosis and treatment of trigger finger, particularly in ultrasound-guided percutaneous release. Although high-resolution ultrasound is widely used to evaluate pulley morphology, the validity of sonographic measurements of A1 pulley length has not been clearly established against anatomical reference standard. This study evaluated the reliability and validity of ultrasound for measuring A1 pulley length and thickness in human cadavers and assessed the reproducibility of A2 pulley length. Twenty fingers from five fresh-frozen cadaveric hands were examined. Two blinded expert musculoskeletal sonographers independently performed ultrasound acquisition and measurements of A1 and A2 pulley length and A1 pulley thickness, while a third blinded observer obtained anatomical measurements after meticulous dissection using a digital caliper. Ultrasound systematically overestimated A1 pulley length compared with anatomical measurements and showed very poor reliability (ICC = 0.05) with wide limits of agreement. In contrast, A2 pulley length showed high interobserver reliability (ICC = 0.83) and relatively better agreement with anatomical values, whereas A1 pulley thickness showed moderate reproducibility (ICC = 0.61). Overall, A1 length measurements showed substantial variability and limited agreement, while A2 length and A1 thickness appeared more consistent within this experimental setting. These findings should be interpreted within the limitations of a cadaveric model. Full article

Background: Periprosthetic joint infections (PJIs), a significant complication of total knee replacement surgery, are influenced by patient, surgeon, and healthcare system factors. Natural disasters can disrupt healthcare services and alter microbiological factors in the hospital environment. The impact of natural disasters on pathogen distribution in periprosthetic joint infection (PJI) is unclear. Therefore, this study investigated the association between the 2023 Kahramanmaraş-centered earthquakes in Türkiye and changes in microbiological patterns of PJI after knee arthroplasty. Methods: This retrospective cohort study included patients who developed PJI following total knee arthroplasty at the study center. The patients were divided into two groups based on the timing of their PJI diagnosis: pre-earthquake and post-earthquake. The demographic characteristics, comorbid diseases, and perioperative characteristics of each patient were recorded, and their microbiological profiles were analyzed. Logistic regression analysis examined the relationships between patient-related factors and causative agents. Results: 56 patients were studied and divided into two groups: 26 patients in the pre-earthquake group and 30 in the post-earthquake group. Furthermore, 79 bacterial isolates were obtained from these patients. Demographic, metabolic, and preoperative characteristics were similar between the two groups. No significant difference was found in the overall distribution of bacterial isolates. However, Gram-negative organisms, primarily Acinetobacter baumannii and Pseudomonas aeruginosa, increased in the isolate distribution after the earthquake. Patient analysis revealed that polymicrobial PJIs were significantly more frequent after the earthquake (56.7% vs. 23.1%; p = 0.011). Diabetes mellitus (DM) and smoking were associated with an increased risk of polymicrobial infection; the association was not statistically significant. Conclusions: In the post-earthquake period, patients who had undergone total knee arthroplasty and developed PJI showed a higher proportion of polymicrobial infections and a numerical increase in Gram-negative pathogens, along with more complex infection patterns compared to the pre-earthquake period. Although both patient groups demonstrated similar characteristics regarding patient-related and surgical factors, the observed changes indicate that the pressure on the healthcare system after a natural disaster can affect a hospital’s microbiological ecology. Identifying these indirect effects is crucial for guiding microbiological surveillance and infection control during post-disaster recovery periods, even for elective patients. Full article

