Debilitating Health Conditions Research Articles

Decoding pediatric spinal tumors: a single-center retrospective case series on etiology, presentation, therapeutic strategies, and outcomes

IntroductionSpinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST.MethodsWe conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients.ResultsThe study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy.ConclusionDespite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient’s neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.

Lifetime Trauma Exposure and Arthritis in Older Adults.

Experiencing potentially traumatic events across one's lifecourse increases risk for poor physical health outcomes. Existing models emphasize the effects of any lifetime trauma exposure, risk accumulation (multiple traumas over time), and sensitive periods of exposure (specific exposure timepoints leading to lasting consequences). We examined how different indices of trauma exposure across the lifecourse were associated with later life arthritis, a common and debilitating health condition. Data include 5717 Health and Retirement Study participants (age mean [standard deviation] = 65.4 [12.9] years) who reported on lifetime adversity and trauma in 2006-2008. Lifetime trauma exposure was modeled as any trauma, accumulation of traumas, and lifecourse profiles (no exposure, childhood only, adulthood only, childhood and adulthood exposure). Outcomes included prevalent arthritis at baseline and incident arthritis across 12 years of follow-up. Covariate-adjusted generalized linear models for prevalence ratios and Cox proportional hazards models for hazard ratios were conducted. Any lifetime trauma was associated with both prevalent arthritis at baseline (prevalence ratio = 1.13, 95% confidence interval = 1.05-1.22) and incident arthritis over 12 years (hazard ratio = 1.25, 95% confidence interval = 1.17-1.47). Greater trauma accumulation was significantly associated with both prevalent and incident arthritis. Childhood exposure was particularly strongly associated with prevalent and incident cases, with adulthood exposure being unassociated with incident arthritis. Across models, trauma exposure was associated with prevalent cases of both immune-related and osteoarthritis types. Higher lifetime trauma burden, especially during childhood, may predispose individuals to arthritis later in life. Early intervention or prevention efforts should identify trauma as an important risk factor for musculoskeletal health across the lifecourse.

Assessing the associations of 1,400 blood metabolites with major depressive disorder: a Mendelian randomization study.

Major Depressive Disorder (MDD) is one of the most prevalent and debilitating health conditions worldwide. Previous studies have reported a link between metabolic dysregulation and MDD. However, evidence for a causal relationship between blood metabolites and MDD is lacking. Using a two-sample bidirectional Mendelian randomization analysis (MR), we assessed the causal relationship between 1,400 serum metabolites and Major Depressive Disorder (MDD). The Inverse Variance Weighted method (IVW) was employed to estimate the causal association between exposures and outcomes. Additionally, MR-Egger regression, weighted median, simple mode, and weighted mode methods were used as supplementary approaches for a comprehensive appraisal of the causality between blood metabolites and MDD. Pleiotropy and heterogeneity tests were also conducted. Lastly, the relevant metabolites were subjected to metabolite function analysis, and a reverse MR was implemented to explore the potential influence of MDD on these metabolites. After rigorous screening, we identified 34 known metabolites, 13 unknown metabolites, and 18 metabolite ratios associated with Major Depressive Disorder (MDD). Among all metabolites, 33 were found to have positive associations, and 32 had negative associations. The top five metabolites that increased the risk of MDD were the Arachidonate (20:4n6) to linoleate (18:2n6) ratio, LysoPE(18:0/0:0), N-acetyl-beta-alanine levels, Arachidonate (20:4n6) to oleate to vaccenate (18:1) ratio, Glutaminylglutamine, and Threonine to pyruvate ratio. Conversely, the top five metabolites that decreased the risk of MDD were N6-Acetyl-L-lysine, Oleoyl-linoleoyl-glycerol (18:1 to 18:2) [2] to linoleoyl-arachidonoyl-glycerol (18:2 to 20:4) [2] ratio, Methionine to phosphate ratio, Pregnanediol 3-O-glucuronide, and 6-Oxopiperidine-2-carboxylic acid. Metabolite function enrichment was primarily concentrated in pathways such as Bile Acid Biosynthesis (FDR=0.177), Glutathione Metabolism (FDR=0.177), Threonine, and 2-Oxobutanoate Degradation (FDR=0.177). In addition, enrichment was noted in pathways like Valine, Leucine, and Isoleucine Biosynthesis (p=0.04), as well as Ascorbate and Aldarate Metabolism (p=0.04). Within a pool of 1,400 blood metabolites, we identified 34 known metabolites and 13 unknown metabolites, as well as 18 metabolite ratios associated with Major Depressive Disorder (MDD). Additionally, three functionally enriched groups and two metabolic pathways were selected. The integration of genomics and metabolomics has provided significant insights for the screening and prevention of MDD.

