Current Concepts Research Articles

The Tibial Tuberosity-Trochlear Groove Distance Can either Increase or Decrease during Adolescent Growth.

Increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance is a risk factor for recurrent lateral patella dislocations (RLPD). Population-based cross-sectional studies on healthy subjects demonstrate that the TT-TG increases gradually during growth until skeletal maturity, but changes in the TT-TG distance during adolescence in patients with RLPD on an individual basis have not been previously investigated. This study aimed to measure changes in TT-TG distance during skeletal maturity. The TT-TG of 13 consecutive patients with open physes (mean age 13 years) with RLPD was measured on MRI at baseline and three years later. The change in TT-TG distance over the three-year period was measured. The mean change in TT-TG distance from the baseline to the three-year follow-up increased overall (2.9 mm, 95% Confidence Interval (CI) 2.1-3.7). However, the TT-TG distance could either increase or decrease during final growth. Our results suggest that the TT-TG distance in patients suffering from RLPD may either decrease or increase individually during the growth spurt. This contradicts the current concept that the TT-TG distance increases gradually during growth.

Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies.

Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.

Remarkably High Internal Transcribed Spacer Haplotype Diversity of the Fungal Select Agent Coniothyrium glycines Discovered Throughout Its Range in Sub-Saharan Africa.

Red leaf blotch of soybean, caused by the fungus Coniothyrium glycines, is a foliar disease characterized by blotching, necrosis, and defoliation that has only been reported from Africa. The species is listed as a Select Agent by the Federal Select Agent Program due to its potentially devastating impacts to soybean production should it spread to the United States. Despite its potential import, very few isolates are available for study. Herein, we obtained 96 new C. glycines isolates from six soybean-producing countries throughout sub-Saharan Africa. Along with 12 previously collected ones, we sequenced each at the internal transcribed spacer (ITS) region. Between all isolates, we identified a total of 28 single-nucleotide polymorphisms and 23 haplotypes. One hypothesis to explain the tremendous diversity uncovered at the ITS-which is generally conserved within a species-is that our current species concept of C. glycines is too broad and that there may be multiple species that cause red leaf blotch. Zambia contained the highest haplotype diversity, a significant fraction of which remains unsampled. Most haplotypes were specific to a single country, except for two, which were found in Zambia and either neighboring Mozambique or Zimbabwe. This geographic specificity indicates that the ITS region may be useful for identifying source populations or routes of transmission should this pathogen spread beyond Africa. The observed geographic partitioning of this pathogen is likely the result of millions of years of replication on little-studied native hosts, given that soybean has only been cultivated in Africa since the early 1900s.

Whole-body cryotherapy in orthopaedics: current concepts.

The use of whole-body cryotherapy (WBC) for musculoskeletal ailments is growing. WBC, involving brief exposure to extremely low temperatures, is increasingly used for its analgesic, anti-inflammatory, and antioxidant effects. The paper examines the physiological impacts of WBC on cardiovascular, musculoskeletal, hematologic, hormonal, and metabolic systems. Specific orthopaedic applications discussed include its role in the management of fractures, osteoarthritis, osteonecrosis of the femoral head, osteomyelitis, adhesive capsulitis, tendinopathies, rheumatic pathologies, chronic pain syndromes, and fibromyalgia. The study also highlights the benefits and drawbacks of WBC, including its potential to improve athletic performance, recovery, mood, and well-being, while noting risks like frostbite and impaired muscle strength. Clinical evidence from various studies is evaluated, revealing a spectrum of outcomes. For instance, WBC shows promise in enhancing bone health in athletes and providing relief in osteoarthritis and fibromyalgia patients. However, evidence for its efficacy in conditions like chronic pain syndromes and osteomyelitis is less robust. The paper underscores the need for further research to establish standardised protocols and understand long-term effects. While WBC offers significant benefits in orthopaedics, understanding its limitations and potential risks is crucial for its safe and effective clinical application.