In this study, we aimed to investigate the clinical characteristics of pulmonary cryptococcosis (PC) patients without acquired immunodeficiency disease (AIDS). In this retrospective study, a total of 101 patients with non-AIDS PC diagnosed at Tangdu Hospital between January 2014 and October 2025 were enrolled. The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, and clinical outcomes were analyzed. Univariate and multivariate logistic regression analyses were used to identify risk factors for cryptococcal meningitis (CM). Among 101 patients (mean age 53.13 ± 12.31 years; 66.3% male), 56.4% were asymptomatic. Underlying diseases were present in 55.4% (mainly hypertension and diabetes), and CM occurred in 17.8% (18/101). Patients with CM had a higher proportion of underlying diseases (83.3% vs. 49.4%) and lower levels of red blood cells, hemoglobin, total protein, albumin, globulin, and potassium. Multivariate analysis revealed underlying diseases (OR = 7.246, 95% CI: 1.426~55.33), hypoglobulinemia (OR = 0.847, 95% CI: 0.734~0.956), and hypokalemia (OR = 0.177, 95% CI: 0.028~0.778) as independent risk factors for CM. The combined model showed good predictive value (AUC = 0.863). Non-AIDS PC often presents asymptomatically. Patients with underlying diseases, hypoglobulinemia, or hypokalemia are at significantly higher risk for concurrent CM and warrant aggressive central nervous system evaluation. Full article

Background/Objectives: Anterior cruciate ligament reconstruction, often combined with anterolateral ligament reconstruction, requires accurate anatomical positioning of bone tunnels, which is a key determinant of surgical success. In current clinical practice, postoperative radiographs are routinely performed for both medico-legal and clinical purposes. The objective of this study is to analyze the content of early postoperative radiology reports following ACL ± ALL reconstruction and assess their clinical relevance regarding tunnel positioning, as well as the terminology used to describe surgical findings. Methods: A retrospective bicentric descriptive study was conducted, including 100 consecutive postoperative radiographic reports performed within two weeks after ACL ± ALL reconstruction. The primary outcome was the mention of bone tunnel positioning. Secondary outcomes included the reporting of joint effusion, surgical complications, fixation devices, and terminology used. All radiographs were independently reviewed by two experienced orthopedic surgeons. Results: Among the 100 reports analyzed, interpretations were performed by 60 different radiologists. None of the reports included an assessment of bone tunnel positioning based on validated anatomical criteria. Joint effusion was reported in 83% of cases, without specification of its physiological nature. In 22% of reports, bone tunnels were not mentioned. Terms such as “sequelae” or “stigmata” of ligament reconstruction were used in 50% of reports. No complications or surgical errors were identified upon independent radiographic review. Conclusions: Early postoperative radiology reports after ACL reconstruction appear standardized but often lack clinically relevant contextualization regarding tunnel-related technical aspects. Rather than advocating replacement of surgeon-led image review, our findings support clearer postoperative terminology and better contextualized reporting, including explicit acknowledgment when detailed tunnel assessment is not feasible on routine radiographs. Full article

The purpose of this study was to compare the rotational stability of cannulated compression headless screws (CCHSs) with cortical positional and lag screws in a simulated cadaveric feline sacroiliac luxation (SIL) model. Thirty-six cadavers of domestic short-haired cats were assigned to three groups. A unilateral SIL model was stabilized using either a single 2.5 mm CCHS, a 2.4 mm cortical positional screw (PS) or lag screw (LS), each engaging 60% of the sacral width. The pelves were mounted in a mechanical testing machine and loaded through the acetabulum to simulate ground reaction forces. Constant displacement was applied at 0.5 mm/s until maximal failure occurred. Yield load, ultimate load, stiffness, and failure modes were compared among the three groups. At the yield load, a statistical trend was observed among the groups, and pairwise comparison showed a significant difference between CCHS and PS. However, no significant differences were identified among the groups for yield load, ultimate load, or stiffness. All specimens failed due to screw loosening, and failure modes differed between CCHSs and cortical screws. Overall, CCHSs and cortical screws placed in a positional or lag fashion showed comparable rotational stability under the single load-to-failure conditions used in this feline SIL model. These findings question the biomechanical advantage of compression screws regarding rotational strength in unilateral feline SIL. Full article

Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (^99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide on the level of amputation, ^99mTc-MIBI scintigraphy should be considered. Methods: Prospectively, 24 patients with DFUs were included in the study. Based on treatment that started with the hospitalization, patients were divided into two groups: those whose DFUs healed and did not need surgical intervention (healed group) and those whose DFUs did not regress despite surgical and medical treatment and who required further surgical intervention (reoperation group). Before surgery, ^99mTc-MIBI scintigraphy was performed. The ^99mTc-MIBI uptake rates of the injured foot relative to the healthy foot were recorded. Deep-tissue culture was taken at surgery. Erythrocyte sedimentation rate, white blood cell count, and C-reactive protein (CRP) and albumin levels were measured. Results: The ^99mTc-MIBI uptake rates of patients with poor prognosis were higher at all times than those of patients who did not require revision surgery. A significant difference was found between these values in the 10 and 30 s rates. The mean ± SD CRP level was 86.04 ± 21.87 mg/dL in the healed group and 144.43 ± 27.54 mg/dL in the reoperation group (p = 0.040). There was a positive correlation between ulcerated foot and healthy foot ^99mTc-MIBI involvement rates at 10 and 30 s and CRP values, and a negative correlation between albumin values. Conclusions: There was a significant relationship between ^99mTc-MIBI involvement rates and poor prognosis and reamputation. The correlation between CRP and albumin levels, which are among the predictive values, and ^99mTc-MIBI uptake confirmed this relationship in DFUs, which are difficult to manage and treat. Full article

Background: This study aims to compare the quality, reliability, and readability of information provided by artificial intelligence-based language models, ChatGPT-5 and DeepSeek V3, regarding foot and ankle disorders. Methods: The quality, reliability, and readability of the texts generated by both AI models were analyzed using DISCERN, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), the Global Quality Score (GQS), and the CLEAR scoring system. DISCERN was used to assess information reliability, PEMAT-P to evaluate understandability and actionability, GQS to assess overall quality, and CLEAR to evaluate content quality and accuracy. Standardized questions were asked to both models for 35 different foot and ankle disorders, and the generated texts were evaluated by two independent orthopedic specialists using a blinded method. Readability analysis was performed using word count, the Flesch–Kincaid Grade Level (FKGL; required reading level), and the Flesch Reading Ease (FRE; ease of readability) scoring systems. Results: ChatGPT-5 scored significantly higher than DeepSeek V3 in DISCERN, PEMAT-P, GQS, and CLEAR evaluations (p < 0.05), indicating that ChatGPT-5 provides more reliable, comprehensive, and higher-quality information. DeepSeek V3 demonstrated better readability, producing simpler and more understandable content, as reflected in its lower FKGL score and higher FRE score. Conclusions: While ChatGPT-5 delivers more detailed and reliable health information, DeepSeek V3 offers simpler and more readable texts. Both models have distinct advantages for patient education. Future research should assess the impact of AI-generated health information on patient decision-making and its clinical application potential. Full article

Polyetheretherketone (PEEK) is widely employed in orthopedic applications due to its bone-mimetic mechanical properties and excellent biocompatibility, establishing it as a promising candidate for bone repair and regeneration. However, the investigation of structural integrity and microstructural features of PEEK implants has remained limited owing to its low atomic number (Z < 8) and hierarchical microstructure. This study presents a comparative characterization of PEEK implants by integrating laboratory X-ray computed tomography (CT) and synchrotron X-ray phase-contrast tomography (SXCT). Laboratory X-ray CT, operating on absorption contrast mechanisms, demonstrates adequate capacity for visualizing macroscopic defects and pore architectures, but exhibits limitations in resolving subtle density variations. In contrast, SXCT, employing phase-contrast imaging, significantly enhances discrimination of ultra-low-contrast features, including interconnected pore networks and localized density gradients. This work elucidates the complementary advantages and inherent limitations of both the imaging modalities for characterizing PEEK-based biomaterials. Furthermore, it demonstrates the potential extensibility of this comparative approach to other polymer composites, offering a methodology to investigate material–tissue interactions in orthopedic research and advancing the development of next-generation implantable devices. Full article