The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial.

Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001). According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.

Noma is a facial disfiguring childhood disease: Insights from cases of Noma in Ethiopia

ObjectivesNoma is a neglected infectious disease that causes severe destruction of facial tissues and poses a significant public health threat. The disease reportedly affects individuals with a debilitating health condition. This study aimed to identify the most vulnerable age group affected by Noma disease and assess the severity of tissue damage among Noma cases in Ethiopia. MethodsA cross-sectional study was conducted to determine the age group most susceptible to noma and assess the disease-associated severity of tissue damage. The research objectives were met by scrutinizing electronic medical records of noma cases treated in Addis Ababa, Ethiopia, from 2007 to 2019, obtained from the Facing Africa database. Data collection was carried out using a standardized survey form, while the severity of facial tissue damage was assessed using the NOIPTUS score. ResultsAmong 164 Noma cases with documented data on disease onset, 92.7 % occurred during childhood, with 92.1 % of those cases being children aged ten years and younger. Approximately 11.6 % of all noma cases had mild tissue damage, classified as NOITULP grade 1, while 26.2 % had an intermediate level of tissue damage, classified as NOITULP grade 2. Severe tissue damage (NOITULP grade 3) was present in 37.2 % of cases, while 25 % had very severe tissue damage (NOITULP grade 4). ConclusionsThe findings underscore the vulnerability of children, particularly those aged ten years and younger, to Noma disease, supporting the argument that Noma is a facial-disfiguring childhood disease. Targeted interventions and preventive measures during childhood can be vital in controlling Noma incidence.

Serum levels of interleukin-33 and mesencephalic astrocyte derived neurotrophic factors in patients with major depressive disorder: a cross-sectional comparative design

BackgroundMajor depressive disorder (MDD) is a debilitating health condition that has significant morbidity and mortality rates. Depression can be caused due to social, biological, environmental, psychological, and genetic factors. A few biological processes have been proposed as the pathophysiological pathways of depression. Neurotrophic factors and inflammatory cytokines have been linked to depression. Thus, we aimed to investigate the serum interleukin-33 (IL-33) and mesencephalic astrocyte-derived neurotrophic factor (MANF) in MDD patients and corresponding healthy controls (HCs).MethodThis study involved the inclusion of 129 MDD patients and 125 HCs matched by sex and age. A psychiatrist evaluated the study participants following DSM-5 criteria. The severity of the illness was assessed utilizing the Hamilton Depression Rating Scale (Ham-D). The serum concentrations of IL-33 and MANF were measured using enzyme-linked immunosorbent assay (ELISA) kits.ResultsThe mean serum levels of IL-33 were decreased (159.12 ± 6.07 pg/ml vs. 180.60 ± 8.64 pg/ml, p = 0.042), and the MANF levels were increased (5.40 ± 0.19 ng/ml vs. 4.46 ± 0.21 ng/ml, p = 0.001) in MDD patients when compared to HCs.ConclusionsThe current study proposes that lower IL-33 and higher MANF serum levels are associated with MDD progression and depression severity. These biomarkers could be used as risk assessment tools for MDD. We recommend more investigation, including a significant population, to determine the precise function of IL-33 and MANF in depression.

Physical activity has a stronger correlation with arterial stiffness than strength, balance, or BMI in an older population.

