Search Results (20)

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

This study examines how South Korea’s 1970s Protestant democratization movement embodied Hans Joas’s concept of the “sacralization of the person” during the authoritarian Yushin regime. Challenging binary narratives of human rights origins as exclusively secular or religious, the research analyzes how Korean Protestant activists created institutions, rituals, and theological frameworks that infused human dignity with sacred character. The study demonstrates how religious actors effectively bridged religious and secular boundaries in human rights advocacy through historical analysis of the National Council of Churches in Korea’s Human Rights Committee, Thursday Prayer Meetings, and the development of Minjung theology. The findings reveal a distinctive process of sacralization that evolved from individual to collective understandings of human dignity, culminating in the radical Minjung Messiah theory. This case study illustrates how Joas’s affirmative genealogy operates in non-Western contexts, showing that sacralization emerges through dynamic interactions between religious conviction, historical events, and cultural transformation rather than through abstract reasoning alone. The Korean experience demonstrates that universal human rights gain moral force when diverse traditions collaborate to uphold human dignity across ideological divides. Full article

Intracranial aneurysm (IA) is a common cerebrovascular disease in which sacral aneurysms occurring in the Wills ring region can lead to devastating subarachnoid hemorrhage. Despite advances in research, the underlying mechanisms of IA formation and rupture remain incompletely understood, hindering early diagnosis and effective treatment. This review comprehensively summarizes the current landscape of IA biomarkers, encompassing genetic markers, DNA, RNA, inflammatory molecules, oxidative stress proteins, and extracellular matrix (ECM) components. Accumulating evidence suggests that various biomarkers are associated with different stages of IA pathogenesis, including initiation, progression, and rupture. Aberrant ECM composition and remodeling have been observed in IA patients, and extracellular matrix-degrading enzymes are implicated in IA growth and rupture. Biomarker research in IA holds great potential for improving clinical outcomes. Future studies should focus on validating the existing biomarkers, identifying novel ones, and investigating their underlying mechanisms to facilitate the development of personalized preventive and therapeutic strategies for IA. Full article

Background/Objectives: Instability is a major reason for revision after total hip arthroplasty (THA), and acetabular cup placement in the “traditional” safe zone does not protect against dislocations. Spinopelvic mobility may play a role in impingement and dislocation after THA. Personalized acetabular cup placement that incorporates spinopelvic mobility is currently lacking in the literature. Methods: The spinopelvic motion of 116 patients was evaluated during preoperative planning. All patients underwent radiological assessments with an anteroposterior pelvis radiograph in the standing and supine positions and a lateral view of the lumbar spine and pelvis in the standing and sitting positions. The pelvic incidence, pelvic tilt, sacral slope, standing anterior pelvic plane tilt, sitting anterior pelvic plane tilt, and lumbar lordosis angle were measured, and the degree of pelvic motion from standing to sitting was calculated. The development of the patient-specific target for the acetabular cup was based on the mean mobility of the whole group and the specific posture of each patient. Results: The average pelvic incidence was 51.0 ± 13.1 degrees, the sacral slope was 35.0 ± 10.3 degrees, the pelvic tilt was 16.0 ± 13.3 degrees, the standing anterior pelvic plane tilt was 3.4 ± 12 degrees backward, and the degree of lumbar lordosis was 39.5 ± 11.3 degrees. The mean spinopelvic mobility was 27.3 ± 13.4 degrees. The measurements had good to excellent interobserver and intraobserver reliability. On the basis of these measurements, we developed a novel algorithm for a patient-specific target for acetabular cup placement. Conclusions: the evaluation of spinopelvic mobility has good to excellent interobserver and intraobserver reliability and can be used for personalized acetabular cup placement. Full article

The African religiosity that permeates all human existence is driven by a consuming desire for connection with the spiritual world that provides and protects human flourishing. African neo-Pentecostal prophets (ANPPs) respond to this need by imposing themselves as the sacral agents that can connect people to God. The sacralisation of prophets leads them to personalise the church as their personal property. The question answered by this article is as follows: from a Christian soteriological perspective of Jesus as the only sufficient intermediary between God and humanity, how can we address the African need for connection with God that fosters a reliance on African neo-Pentecostal prophets and leads to the sacralisation of these prophets and the personalisation of the church? This article uses Christ’s redemption of believers to challenge ANPPs’ response to the African need for connection with God that leads to these prophets’ domination and exploitation of their followers. This article challenges ANPPs to promote the freedom of Christ’s redemptive work instead of sacralising themselves and personalising the church, which instils a religion of fear that keeps their followers subservient to prophets. The contribution of this article lies in assisting Christians, in this case the followers of ANPPs, to realise that sacralising the prophets provides grounds for these prophets to personalise the church. Therefore, Christ’s redemptive work should be affirmed and promoted as a means of protecting the church from being personalised by sacralised prophets. Full article