Morphology of skin armament of the diadromous and freshwater sculpins (Actinopterygii, Scorpaeniformes, Cottidae) of Eurasia

The morphology of skin armament has long been studied in some of freshwater sculpins, but has not found wide use in the taxonomy of this group. To assess the taxonomic value and determine the patterns of variability of this character, alizarin-stained skin samples of 19 diadromous and freshwater sculpins from Eurasia and one ancient North American species, Leptocottus armatus, were examined for the morphology of prickles. Three morphological types of prickles were ascertained. The largest prickles with a wide basal plate having an uneven anterior edge and a short, strong spine should be considered as the ancestral state. On a series of prickles examined a successive process of reduction was revealed from the ancestral type to the prickles that represent a thin, elongated, fusiform spine extending from a barely visible rounded basal plate with a smooth anterior edge, usually specific for younger freshwater species. The types of skin armament are not strictly consistent with the current concepts on the phylogeny of the studied freshwater Cottidae in view of the phenotypic parallelisms in this group. It is tentatively indicated insignificant intraspecific variation of the prickles shape in Mesocottus haitej, Cottus amblystomopsis, C. czerskii, and C. volki. Identification of most species studied using a single prickle is quite a challenge, although some species are easily identified this way. The species-specificity of prickles is shown to be the greatest in deeply divergent lineages, providing the opportunity to use these structures for diagnosing species and revealing hidden species richness. The skin armament morphology may also become an accessible and useful tool for testing taxonomic, biogeographical, and evolutionary hypotheses.

Counterintelligence and escalation from hybrid to total war in the Russo-Ukrainian conflict 2014–2024

ABSTRACT This article examines certain counterintelligence (CI) aspects of the on-going conflict between Russia and Ukraine since 2014 in terms of key problems in current western CI concepts, doctrine and processes. It examines not only the CI threat to Ukraine during the Donbas ‘frozen war’ and 2022 invasion from the traditional CI triad of espionage, sabotage and subversion but also from Russian intelligence, surveillance and reconnaissance (ISR) capabilities and activities supporting both irregular and regular combatants. The article concludes that a UK and allied approach to CI shaped by a two-decade security focus on counterterrorism and counterinsurgency may not be fit for purpose in a contemporary strategic environment characterized by a persistent and escalating threat from strategic peers engaged in state-supported hybrid conflict.

Current Concepts in the Management of Sanfilippo Syndrome (MPS III): A Narrative Review.

Sanfilippo syndrome is a childhood-onset (1-4 years) autosomal recessive lysosomal storage disease that presents as a neurodegenerative disease by targeting the brain and spinal cord. It is also known as mucopolysaccharidosis III. Mucopolysaccharidosis III is divided into four subtypes (A, B, C, or D). It can cause delayed speech, behavior problems, and features of autism spectrum disorder. Sanfilippo syndrome is of a higher prevalence within consanguineous families that carry its gene alteration. If both parents have a nonfunctional copy of a gene linked to this condition, their children will have a 25% (1 in 4) chance of developing the disease. In Saudi Arabia, the incidence rate is estimated at2 per 100,000 live births. Recent research focused on promising treatment approaches, such as gene therapy, modified enzyme replacement therapy, and stem cells. These approaches work by exogenous administration of the proper version of the mutant enzyme (enzyme replacement therapy), cleaningthe defective enzyme in individuals with glycolipid storage disorders (substrate reduction therapy), or using a pharmacological chaperone to target improperly folded proteins. However, there is currently no approved curative medication for Sanfilippo syndrome that can effectively halt or reverse the disorder.