Background: Arterial stiffness is associated with an array of debilitating health conditions. While exercise typically has beneficial effects on both arterial stiffness and overall health, more research is needed to understand the associations of different types of fitness indices with arterial stiffness. Aim: To investigate the relationship between balance, strength, cardiovascular fitness and physical activity with arterial stiffness (as measured by pulse wave velocity (PWV)) in older adults. Method: Eighty retirement-village residents (24 males, 56 females, age: 78.2 ± 6.4years, weight: 69.4 ± 12.5kg, height: 162.9 ± 8.5cm) completed the Yale Physical Activity Survey, PWV measurement, 30-s sit-to-stand leg strength test, hand grip strength assessment, 4-stage balance test, and a 6-min walk fitness test. The number of exiting risk factors (smoking, previous heart incidents, previous stroke(s), having hypertension, or taking anti-hypertension medication) were tallied. Pearson's correlations were used to assess the relationship between PWV and health and fitness parameters. Results were interpreted using qualitative inference. Results: The number of risk factors (r = 0.57, p < 0.001), age (r = 0.51, p < 0.001) and systolic blood pressure (r = 0.50, p = 0.001) had strong, harmful associations with PWV. Total physical activity minutes/week (r = -0.31 p = 0.01), total energy expenditure Kcal/week (r = -0.30, p = 0.01), and the 6-min walk test (r = -0.29, p = 0.01) had a moderate, beneficial association with PWV, while sit-to-stand (r = -0.27, p = 0.02) and balance (r = -0.27, p = 0.01) had a weak, beneficial association with PWV. Hand grip strength (r = 0.02, p = 0.94) and body mass index (r = -0.04, p = 0.75) had no significant associations with PWV. Discussion: All measured fitness indices had beneficial associations with PWV. However, having more risk factors, increased age, and higher systolic blood pressure had significant (harmful) associations with PWV in our older population. Conclusion: Controlling cardiovascular risk factors, especially high systolic blood pressure, is likely to have the largest beneficial effect on PWV. Improving general physical activity, including walking capacity, may prove beneficial in improving PWV in an older population.

Predicting Exercise Behavior Among Caregivers of Persons With Dementia-A Longitudinal Investigation Using an Extended Health Belief Model.

Family caregivers of persons with dementia face an elevated risk of several chronic illnesses compared to their noncaregiver counterparts. Although exercise is a strong preventive measure for several debilitating health conditions, longitudinal research guided by theoretical frameworks has not identified how behavioral determinants predict exercise among caregivers. This study aimed to investigate how intrapersonal exercise determinants contribute to caregivers' exercise participation while accounting for social-contextual factors, including perceived caregiving burden and pandemic-related distress, by employing an extended Health Belief Model. The study was a longitudinal observational design. Community-dwelling older adult family caregivers of individuals with dementia (n = 127) were recruited with the support of a nonprofit organization. Participants completed measures of the Health Belief Model that also included dual process constructs (intention and habit), along with caregiving burden, pandemic-related distress, and exercise behavior across three consecutive months. Data were analyzed using a multilevel structural equation model with participants (Level 2) nested within time (Level 1). The model revealed direct effects of caregiving burden that debilitate perceived behavioral control, attitudes, threats, and worsen burden, in addition to hampering intention and habit when accounting for total effects. Pandemic-related distress exacerbated caregiving burden and weakened Health Belief Model constructs via total effects. These findings inform constructs to develop a community-based education program for family caregivers to successfully adopt and maintain exercise behavior. Incorporating supportive resources and coping strategies for caregivers of persons with dementia is needed to address the effects of behavioral deterrents.