Background and Objectives: Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. Methods: We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, and pelvic osteosarcomas in children 0 to 21 years. Our analysis involved logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. Results: The study population included 207 patients. For vertebral osteosarcomas, 62.5% of patients were female, and 78.1% were white. Regional lymph node involvement predicted 80 times higher mortality hazard (p = 0.021). Distant metastasis predicted 25 times higher mortality hazard (p = 0.027). For sacral and pelvic osteosarcomas, 58.3% of patients were male, and 72% were white. Patients with residual tumor were 4 times more likely to have prolonged LOS (p = 0.031). No residual tumor (HR = 0.53, p = 0.03) and radiotherapy receipt (HR = 0.46, p = 0.034) were associated with lower mortality hazards. Distant metastasis predicted 3 times higher mortality hazard (p < 0.001). Hispanic ethnicity was linked to lower resection odds (OR = 0.342, p = 0.043), possibly due to language barriers affecting patient understanding and care decisions. Conclusions: In conclusion, our examination of NCDB offers a thorough exploration of demographics, treatment patterns, and results, highlighting the importance of personalized approaches to enhance patient outcomes. Full article

Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual’s sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of lumbar sagittal radiographic alignment and modeling variables to identify if these can discriminate between normal controls and CLBP patients. Methods: We conducted a computer analysis of digitized vertebral body corners on lateral lumbar radiographs of normal controls and CLBP patients. Fifty normal controls were attained from a required pre-employment physical examination (29 men; 21 women; mean age of 27.7 ± 8.5 years), with no history of low back pain, a normal spinal examination, no pathologies, anomalies, or instability. Additionally, 50 CLBP patients (29 men; 29.5 ± 8 years of age) were randomly chosen and matched to the characteristics of the controls. The inclusion criteria required no abnormalities on lumbar spine radiographs. The parameters included the following: ARA L1-L5 lordosis, ARA T12-S1 lordosis, Cobb T12-S1, b/a elliptical modelling ratio, sacral base angle (SBA), and S1 posterior tangent to vertical (PTS1). Two measures of pelvic morphology were determined for each person—the angle of pelvic incidence (API) and posterior tangent pelvic incidence angle (PTPIA)—and the relationships between API − ARA T12-S1, API − Cobb T12-S1, and API − ARA L1-5 was determined. Descriptive statistics and correlations among the primary variables were determined. The receiver operating characteristic curves (ROC curves) for primary variables were analyzed. Results: The mean values of LL were statistically different between the normal and CLBP groups (p < 0.001), indicating a hypo-lordotic lumbar spine for the CLBP group. The mean b/a ratio was lower in the chronic pain group (p = 0.0066). The pelvic morphology variables were similar between the groups (p > 0.05). API had a stronger correlation to the SBA and Cobb T12-S1 than PTPIA did, while PTPIA had a stronger correlation to the S1 tangent and ARA T12-S1 than API did. While CLBP patients had a stronger correlation of ARA T12-S1 and Cobb T12-S1 relative to the pelvic morphology, they also had a reduced correlation of ARA L1-L5 lordosis relative to their SBA and pelvic morphology measures. API − T12-S1, API − L1-L5, and API − Cobb T12-S1 were statistically different between the groups, p < 0.001. Using ROC curve analyses, it was identified that ARA L1-L5 lordosis of 36° and ARA T12-S1 of 68° have a good sensitivity and specificity to discriminate between normal and CLBP patients. ROC curve analyses identified that lordosis ARAT12-S1 < 68° (AUC = 0.83), lordosis ARAL1-L5 < 36° (AUC = 0.78), API − ARA T12-S1 < −18° (AUC = 0.75), API − ARAL1-L5 > 35° (AUC = 0.71), and API − Cobb T12-S1 < −5° (AUC = 0.69) had moderate to good discrimination between groups (AUC = 0.83, 0.78, 0.75, and 0.72). Conclusions: Pelvic morphology is similar between normal and CLBP patients. CLBP patients have an abnormal ‘fit’ of their API − ARAT12-S1 and L1-L5 lumbar lordosis relative to their pelvic morphology and sacral tilt shown as a hypolordosis. Full article

