Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis

Purpose: To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment. Methods: Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°-110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center-edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters. Results: Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R2: 0.08-0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12. Conclusions: Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.This study was funded by the University of Saint-Joseph (Grant No. FM300)

Is the apical vertebra the most rotated vertebra in the scoliotic curve ?

OBJECTIVE The aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment. METHODS A total of 158 patients with AIS (Cobb angle range 20°–101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed. RESULTS The distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001). CONCLUSIONS This study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases

How do 3D skeletal parameters and demographics determine kinematic adaptation from normal to fast speed gait?

The occurrence of falls during gait in elderly people is an important source of morbidity [1]. One of the useful screening tests for falls is the kinematic analysis of fast walking, that identifies subjects with risk of multiple falls [2]. Although the kinematic adaptations from normal to fast speed gait have been studied in asymptomatic adults [3], the demographic and skeletal determinants of these adaptations are still unknown

How does the variation of the 3D orientation of the acetabulum during walking influence hip kinematics?

Acetabular cup orientation is crucial for total hip arthroplasty (THA), and its malpositioning could lead to impingement and dislocation [1]. Acetabular cup orientation currently relies on static 3D hip parameters [2] and was shown to be related to changes in pelvic positioning [3]. While pelvic position varies during walking, it is still unknown how dynamic variation of hip orientation during gait could influence hip kinematics

The variation of lateral and posterior coverage of the femoral head by the acetabulum during walking influences stability during gait

1. Introduction Gait balance, assessed by the angle formed between the line joining the center-of-mass (COM) to the center-of-pressure (COP) and the vertical during gait, has been shown to be related to skeletal-postural and anthro- pometric parameters [1]. Although skeletal-postural parameters are mea- sured on standing radiographs, they are known to vary during gait. There are currently no studies evaluating how the variations of skeletal-postural parameters during gait influence subject’s balance during walking. 2. Research question How does the variation of skeletal-postural parameters during gait influence subject’s balance during walking? 3. Methods 72 asymptomatic subjects (age: 28.6 ± 11 years [18–59], 29F) underwent 3D gait analysis [2] with additional markers on the thighs and shanks. The COM-COP angle with the vertical was calculated in both the frontal and sagittal planes during the gait cycle [3] (Fig. 1). Subjects then underwent low-dose full-body biplanar X-rays with the markers still in place. 3D reconstructions were obtained for the spine, pelvis and lower limbs. 3D bones were registered at each frame of the gait cycle [4]. A new technique developed for this study, utilizing finite element modelling, was used to reduce soft tissue artefacts. Skeletal- postural parameters were then computed during the gait cycle, using the 3D registered bones, at each time frame (Fig. 2); mean, minimum, maximum and ROM were calculated on the waveforms during the gait cycle. In order to determine which varying skeletal-postural parameter during gait determined the variation of the COM-COP angles, univariate analysis (Pearson’s correlation) followed by a multivariate analysis (stepwise-multiple-linear-regression models) were computed; COM- COP parameters were the dependant variables and varying skeletal- postural parameters during gait were the independent variables. 4. Results Minimum (−14.2 ± 3.4°) and average (3.1 ± 1.6°) of the sagittal COM-COP angle were found to be determined by the minimum of the posterior coverage (post_cov) of the femoral head by the acetabulum during gait (β = 0.40; R2 = 0.16; p = 0.003 and β = 0.32; R2 = 0.1; p = 0.001,respectively).ROM(33.9 ± 5.1°)andmaximum (19.7 ± 2.8°) of the sagittal COM-COP angle were found to be related to the ROM (β = 0.29; R2 = 0.09; p = 0.03) and maximum (β = 0.34; R2 = 0.11; p = 0.006) of the acetabular abduction during gait, re- spectively. ROM of the frontal COM-COP angle (8.8 ± 2.51°) was found to be determined by the average of the post_cov (β = 0.51; R2 = 0.26; p = 0.004) during gait. 5. Discussion This is the first study to evaluate how the variation of skeletal- postural parameters during walking influences the stability during gait (Fig. 3). A less pronounced posterior coverage of the acetabulum during gait predisposes to more instability by decreasing the minimum COM- COP angle; a more pronounced acetabular abduction (decreased lateral coverage) during gait predisposes to more instability by increasing the ROM and the maximum of the COM-COP angle. Therefore, gait in- stability in the sagittal plane seems to be influenced by the variation of the posterior and lateral coverage of the femoral head by the acet- abulum during walking

How do 3D skeletal parameters influence kinetics?

Lower limb joints are subject to mechanical load during daily activities, such as gait, which is an important risk factor of osteoarthritis. Moreover, kinetics are known to be influenced by gait alterations in patients with osteoarthritis [1]. While skeletal parameters are known to determine gait kinematics [2], it is still unknown how skeletal parameters influence kinetic parameters

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Urinary microbiota and prostatic diseases. the key for the lock? A systematic review

Background Urinary microbiota is implicated in many diseases of the urinary tract. The aim of this study was to perform a systematic review of the role of urinary microbiota in prostatic diseases. Methods A PubMed/Medline search was undergone from inception through June 2022 for studies investigating urinary microbiota alterations in prostatic diseases, subdivided into benign prostatic hyperplasia (BPH), prostate cancer (PCa), and chronic prostatitis (CP). Study selection followed the PRISMA statement. Phylum, family, genus and species of each bacterium in cancer patients and controls were recorded. Quality of included studies was evaluated using the Critical Appraisal Skills Program (CASP) checklist for non-randomized studies. Results A total of 16 studies (4 studies on BPH, 9 studies on PCa and 3 studies on CP) comprising 1486 patients were included in our final analysis. Patients with BPH had a different urinary microbial composition, with a certain pattern proven to be associated with a higher lower urinary tract symptoms severity. Regarding PCa, some bacterial phyla/genera/classes/species were more abundant in PCa and others predicted a higher grade disease. In patients with CP, a different microbiota composition and a higher diversity were found, with the symptom severity being influenced mainly by microbiota composition, favoring aerobic microorganisms. Conclusion Urinary microbiota is implicated in prostatic diseases, especially in BPH, PCa and CP. However, given the relative heterogeneity among published studies, this implication suggests better delineation is needed. Further studies are needed to confirm these findings