Are positive clinical gains observed following physiotherapy treatment for persistent pelvic pain sustained to 12 months following programme completion? A follow up study

Introduction: Persistent pelvic pain is a common and often debilitating health condition, which is associated with significant healthcare costs. A three-treatment arm clinical trial investigating the impact of physiotherapy in the management of persistent pelvic pain demonstrated positive clinical outcomes, as measured at the conclusion of the programmes, in terms of pain score and pain impact. This study aimed to test the sustainability of the clinical gains observed through to 12 months post-programme completion. Methods: Participants who completed the clinical trial ( N = 66) were contacted as they neared the 12 months anniversary of the completion of their treatment programme. Returned data was collated and analysed against data obtained during the trial, allowing comparison pre-treatment, post-treatment and at 12 months following programme completion. Results: There were 24 returned outcome measurement documents, representing a 38% response rate. Of the three treatments arms piloted in the trial, one arm demonstrated further clinical improvement across a range of domains in the 12 months following treatment, while participants in the other two treatment arms returned data suggesting mild clinical decline. However, when comparing pre-treatment baseline data with data obtained at 12 months post treatment, all three treatment cohorts returned positive clinical gains across all measures. This effect was more pronounced in those who maintained three to six monthly contact with the department following treatment programme completion. Discussion: Physiotherapy treatment – either individual sessions, or a series of individual sessions coupled with group education ± group exercise – results in positive clinical gains from baseline assessment that are sustained through to 12 months following treatment programme completion. Universal trial number: U1111-1228-4810 ANZCTR.

Psychosocial burden and healthcare disillusionment in recurrent UTI: a large-scale international survey of patient perspectives

ObjectivesRecurrent UTI (rUTI) is a debilitating health condition that is associated with persistent mental, physical, and social burdens. People living with rUTI face inconsistencies in diagnostic testing and fragmented treatment pathways alongside their symptoms, which are likely to add considerably to their illness-related burdens. This study aimed to characterize the factors negatively impacting this population using the qualitative perspectives of people living with the condition.MethodsQualitative data were collected via free-text responses using an online survey hosted by an rUTI patient advocacy website. Female participants with self-reported rUTI (n = 1,983) described the factors that were most salient to their experience of living with the condition. Data were analyzed using a coding reliability approach to thematic analysis.ResultsTwo overarching themes were identified: (1) the patient burden of rUTI, which describes the multifaceted biopsychosocial impact of the illness, and (2) healthcare disillusionment, which describes patient dissatisfaction with healthcare received, both in terms of the treatments offered and communication with healthcare professionals. The patient burden of rUTI encompassed four subordinate themes: facing ongoing uncertainty; symptom salience; sex is not simple anymore; and perceived UTI stigma. Healthcare disillusionment included three subordinate themes: discomfort with frequent antibiotic use; fragmented treatment pathways; and devalued patient perspectives.ConclusionsThe findings demonstrated that ambiguity in the diagnosis of rUTI and inconsistencies in the subsequent treatment pathway are exacerbated by poor patient–clinician communication. The extent of the female-specific burden of rUTI symptoms confirmed the harmful effects of illness-related stigma. This novel qualitative reporting of rUTI symptom burden and life impact highlights the urgent need for increased patient-centered care for those living with rUTI. More effective rUTI management could have a major impact on treatment outcomes and patient-reported psychosocial wellbeing.

ComPAIN—Communication of Pain in Patients with Headache

Primary headaches are a common debilitating health condition. Proper diagnosis and treatment depend on patients’ communication. We wanted to explore differences in pain communication with a special interest in potential sex differences. Patients visiting our headache unit for the first time filled in two different questionnaires (one before entering the consultation and one directly after finishing the consultation), through which we captured patients’ descriptions of their pain, its potential impact on daily lives, the well-being of our patients and the satisfaction with our consultation. We included a total of 35 patients (22 female, 13 male). Women reported experiencing a greater loss of socially active days during the last 3 months because of headaches compared to men. Furthermore, women were more satisfied with our consultation. In addition, we revealed migraineurs characterize their pain differently than stated in the International Classification of Headache Disorders (ICHD-3) criteria. The adjective “pressing” (drückend) was used significantly more often by migraineurs compared to patients with tension-type headaches. Nevertheless, in the physicians’ written report, the characterization more often contained the ICHD-3 corresponding adjective “pulsating” (pulsierend). Since the typification of headaches and subsequent therapy depends predominantly on the patients’ communication, consideration of the individual pain description and further research on headache characterization are indispensable.