The reflection on sacred places continues to assume significant relevance today in urban space production. The public value of sacred buildings has consolidated over time an aggregating sense of community, representing spaces for meeting and sharing. Their historical relevance as spaces for meditation represents for mankind places of personal reflection, while they have always played an important role in the city and in its symbolic and spatial structure. Thus, starting from the hypothesis that the sacred space is affirmed as an interface, because it welcomes the individual and serves the community, we examine the architectural features that enhance this ambivalence, exposing transition systems between private and collective spaces, seeking to systematize essential composition matrices for new urban spaces for public use. Assuming Lisbon as a framework, this article proposes a comparative reading between two paradigmatic buildings—Sagrado Coração de Jesus Church and the New Mosque of Lisbon—with similar goals according to the relationship between architecture, place sacrality, and the urban public space. Methodologically, drawing is used as an interpretative tool and, through formal decomposition, this article tries to demonstrate that these buildings are the result of a reflection deeply determined by the value of the place’s identity in the city’s public space system. According to these case studies, sacred buildings are conceived based on formal and spatial links that are rooted in Lisbon’s urban layout. It is sacred buildings that are at the origin of urban places for public use. Each one of these buildings share an idea of architecture with an urban and public role which integrates the objects with the shape of the city and contradicts the tendency for the dissociation between urban elements. In a way, they can be considered paradigmatic examples of architecture with an urban vocation. Full article

Christian environmental ethics have always navigated the thin line between the Scylla of pantheism and the Charybdis of deism. On the one hand, removing God from the world avoids pantheism but can inadvertently render the divine a distant, absentee father who cares little about what we do with the environment. On the other hand, if we bring the Creator too close to creation, we may begin to blur the distinction between them, fringing on pantheism. While making nature divine might at first seem to heighten the environmental desecration of the earth by making it a literal de-sacralizing of the sacred, this may be only a surface-level reading (or, at least, only true of very carefully nuanced versions of pantheism). For the pantheist, God would not just be the trees but the machines that log them; God would not just be the polar bears but the carbon dioxide that is evicting them. God would be no more present in that which is desecrated than in that which does the desecration (e.g., God would be one with the pesticides, bulldozers, and factory smoke). By making God everything, it becomes difficult to call any person, act, legislation, or event godless. This paper offers Henry More’s view of divine space as a constructive, Platonic Christian middle way between these two extremes, charting a God who is spatially present to nature without being pantheistically reducible to it, in the same way that space is intimately close to the objects within it while nonetheless remaining distinct from them. The bulk of the paper counters potential opponents to this proposal, specifically defending Morean space from the charge that it would break down the Creator–creature distinction and/or cave to the environmental Scylla of pantheism. Full article

Books are complex objects. They have an undeniable material dimension, because they are artifacts characterized by a refined technology that has evolved over the centuries, and at the same time, they are vectors of intellectual products, consisting of the work(s) that they convey. However, books may also have a third dimension, since they embody the sacrality of a cult, belong to a performing rite, are offered to god(s) for the salvation of a soul, etc. Therefore, they incorporate an intrinsic sacredness for the simple reasons that they contain certain texts and are used on certain occasions to perform a certain rite. This paper explores the sacred aspect of Coptic codices and their third dimension, analyzing in particular the special case of books buried with a deceased person. Full article

We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a suspected isolated lymph-nodal pelvic recurrence. A positron emission tomography acquisition with contrast enhanced computed tomography (PET-CT) scan revealed an increased node at the level of the right external iliac (SUV 6.9) in correspondence with the obturator nerve, which was confirmed by transvaginal ultrasound. Since the recurrence was in a single site and the patient had previously undergone three lines of chemotherapy and maintenance with Poly(ADP-ribose) polymerase (PARP) inhibitors, we decided to perform tertiary cytoreductive surgery by minimally invasive laparoscopic approach. After gradual and careful isolation of the obturator nerve, lumbo-sacral trunk and venous vessels afferent to the external and internal iliac vein, the suspected node has been removed. No intra- and postoperative complications occurred. The patient was discharged three days after procedure. We decided to quarterly follow-up; actually, after 16 months no recurrence was detected. Several studies have reported ILNR as a unique clinical disease with low growth rate and less chemosensitivity; this can lead to considered ILNR more susceptible to take advantage of surgical treatment, even in case of second or third recurrence. The BRCA mutational status seems to play a role in the decision-making process in the approach to patients with platinum sensitive relapse of ovarian cancer or in specific isolated forms of recurrence such as the hepatic one. However, data on frequency and prognostic impact of BRCA gene mutation in ILNR are very limited. In this article we investigated the role of BRCA 1 or 2 mutational status in this rare pattern of recurrence according to more recent advances in literature. Full article