Current concepts in the diagnosis and management of acute pain in children

BACKGROUND: In children, injuries are the focus of attention both for the increasing incidence and necessity of pain management, and pain can be indicate the severity of injuries or serious complications that worsens the treatment results. Despite the obvious problem, information available in the literature regarding the theoretical and practical aspects of acute pain in children is often contradictory and needs to be systematized.
 AIM: To present current information about the epidemiology, physiology, diagnosis, and treatment of acute pain in children to pediatric orthopedic and trauma specialists.
 MATERIALS AND METHODS: Selective analysis and narrative review of relevant studies analyzing the epidemiology, diagnosis, and management of acute pain in children were performed.
 RESULTS: Although various pain assessment tools are available, the clinical assessment of acute pain in children remains challenging. The use of these tools depends on the child’s age, cognitive and communication skills, and pain location. The term oligoanalgesia has been used to describe inadequate pain relief in the emergency department. Oligoanalgesia in children has negative physiological and psychological effects, sometimes with long-term consequences, and may negatively affect their future pain experiences. Parents often underestimate their child’s pain level and have serious misunderstandings about how children express pain. The World Health Organization has developed recommendations for pain management in children. Ibuprofen and paracetamol are recommended as analgesics for mild-to-moderate pain in children aged 3 months. This choice considered extensive data on the effectiveness and safety.
 CONCLUSIONS: Personalized management strategies utilizing biopsychosocial approach will ensure that children are treated comprehensively according to their unique pain status.

Composite ZnFe2O4/SrWO4 hollow microspheres as catalyst for high-performance photo-Fenton degradation

Low degradation rate for a long degradation time and poor cycle stability caused by rapid recombination of generated electron-hole pairs are tough challenges for photo-Fenton degradation The unique microstructure catalyst can provide enough catalytic surface to prevent the recombination of electron-hole pairs and facilitate the barrier-free transport of active species. In addition, the special hollow microsphere structure can effectively accelerate the Rhodamine B (RhB) penetration and the photo-Fenton process. Introducing SrWO4 can increase oxygen vacancies and optimize the electronic structure of ZnFe2O4, thus enhancing electron transport and RhB degradation in the photo-Fenton process. This kind of catalytic material ZnFe2O4/SrWO4 (ZFO/SW) in the photo-Fenton process can effectively degrade the 99.18 % RhB dye only within 20 min with remarkable cycling stability. This work demonstrates the high efficiency of ZFO/SW as a photocatalyst and confirms the contribution of the current design concept to the development of photo-Fenton degradation materials.

Validity evidence of the use of quantitative measures of students in elementary mathematics education

AbstractQuantitative measures in mathematics education have informed policies and practices for over a century. Thus, it is critical that such measures in mathematics education have sufficient validity evidence to improve mathematics experiences for students. This article provides a systematic review of the validity evidence related to measures used in elementary mathematics education. The review includes measures that focus on elementary students as the unit of analyses and attends to validity as defined by current conceptions of measurement. Findings suggest that one in ten measures in mathematics education include rigorous evidence to support intended uses. Recommendations are made to support mathematics education researchers to continue to take steps to improve validity evidence in the design and use of quantitative measures.

Enhancing Privacy Measures in Healthcare within Cyber-Physical Systems through Cryptographic Solutions

INTRODUCTION: The foundation of cybersecurity is privacy, standardization, and interoperability—all of which are essential for compatibility, system integration, and the protection of user data. In order to better understand the complex interrelationships among privacy, standards, and interoperability in cybersecurity, this article explains their definitions, significance, difficulties, and advantages.
 OBJECTIVES: The purpose of this article is to examine the relationship between privacy, standards, and interoperability in cybersecurity, with a focus on how these factors might improve cybersecurity policy and protect user privacy.
 METHODS: This paper thoroughly examines privacy, standards, and interoperability in cybersecurity using methods from social network analysis. It combines current concepts and literature to reveal the complex processes at work.
 RESULTS: The results highlight how important interoperability and standardization are to bolstering cybersecurity defences and preserving user privacy. Effective communication and cooperation across a variety of technologies are facilitated by adherence to standards and compatible systems.
 CONCLUSION: Strong cybersecurity plans must prioritize interoperability and standardization. These steps strengthen resilience and promote coordinated incident response, which is especially important for industries like healthcare that depend on defined procedures to maintain operational security.