Deep transcranial magnetic stimulation alters resting-state neurophysiological traits in major depressive disorder

ObjectiveMajor depressive disorder (MDD) is one of the most prevalent and debilitating health conditions worldwide; unfortunately, many patients do not respond to traditional antidepressant medication or talk therapy approaches. Deep transcranial magnetic stimulation (Deep TMS) has emerged as an effective treatment option for such “treatment-resistant” cases; however, the mechanisms by which Deep TMS attenuates depressive symptoms are still ambiguous. MethodsIn the current study, resting-state quantitative electroencephalography (QEEG) measures were assessed pre-and-post treatment to illustrate neurophysiological changes resulting from Deep TMS. ResultsThe results showed reduced slow-frequency brain activity (delta and theta waves) in the prefrontal cortex following 36 treatments. Additionally, baseline QEEG measures predicted treatment response with 93 % accuracy. ConclusionsThese findings provide preliminary evidence that TMS improves depressive symptoms by mitigating slow-wave brain activity in the prefrontal cortex. SignificanceDeep TMS paired with QEEG should continue to be utilized for treatment of MDD in clinical practice and future studies should explore its potential for other neuropsychiatric conditions.

Fluocinolone Acetonide Enhances Anterograde Mitochondria Trafficking and Promotes Neuroprotection against Paclitaxel-Induced Peripheral Neuropathy.

Paclitaxel (PTX)-induced peripheral neuropathy (PIPN) is a debilitating health condition which is a result of degeneration of peripheral nerves found in extremities. Currently, there are no established treatment methods that can prevent or protect from PIPN. Fluocinolone acetonide (FA) has been recently identified as a potential candidate for protection from PIPN. However, the fundamental mechanism of action is still unknown. In this study, we showed that enhanced anterograde mitochondrial movement in dorsal root ganglion (DRG) cells has a major role in FA-mediated neuroprotection in PIPN. In this study, cells were treated with PTX or FA along with their combination followed by mitochondrial fluorescence staining. Somal (proximal) and axonal (distal) mitochondria were selectively stained using a microfluidic compartmentalized chamber with different MitoTrackers blue and red, respectively, which we termed, the two-color staining approach. Results revealed that axons were protected from degeneration by the PTX effect when treated along with FA. PTX exposure alone resulted in low mitochondrial mobility in DRG cells. However, cotreatment with PTX and FA showed significant enhancement of anterograde trafficking of somal (proximal) mitochondria to distal axons. Similarly, cotreatment with FA restored mitochondrial mobility significantly. Overall, this study affirms that increasing mitochondrial recruitment into the axon by cotreatment with FA can be a worthwhile strategy to protect or prevent PIPN. The proposed two-color staining approach can be extended to study trafficking for other neuron-specific subcellular organelles.

Comparison of Analgesic Efficacy between Epidural and Perineural Administration of Autologous Conditioned Serum in the Conservative Treatment of Low Back Pain Due to Lumbar Degenerative Disc Disease: A Randomized, Open-Label, Controlled Clinical Trial.

Lumbar degenerative disc disease (LDDD) is widely acknowledged as a significant contributor to low back pain (LBP), which is a prevalent and debilitating health condition affecting millions of individuals worldwide. The pathogenesis of LDDD and associated pain mechanisms are thought to be mediated by inflammatory mediators. Autologous conditioned serum (ACS, Orthokine) may be used for symptomatic treatment of LBP due to LDDD. This study aimed to compare the analgesic efficacy and safety of two routes of ACS administration, perineural (periarticular) and epidural (interlaminar), in the conservative treatment of LBP. This study used an open-label, randomized, controlled trial protocol. A group of 100 patients were enrolled in the study and randomly allocated into two comparative groups. Group A (n = 50) received the epidural (interlaminar) approach-2 ultrasound-guided injections as control intervention (each containing two doses of ACS-8 mL). Group B (n = 50) received the perineural (periarticular) approach-2 ultrasound-guided injections as experimental intervention at 7-day intervals (the same volume of ACS). Assessments consisted of an initial assessment (IA) and control assessments at 4 (T1), 12 (T2), and 24 (T3) weeks after the last intervention. Primary outcomes comprised Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Questionnaire (RMQ), and Euro Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L): Index, Visual Analogue Scale (VAS), and Level Sum Score (LSS). Secondary outcomes included differences between groups in specific endpoints for the above-mentioned questionnaires. In conclusion, this study revealed that both perineural (periarticular) and epidural ACS injections tended to perform in a very similar way. Both routes of Orthokine application show significant improvement in the primary clinical parameters, such as pain and disability, and therefore, both methods can be considered equally effective in managing LBP due to LDDD.