By attributing the term “charismatic” to Saint Louis, Jacques Le Goff identified two sources of charisma: sacred kingship and personal holiness. Without denying these aspects of the holy king’s reputation, we should investigate the nature of the charismatic relationship that linked Louis IX to his contemporaries. The sacrality of Louis IX pre-existed him; his sanctity is a post-death construction. What are the attributes of the living character that would allow us to recognize a charismatic personality? This paper argues that the religious aura of the king, which best echoes the Paulinian version of charisma, was sometimes at odds with the political expectations levied on a medieval ruler, which a Weberian definition of charisma helps to define. In this light, the crusades provided a unique setting where the king’s Christ-like qualities and his political leadership could be reconciled. To conduct this argument, this paper proposes to look for the symptoms of Louis IX’s living charisma in the reactions of his contemporaries, based on the re-examination of classical sources on the life of the king, carefully contextualized. Full article

Gait assessment is of interest to clinicians and researchers because it provides information about patients’ functional mobility. Optoelectronic camera-based systems with gait event detection algorithms are considered the gold standard for gait assessment. Yet, the choice of the algorithm used to process data and extract the desired parameters from those detected gait events has an impact on the validity and reliability of the gait parameters computed. There are multiple techniques documented in the literature for computing gait events, including the analysis of the minimal position of the heel and toe markers, the computation of the relative distance between sacrum and foot markers, and the assessment of the smallest distance between the heel and toe markers. Validation studies conducted on these algorithms report variations in accuracy. Yet, these studies were conducted in different conditions, at varying gait velocities, and on different populations. The purpose of this study is to compare accuracy, precision, and robustness of three algorithms using motion capture data obtained from 25 healthy persons and 21 psoriatic arthritic patients walking at three distinct speeds on an instrumented treadmill. Errors in gait events recognition (heel strike—HS and toe-off—TO) and their impact on gait metrics (stance phase and stride length) are reported and compared to ground reaction force events measured with force plates. Over the 9114 collected steps across all walking speeds, more than 99% of gait events were recognized by all algorithms. On average, HS events were detected within 1.2 ms of the reference for two algorithms, while the third one detected HS late, with an average detection error of 40.7 ms. Yet, significant variations in accuracy were noted with gait speed; the performance decreased for all algorithms at slow speed. TO events were identified early by all algorithms, with an average error ranging from 16.0 to 100.0 ms. These gait events errors lead to 2–15% inaccuracies in stance phase assessment, while the impact on stride length remains below 0.3 cm. Overall, the algorithm based on the relative distance between the sacral and foot markers stood out for its accuracy, precision, and robustness at all walking speeds. Full article

Background: The posterior trunk has been considered a challenging area to reconstruct following soft tissue tumor excision because of the shortage of local donor sites. The advent of innovative procedures such as perforator flaps has radically changed this perspective and offered a new approach to the problem. Methods: Upon a review of the literature and the personal experiences of the senior author, an algorithm is developed according to the most updated procedure, combined with more conventional options that maintain a role in decision-making. Results: The upper back latissimus dorsi and trapezium flap are still the most reliable approaches, while perforator flaps based either on the circumflex scapular arteries or the transverse cervical artery represent a more refined option. In the middle third, few indications remain for the reverse latissimus dorsi, while the gold standard is represented by local perforator flaps based on the posterior intercostal system. In the lower back, conventional VY advancement flaps are still a safe and effective option in the sacral area, and perforator flaps based on posterior intercostal arteries, lumbar arteries and superior gluteal arteries are the first choice in most cases. Conclusions: Using perforator flaps significantly improved soft tissue reconstruction in the posterior trunk. Full article

Fecal incontinence is a condition that carries high social stigmatization and a determining factor in the quality of life of the person who suffers from it. Its etiology is multifactorial and treatment includes surgical and conservative measures, including stimulation of the posterior tibial nerve. The aim of this review is to determine whether posterior tibial nerve stimulation (PTNS) is more effective than other treatments in reducing episodes of fecal incontinence in adults. A systematic review of randomized clinical trials that analyzed different approaches and comparisons with other treatments in adults without neurological or metabolic diseases was carried out, analyzing, fundamentally, the reduction of episodes of fecal incontinence. In general, a reduction in fecal incontinence episodes is observed in the experimental groups compared with the control groups, although these differences are not significant in most studies. The results regarding the effectiveness of PTNS in reducing episodes of fecal incontinence compared to other treatments are not entirely conclusive, although benefits are observed regarding the stimulation of sacral roots. More well-designed studies with a long-term follow-up of the results are needed so that the recommendation of this treatment can be generalized. Full article