Atopic Keratoconjunctivitis: Pathophysiology, Clinic, and Potential New Therapeutic Concepts.

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease with a bipolar age distribution in childhood, adolescence and middle adulthood. Up to 50% of AD patients show ocular involvement, which can be potentially sight threatening. Clinically, the majority of cases present with atopic blepharo(kerato)conjunctivitis or atopic keratoconjunctivitis (AKC); other clinical variants from this group of inflammatory ocular surface diseases are keratoconjunctivitis vernalis in childhood and adolescence and allergic conjunctivitis. In addition to the aforementioned blepharitis, keratitis and conjunctivitis, AD is also associated with eyelid involvement with subsequent eyelid malposition, limbal insufficiency with the development of pseudopterygia, (chronic) cicatrizing conjunctivitis with symblephara formation and fornix shortening, as well as ocular surface malignancies such as conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma. In addition, an association with AD or AKC has been described for keratoconus. Whereas the therapy of AD in dermatology has made revolutionary advances in recent years through the use of biologicals, the primary use of these biologicals in ophthalmological complications is still very hesitant. Treatment here is often provided using topical steroids and calcineurin inhibitors. The following article summarises recent developments in basic and clinical dermatological research and discusses them in the context of current concepts for ophthalmological therapy.

ATUAÇÃO DA FISIOTERAPIA NA CAPSULITE ADESIVA DE OMBRO: REVISÃO DE LITERATURA

Adhesive Capsulitis affects the glenoid joint capsule, leaving this joint thick and inelastic, with loss of active and passive shoulder movements, in addition to pain and decreased range of motion. this article aims to analyze, through a systematic review, the techniques used by physical therapists available in the literature for the treatment of adhesive capsulitis. The purpose of this article is to bring together the most current concepts in physical therapy treatment for adhesive capsulitis. For this, we used Google Scholar, Virtual Health Library, Pubmed and Scielo as a search tool. It was possible to verify that physiotherapy has shown good results in the treatment of adhesive capsulitis, reducing pain and restoring range of motion to the affected patient.

Current Concepts in the Treatment of Giant Cell Tumor of Bone: An Update.

Curettage is recommended for the treatment of Campanacci stages 1-2 giant cell tumor of bone (GCTB) in the extremities, pelvis, sacrum, and spine, without preoperative denosumab treatment. In the distal femur, bone chips and plate fixation are utilized to reduce damage to the subchondral bone and prevent pathological fracture, respectively. For local recurrence, re-curettage may be utilized when feasible. En bloc resection is an option for very aggressive Campanacci stage 3 GCTB in the extremities, pelvis, sacrum, and spine, combined with 1-3 doses of preoperative denosumab treatment. Denosumab monotherapy once every 3 months is currently the standard strategy for inoperable patients and those with metastatic GCTB. However, in case of tumor growth, a possible malignant transformation should be considered. Zoledronic acid appears to be as effective as denosumab; nevertheless, it is a more cost-effective option. Therefore, zoledronic acid may be an alternative treatment option, particularly in developing countries. Surgery is the mainstay treatment for malignant GCTB.

Implementing Zero Impact Factories in Volkswagen’s Global Automotive Manufacturing System: A Discussion of Opportunities and Challenges from Integrating Current Science into Strategic Management