Articular cartilage defects affect millions of patients annually and pose one of the most persistent challenges in orthopedic surgery, owing to the tissue’s inherent avascular and alymphatic nature. Current surgical approaches, microfracture, autologous chondrocyte implantation (ACI/MACI), and osteochondral grafting, share a common failure mode: inadequate adhesion between repair constructs and surrounding native cartilage, contributing to deterioration rates of 15–75% at five-year follow-up across all techniques. This review repositions adhesion not as a supplementary material property but as the central determinant of clinical success in cartilage repair. We systematically evaluate the biomechanical demands imposed by the joint environment and define clinically relevant adhesion thresholds. Adhesive hydrogel strategies are categorized by surgical context: microfracture augmentation, ACI/MACI enhancement, osteochondral graft integration, and standalone repair platforms. Material platforms are analyzed across catechol/dopamine systems, NHS ester chemistry, photocrosslinkable hydrogels, supramolecular approaches, and multi-mechanism hybrids. Injectable formulations for arthroscopic delivery are critically examined alongside key translational barriers, including fatigue durability, biocompatibility–adhesion trade-offs, sterilization compatibility, batch variability, and regulatory classification ambiguity. Future directions encompass 4D bioprinting, AI-guided formulation optimization, and stimuli-responsive reversible adhesion systems. Adhesive hydrogels represent the missing link that current cartilage repair paradigms require. Full article

Background: Megaprosthetic reconstruction is the standard of care for limb salvage after tumor resection around the knee, but the full burden of unplanned revision surgery is rarely reported as a structured composite outcome. We evaluated 241 consecutive patients over 21 years at a tertiary orthopedic oncology center. Methods: This retrospective cohort included 241 patients (160 distal femur, 78 proximal tibia, three combined) treated between 2003 and 2024. Revision-free survival (RFS, composite of any unplanned revision or amputation) and amputation-free survival were estimated by Kaplan–Meier analysis; independent predictors were identified by Cox regression. A pre-specified major-event composite (amputation, implant removal, or recurrence resection) was used for sensitivity analysis. Results: Mean age was 34.9 ± 19.5 years; mean follow-up was 120.2 months. Negative resection margin (R0) was achieved in 85.5% (206/241). Unplanned revision was required in 25 patients (10.4%); overall limb salvage was 92.9%. Five-year RFS was 73.8% (distal femur) vs. 65.0% (proximal tibia; p = 0.084), and 5-year limb salvage was 88.9% vs. 84.3% (p = 0.081). Surgical margin was strongly associated with outcome: 5-year RFS 75.4% (R0) vs. 48.7% (R1/R2; p < 0.001); 5-year limb salvage 90.6% vs. 71.5% (p = 0.003). On exploratory multivariate Cox analysis, proximal tibia site and positive margin were associated with worse revision-free survival; within the proximal tibia subgroup, absence of gastrocnemius flap coverage was also associated with worse outcome (interpreted with caution given the small flap subgroup, n = 11, and limited event count). Conclusions: In this single-center series, megaprosthetic reconstruction around the knee achieved acceptable revision-free survival and limb salvage. Surgical margin status was the strongest independent predictor of both endpoints, reinforcing the well-established importance of oncologic margin quality and site-specific soft tissue strategies. Full article

