Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder characterized by the early development of pathological features associated with aging, ultimately leading to premature death. HGPS primarily affects tissues of mesenchymal origin, as evidenced by the clinical manifestations characteristic of this premature aging disorder, including, but not limited to, osteoporosis, muscle wasting, lipodystrophy, and cardiovascular disease. In this study, we used preclinical mouse models and both genetic and translational approaches to investigate whether an antiresorptive strategy, based on RANKL targeting, ameliorated the bone loss phenotype of progeroid mice. Here we show that osteocyte-derived RANKL deletion in the Zmpste24[-/-] mouse model of HGPS reverted bone loss in both long bones and vertebrae. These mice also exhibited increased grip strength and improved endurance capacity. Furthermore, Zmpste24[-/-] mice showed increased survival upon osteocyte-specific RANKL deletion. Notably, the use of a translational approach based on the administration of a neutralizing antibody against RANKL also restored bone mass, reduced muscle fibrosis, and extended the lifespan of Zmpste24[-/-] mice. Altogether, these findings support that targeting RANKL exerts a beneficial effect on both osseous and extra-osseous phenotypes of HGPS, suggesting the potential of this therapeutic approach to explore in the treatment of this disease.

Metallic ureteral stents provide excellent resistance to extrinsic compression, allowing for prolonged indwelling times; however, their extraction can be complicated by tissue ingrowth and mechanical failure. We report a complex case of a 33-year-old male with a history of bladder exstrophy, a Mitrofanoff appendicovesicostomy, and chronic kidney disease who underwent an antegrade percutaneous exchange of a right 6Fr metallic ureteral stent. During extraction, a sub-optimal grasp along the stent's shaft caused the rigid device to fold over itself and become wedged within the 8Fr working sheath, severely bending the stent. After the sheath was withdrawn, the proximal portion of the stent became embedded extra-renally within the subcutaneous fat. Standard endourological graspers lacked sufficient mechanical strength for extraction. A practical soft-tissue foreign body retrieval technique was employed under continuous real-time fluoroscopy, utilizing a robust curved artery forceps to successfully grasp and extract the metallic stent completely. This case underscores the technical challenges associated with the unique design of metallic stents, the importance of accurate proximal tip grasping, the necessity of appropriately sized working sheaths, and the utility of real-time fluoroscopy in managing retained percutaneous foreign bodies.

Synesthesia describes cross-over processes that can generate 'extra' conscious percepts, such as seeing additional color when reading numbers. While existing research focuses on the mechanisms and effects of synesthetic associations, it often overlooks its most distinctive feature: unique sensory phenomenology. Here, we introduce pupillometry as an objective physiological measure of synesthetic color phenomenology. Across 16 grapheme-color synesthetes and two matched control groups, pupil responses tracked the brightness of synesthetic colors under constant physical visual input, scaling with self-reported strength. Synesthetic colors elicited pupil dynamics comparable to real colors, dissociating synesthetes from non-synesthetes. These responses emerged too rapidly to reflect imagery and scaled with reported color brightness, revealing cross-over caused genuine perceptual processing. Controls required to generate color associations showed greater effort-linked pupil dilation than synesthetes or controls who did not report colors, providing evidence for the effortless nature of synesthesia. Synesthesia thus provides a tractable human model for studying physiologically measurable phenomenology.

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease associated with significant morbidity and impaired quality of life. Rapid advances in diagnosis, monitoring, and especially treatment over the past decade have increased the complexity of axSpA management and contributed to variability in clinical practice. To address this need, the Spanish Society of Rheumatology (SER) has developed an updated version of ESPOGUÍA, its clinical practice guideline for spondyloarthritis. This review summarizes the updated recommendations. A multidisciplinary panel (including rheumatologists, other medical specialists, nurses, physiotherapists, methodologists, and patients) formulated key clinical questions using the PICO framework. Systematic literature reviews covering the period 2018-2023 were conducted across major databases. Evidence quality and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. When evidence was insufficient, recommendations were formulated through a structured deliberative consensus process using the GRADE Evidence-to-Decision framework. Patient representatives actively contributed throughout the process, and the draft guideline underwent public consultation. ESPOGUÍA provides evidence-based recommendations for the management of adult patients with axSpA, focusing on pharmacological and non-pharmacological interventions. The guideline addresses the use of biologic and targeted synthetic disease-modifying antirheumatic drugs, prognostic factors for treatment response and radiographic progression, management of treatment failure, and strategies for treatment optimization, including dose tapering. Special attention is given to extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease, and psoriasis. Non-pharmacological approaches-including physical activity, smoking cessation, weight management, and nurse-led education-are emphasized as integral components of comprehensive care. ESPOGUÍA 2024 offers a comprehensive, evidence-based framework to support harmonized and patient-centered management of axSpA in Spain. By integrating recent therapeutic advances and multidisciplinary perspectives, the guideline aims to reduce variability in clinical practice, improve outcomes, and enhance quality of life for patients with axSpA, while also identifying key areas for future research.