My experience with ME/CFS and implications: A personal narrative.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, debilitating health condition characterized by overwhelming fatigue and post-exertional malaise, or exacerbation of symptoms following physical, mental, or emotional exertion. ME/CFS often impacts every aspect of an individual's life, and one's new reality may be much different from the daily life experienced before the onset of the condition. Though the long-term effects of COVID-19 have brought increased attention to chronic fatigue and related disorders, ME/CFS is still vastly understudied and frequently misunderstood. People with ME/CFS are often passed between various healthcare providers as evidence-based treatments remain scarce. These patients are sometimes sent to rehabilitation professionals, who often lack appropriate education and experience with this patient population. This article describes the experience of a young woman and physical therapist with ME/CFS following COVID-19 infection, as well as potential implications for rehabilitation professionals and those who care for those with this condition.

Handgrip strength is a substitutive metric to the GLIM criteria-defined malnutrition and predicts long-term mortality among hospitalized patients with cirrhosis.

Hospitalized patients with cirrhosis are prone to debilitating health conditions and fluid fluctuations, posing barriers to accurately obtain anthropometric measures and physical examinations as surrogates for muscle mass within the Global Leadership Initiative on Malnutrition (GLIM). We hypothesize the handgrip strength (HGS) would serve as a substitutive metric, by comparing the diagnostic consistency and prognostic accuracy with computed tomography-demarcated skeletal muscle index (SMI)-defined malnutrition according to the GLIM criteria. Patients with cirrhosis underwent a two-step approach involving nutrition risk screening and those fulfilling GLIM consensus were further diagnosed. The evaluation of muscle mass as one constituent contained in the GLIM criteria was conducted by SMI and HGS, respectively. Consistency test, Kaplan-Meier curve, and multivariate Cox regression were used to assess the performance of GLIM-SMI and GLIM-HGS. Among 184 hospitalized patients with cirrhosis, 63 (34.2%) and 78 (42.4%) were diagnosed with malnutrition following GLIM-SMI and GLIM-HGS criteria, respectively. Considering the GLIM-SMI a gold standard, GLIM-HGS had a sensitivity of 87.3% and a specificity of 81.0%. GLIM-HGS criteria denoted good agreement (κ value = 0.858, P < 0.001) as compared with GLIM-SMI. Both criteria were independently associated with 1-year all-cause mortality, whereas GLIM-SMI showed slightly higher hazard ratios. Moreover, HGS positively correlated with SMI in the population alongside more pronounced correlation among patients at nutrition risk. HGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict long-term mortality among patients with cirrhosis.

Rural former service members participate in meaningful occupations to 'fill the void' after military service.

Over 50% of former service members report debilitating health conditions and difficulty adjusting to civilian life. Former service members living in rural areas are even more likely to experience poor health outcomes and have decreased access to specialist health-care services. Participation in meaningful occupations can support health and adjustment after military service. However, little is known about rural former service members' perspectives and experiences of participating in occupations after separating from military service. This study explored rural former service members' experiences of participating in occupations during their transition and their perceptions of how these experiences influenced their health and adjustment. Purposive sampling was used to recruit 10 rural former Australian Defence Force members discharged from service between 1 July 2013 and 1 July 2018. Former service members participated in a series of semi-structured interviews. Interpretative phenomenological analysis was used to determine themes for individual participants and then overarching themes that characterised the experiences of the group. A single overarching theme, 'It can't all be for nothing': Searching for ways to fill 'the void' through meaningful occupational participation, reflected rural former service members' experiences. The different ways that participants sought to fill 'the void' after military service were interpreted through two sub-themes: (1) 'You can't heal if you're still in a battlefield': Participating in occupations to re-establish safety and wellbeing, and (2) 'I was in a uniform and I could still do well': Participating in occupations to reconnect with self and continue the mission to serve. Rural former service members participated in various occupations to establish safety, wellbeing, and reconnection after transitioning from military service. The findings point to the need for further research to inform the development of consumer-led occupation-based interventions that are sensitive to individuals' service history, environmental context, and trauma recovery needs.