Background: Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve entrapment neuropathy, with rising incidence in aging populations. Uncertainty persists regarding the efficacy and safety of carpal tunnel release (CTR) in patients aged ≥ 70 years. Objectives: To systematically evaluate the indications, clinical outcomes, and utility of CTR in elderly patients (≥70 years), with comparison to younger cohorts. Methods: Following PRISMA 2020 guidelines, PubMed/MEDLINE, Scopus, CENTRAL, Embase, Web of Science, and grey literature sources were searched from inception through September 2025. Two independent reviewers extracted data; inter-rater agreement was strong (κ = 0.81–0.86). The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using DerSimonian–Laird random-effects models. Certainty of evidence was assessed using the GRADE framework. Results: A total of 20 studies encompassing 3841 operated hands, including 1139 hands in elderly patients and 2702 hands in younger comparators across comparative studies, were analyzed. Mean SS-BCTQ improvement was 1.8 points (95%CI: 1.6–2.0; exceeding the established MCID of 1.04–1.05 points). FS-BCTQ improvement was 1.1 points (95%CI: 0.9–1.3; marginally below the pooled MCID of 1.13 points). Elderly patients demonstrated SS-BCTQ improvement of 1.7 points and satisfaction rates of 72–94%, comparable to younger cohorts (75–95%; p = 0.38). Grip strength improved 15–25% in younger patients but remained unchanged in elderly patients (p < 0.001). Sensory recovery reached 42% in elderly versus 58% in younger patients (p < 0.01). Complication rates were low and age-independent (3.1%; RR 1.08; 95%CI: 0.86–1.35; p = 0.52). GRADE certainty was as follows: low for symptom and functional improvement; very low for surgery versus conservative management. Conclusions: CTR is associated with significant symptomatic benefit in elderly patients when conservative treatment fails, with complication rates comparable to younger populations. Age alone should not constitute a surgical contraindication. Preoperative counseling must establish realistic expectations regarding grip strength and functional recovery. High-quality randomized trials in elderly populations remain an urgent research priority. Full article

Background: Standardized operating procedures (SOPs) for intravenous vancomycin therapy have been shown to improve population-level trough target attainment and to reduce nephrotoxicity in orthopedic inpatients. However, mean target attainment on a population level does not capture how stably an individual patient remains within the therapeutic window. Intra-individual variability of vancomycin trough concentrations has remained underreported as a patient-level quality indicator in the orthopedic stewardship literature, despite its direct clinical relevance, as alternating sub- and supratherapeutic phases compromise both efficacy and safety independently of the mean exposure. Methods: We conducted a secondary analysis of the prospectively and retrospectively collected data of the Halle Vancomycin SOP cohort. Pre-SOP (n = 58) and post-SOP (n = 23) patient cohorts were compared with respect to patient-level variability metrics, including the coefficient of variation (CV%), swing index, mean absolute successive difference (MSSD), range of trough values, zone-transition frequencies, and the proportion of “stable” patients defined as CV% below 20%. First-order Markov transition matrices were computed to characterize the directionality of trough movements between subtherapeutic, target, and supratherapeutic zones. The primary analysis was restricted to patients with at least three documented trough measurements. Results: The median CV% decreased from 43.5% (IQR 33.5–51.5) pre-SOP to 32.5% (IQR 21.9–38.6) post-SOP (Mann–Whitney U, p = 0.011). The swing index decreased from 1.09 to 0.75 (p = 0.002), and the median range of individual trough concentrations shrank from 19.1 mg/L to 13.2 mg/L (p = 0.029). The absolute number of zone transitions per patient did not differ significantly between cohorts, but their directionality differed substantially: target-zone persistence increased from 37.8% to 57.6%. Across all 403 measurements, subtherapeutic values declined from 38.5% to 26.6%, while target-zone measurements rose from 28.5% to 44.7%. In the post-SOP cohort, longer therapy duration was associated with lower CV% (Spearman ρ = −0.52, p = 0.032). Conclusions: In addition to improvements in population-level target attainment, implementation of the SOP was associated with stabilization of the individual exposure profile of orthopedic inpatients receiving intravenous vancomycin. Intra-individual variability was lower in the post-SOP cohort, and transitions between zones were more often oriented toward the target range. These findings, derived from a single-centre secondary analysis with a small post-SOP cohort, support patient-level variability metrics as a complementary quality indicator in protocolized vancomycin management and warrant prospective multicentre validation. Full article