The current exceeding of six out of nine planetary boundaries requires a significant transition of human societies towards absolute sustainability. Industrial manufacturing systems were and still are an important motor for socio-economic development but at the cost of a significant negative impact on the biosphere. Current concepts in absolute sustainability and sustainable manufacturing provide solutions for sustainability transitions in industry, but various methodological, technical and procedural challenges arise during their adaptation in industrial practice. The development and operationalization of a “zero impact factory” strategy by Volkswagen Group has identified various implementational challenges, which are discussed in this article. First, an overview of motivations for “zero impact” transformations in industry are pointed out. Second, relevant aspects for the strategic management of sustainability transitions in manufacturing companies are highlighted based on a literature analysis. Third, the strategy development process is explained based on a systematic structure, which includes design-thinking principles for sustainability transitions of large technical systems such as factories in global manufacturing systems. Fourth, the developed strategy content is presented, including (1) the strategy vision, (2) the defined quantified “zero impact” goals, (3) a system model and a prototype of a zero impact factory, (4) the developed “Impact Points” and the “Site Checklist” methods (for evaluating the environmental transformation of a factory) and (5) the definition of processes for strategic management during strategy operationalization. Finally, various organizational challenges and opportunities are pointed out, which are considered novel insights from industrial practice and relevant for the science-based strategic management within automotive companies and other global industrial manufacturing organizations, as well for advancing sustainability concepts in applied industrial science.

Interferons and epigenetic mechanisms in training, priming and tolerance of monocytes and hematopoietic progenitors.

Training and priming of innate immune cells involve preconditioning by PAMPs, DAMPs, and/or cytokines that elicits stronger induction of inflammatory genes upon secondary challenge. Previous models distinguish training and priming based upon whether immune activation returns to baseline prior to secondary challenge. Tolerance is a protective mechanism whereby potent stimuli induce refractoriness to secondary challenge. Training and priming are important for innate memory responses that protect against infection, efficacy of vaccines, and maintaining innate immune cells in a state of readiness; tolerance prevents toxicity from excessive immune activation. Dysregulation of these processes can contribute to pathogenesis of autoimmune/inflammatory conditions, post-COVID-19 hyperinflammatory states, or sepsis-associated immunoparalysis. Training, priming, and tolerance regulate similar "signature" inflammatory genes such as TNF, IL6, and IL1B and utilize overlapping epigenetic mechanisms. We review how interferons (IFNs), best known for activating JAK-STAT signaling and interferon-stimulated genes, also play a key role in regulating training, priming, and tolerance via chromatin-mediated mechanisms. We present new data on how monocyte-to-macrophage differentiation modulates IFN-γ-mediated priming, affects regulation of AP-1 and CEBP activity, and attenuates superinduction of inflammatory genes. We present a "training-priming continuum" model that integrates IFN-mediated priming into current concepts about training and tolerance and proposes a central role for STAT1 and IRF1.

The one-step synthesis of Fe-N co-doped peony pod-based porous carbon for the removal of tetracycline

The peony pod is a component of the cash crop oil peony (Paeonia suffruticosa Andr.), it accounts for more than half of the quality of the peony seed. However, indiscriminate disposal leads to resource waste. In addition, the pollution caused by the overuse of antibiotics and the evolution of resistance have been a conundrum. There is an urgent need to find a pollutant removal method that conforms to the current concept of sustainable development. In this study, the biomass porous carbon (PCN,Fe-0.5) was prepared and modified by one-step synthesis method using the by-product peony pod as carbon precursor, urea as nitrogen source, and steel slag as magnetic material. The utilization of biomass waste solved resources waste caused by the unreasonable disposal of agricultural solid waste. The doped materials were cheap and easy to obtain, and they improved the structure and function of porous carbon. The maximum adsorption capacity of PCN,Fe-0.5 reached 726.4 mg·g−1 with 100 mg·L−1 of tetracycline (TC). The adsorption mechanism was summarized as pore filling, van der Waals force, π-π EDA, surface complexation, hydrogen bonding and chemisorption. A low-budget tetracycline (TC) removal method was explored through the investigation on the adsorption performance and recovery capability of PCN,Fe-0.5, which was also conducive to realizing the recycling of biomass waste and industrial waste.

Research progress on molecular mechanism of pyroptosis caused by Helicobacter pylori in gastric cancer.