Unveiling the potential of melt electrowriting in regenerative dental medicine.

For nearly three decades, tissue engineering strategies have been leveraged to devise effective therapeutics for dental, oral, and craniofacial (DOC) regenerative medicine and treat permanent deformities caused by many debilitating health conditions. In this regard, additive manufacturing (AM) allows the fabrication of personalized scaffolds that have the potential to recapitulate native tissue morphology and biomechanics through the utilization of several 3D printing techniques. Among these, melt electrowriting (MEW) is a versatile direct electrowriting process that permits the development of well-organized fibrous constructs with fiber resolutions ranging from micron to nanoscale. Indeed, MEW offers great prospects for the fabrication of scaffolds mimicking tissue specificity, healthy and pathophysiological microenvironments, personalized multi-scale transitions, and functional interfaces for tissue regeneration in medicine and dentistry. Excitingly, recent work has demonstrated the potential of converging MEW with other AM technologies and/or cell-laden scaffold fabrication (bioprinting) as a favorable route to overcome some of the limitations of MEW for DOC tissue regeneration. In particular, such convergency fabrication strategy has opened great promise in terms of supporting multi-tissue compartmentalization and predetermined cell commitment. In this review, we offer a critical appraisal on the latest advances in MEW and its convergence with other biofabrication technologies for DOC tissue regeneration. We first present the engineering principles of MEW and the most relevant design aspects for transition from flat to more anatomically relevant 3D structures while printing highly-ordered constructs. Secondly, we provide a thorough assessment of contemporary achievements using MEW scaffolds to study and guide soft and hard tissue regeneration, and draw a parallel on how to extrapolate proven concepts for applications in DOC tissue regeneration. Finally, we offer a combined engineering/clinical perspective on the fabrication of hierarchically organized MEW scaffold architectures and the future translational potential of site-specific, single-step scaffold fabrication to address tissue and tissue interfaces in dental, oral, and craniofacial regenerative medicine. STATEMENT OF SIGNIFICANCE: Melt electrowriting (MEW) techniques can further replicate the complexity of native tissues and could be the foundation for novel personalized (defect-specific) and tissue-specific clinical approaches in regenerative dental medicine. This work presents a unique perspective on how MEW has been translated towards the application of highly-ordered personalized multi-scale and functional interfaces for tissue regeneration, targeting the transition from flat to anatomically-relevant three-dimensional structures. Furthermore, we address the value of convergence of biofabrication technologies to overcome the traditional manufacturing limitations provided by multi-tissue complexity. Taken together, this work offers abundant engineering and clinical perspectives on the fabrication of hierarchically MEW architectures aiming towards site-specific implants to address complex tissue damage in regenerative dental medicine.

"It's like a nail being driven in the ankle": A qualitative study of individuals' lived experiences with ankle osteoarthritis

Background: Ankle osteoarthritis is a debilitating health condition that is increasing in prevalence. Quantitative studies have shown that individuals with end-stage ankle osteoarthritis have a poor quality of life and experience similar physical and mental disabilities to those with end-stage hip OA as well as a range of comorbidities, such as radiculopathy, renal failure, and congestive heart failure. Despite the seriousness of ankle osteoarthritis, little is known about the impact of the condition from the perspective of individuals who have the condition.

Protocol for the development of a core domain set for individuals with ankle osteoarthritis

BackgroundAnkle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis—an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA.MethodsWe established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys.ConclusionThis protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms.Project registrationThis project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837.