Gastric cancer (GC) is a prevalent malignancy worldwide. Helicobacter pylori (H. pylori), a Gram-negative spiral bacterium, has the ability to colonize and persist in the human gastric mucosa. Persistent H. pylori infection has been identified as a major risk factor for ~80% of GC cases. The interplay between H. pylori pathogenicity, genetic background, and environmental factors collectively contribute to GC transformation. Eradicating H. pylori infection is beneficial in reducing the recurrence of gastric cancer and residual cancer. However, the underlying molecular mechanisms involved in GC remain incompletely understood. Additionally, H. pylori reshapes the immune microenvironment within the stomach which may compromise immunotherapy efficacy in infected individuals. Clinical eradication of H. pylori infection still faces numerous challenges. In this review, the authors summarize recent research progress on elucidating the molecular mechanisms underlying H. pylori infection in GC development. Notably, CagA protein-a carcinogenic virulence factor predominantly expressed by Asian strains of H. pylori-induces inflammation and excessive ROS production within gastric mucosa cells. Dysregulation of multiple pyroptosis signalling pathways can lead to malignant transformation of these cells. MiRNA-1290 plays a crucial role in GC initiation and progression while serving as an indicator for disease progression dynamics. Pyroptosis exhibits dual roles both promoting carcinogenesis and inhibiting tumour growth; thus it holds potential clinical applications for drug-resistant GC treatment strategies. Furthermore, pyroptosis may play a regulatory role within the immune system during gastric cancer development. Lastly, the authors provide an overview on current concepts regarding pyroptosis as well as insights into miRNA-1290's pathogenicity and clinical value within immune mechanisms associated with GC, aiming to serve as reference material for researchers.

Three-dimensional printed models for surgery planning of post-traumatic stiff elbow: Current concepts

The post-traumatic stiff elbow is a challenge for the surgeon, requiring expertise for the treatment choice and accurate planning. Stiffness can result from traumatic injury involving the periarticular soft tissues and the joint articular surfaces. In this article, we want to assess the impact of three-dimensional (3D) printed models in selecting the appropriate surgical strategy for this pathology.Six cases of increasing complexity regarding post-traumatic stiff elbow were submitted to four expert elbow surgeons who had the possibility to evaluate videos and reports of clinical examination, plain radiograms and CT with 3D reconstruction for each case.After a first treatment proposition given by the experts for each patient, a three-dimensional printed model of each elbow based on the CT was provided to the surgeons, asking them to evaluate again all the cases having the possibility to assess also the 3D models.In the four most complex cases all surgeons found more beneficial the use of three-dimensional representation for treatment planning and rate the risk of complications than the sole CT imaging with 3D reconstruction and many of them changed surgical strategy after analysing the model.3D printing technology is a useful tool in surgery planning for treating complex cases of post traumatic elbow stiffness, especially in the presence of joint deformity. Level of EvidenceIV

Current concepts in the aetiology, assessment and management of partial distal biceps tendon tears

Partial distal biceps tendon tears encompass a spectrum of disease. They can be either traumatic or degenerative in nature. Traumatic tears usually involve the short head. Degenerative tears can involve either or both short and long head components with the tear affecting the lateral fibres first. Chronic tears may be associated with a narrow radioulnar space, distinct head insertions and radial tuberosity hypertrophy. Patient history and clinical examination findings suggestive of partial tearing of the distal biceps tendon should be confirmed with advanced imaging. Magnetic resonance imaging allows assessment of the tear size, morphology and associated pathologies. Non-surgical management, including physiotherapy and injections, is appropriate in selected cases. Surgical management can involve either endoscopic or open techniques. In small tears or low demand patients, a simple debridement of the bursa, tuberosity and tendon may be indicated. In larger tears in higher functioning patients, release of the remaining fibres, debridement and an anatomical repair is indicated. In this review paper, the authors present current concepts on the pathogenesis and management of partial distal biceps tendon tears.