Anterior cruciate ligament reconstruction (ACLR) is complicated by high failure rates in young, active individuals, which is associated with worse outcomes and higher rates of osteoarthritis (OA). Failure of ACLR limits activity, reduces quality of life and substantially increases socio-economic costs. Thus, strategies to reduce ACLR failure are imperative. In the STABILITY 1 trial, we showed that adding a lateral extra-articular tenodesis (LET) to ACLR with a hamstring tendon (HT) graft provided greater stability than HT alone (Relative Risk Reduction (RRR)=0.38; 95% CI 0.21 to 0.52; p<0001). Recent meta-analyses suggest patellar tendon (bone patellar tendon bone (BPTB)) grafts provide better stability than HT although with greater donor site morbidity. Recently, the quadriceps tendon (QT) graft has become popular, claiming similar stability to BPTB without donor site morbidity. However, no high-quality studies have shown it to be better and no study has determined if the reduced rate of ACLR failure seen with the addition of a LET to a HT graft is still present when using stronger, stiffer BPTB or QT grafts. Therefore, this study will evaluate whether in patients at high risk of rerupture, graft type (QT, BPTB, HT) with or without a LET offers a greater reduction in rate of clinical failure, better performance-based function and patient-reported symptoms, function and quality of life or higher rates of return to sport 2 years after ACLR. And does graft type±LET affect muscle strength recovery or increase the risk of donor site morbidity or lateral compartment articular cartilage degeneration? Do females, who are more often quadriceps dominant in their landing biomechanics, experience better outcomes if their ACLR uses a BPTB and/or QT autograft compared with a HT+LET autograft? Finally, is a particular graft type±LET a more cost-effective approach to ACLR?

Distal radius fractures (DRF) account for up to 18% of adult fractures, with malunion occurring in up to 25% of conservatively managed cases and 10% of surgically managed cases. Symptomatic malunion can lead to significant morbidity, including loss of forearm rotation, adaptive carpal instability, and arthritis. Corrective osteotomy is a key surgical intervention, yet there is no consensus on the optimal surgical approach, fixation technique, or necessity of bone grafting.

Highly soluble and mobile U(VI) renders rare-earth tailing uranium wastewater hard to remediate. Conventional reduction treatments demand extra energy, and show weak removal efficiency in strongly acidic conditions, restricting their practical application. Herein, we present a rationally engineered, self-assembled phytate-Fe-polyaniline (PA-Fe-PANI) composite that functions as an autonomous microscale redox reactor, enabling concurrent adsorption and catalytic reduction of UVI. The material leverages an intrinsic, self-sustaining Fe2+/Fe3+ redox cycle to drive the in situ reduction of adsorbed UVI to immobile tetravalent UIV without requiring any external energy input. PA-Fe-PANI shows outstanding uranium adsorption performance over pH 1.0-7.0, reaching a maximum capacity of 130.70 mg/g under the strongly acidic condition at pH 1.0. Tests on actual high-ionic-strength rare-earth tailings wastewater with complicated coexisting ions confirm the composite removes 96.8% uranium. This study develops an energy-neutral, scalable, and chemically stable approach to effectively immobilize uranium in strongly acidic complex industrial wastewater.

Exercise-induced reactive oxygen and nitrogen species (RONS) serve as crucial signaling molecules for training adaptation, mitochondrial biogenesis, and inflammatory resolution, rather than being mere markers of oxidative damage. Chronic or excessive high-dose antioxidant supplementation may suppress these vital redox-sensitive pathways. Consequently, this narrative review examines food-based antioxidant strategies as approaches for redox modulation, meaning support for recovery and redox homeostasis without indiscriminately suppressing exercise-induced redox signals that may contribute to training adaptation, while emphasizing the distinction between whole-food matrices and isolated supplements. A structured literature search was conducted across major electronic databases, including PubMed, Web of Science, Scopus, and SPORTDiscus. The search focused on intersecting themes of exercise physiology, redox biology, and sports nutrition. The reviewed evidence includes short-term human intervention studies, systematic reviews, meta-analyses, and mechanistic studies examining tart cherry, berries, pomegranate, cocoa, green tea, beetroot, extra virgin olive oil, and Mediterranean-style dietary patterns. Overall, the evidence suggests that these food-based strategies may influence recovery-related outcomes through mechanisms extending beyond direct radical scavenging, including inflammatory regulation, vascular function, and gut-derived metabolism; however, the strength and consistency of findings vary by food source, outcome, dose, timing, study population, dietary matrix, and bioavailability. Current literature does not support universal, fixed daily antioxidant use. Food-based strategies appear most appropriate during periods of elevated recovery demands, such as heavy training blocks, congested competition, muscle damage, or environmental stress. Food-based antioxidant nutrition should therefore be interpreted as a conceptual, evidence-informed approach to periodized and context-specific recovery support, rather than as a universal or evidence-graded guideline, because much of the available evidence derives from short-term and heterogeneous intervention studies. These strategies should complement foundational sports nutrition practices (energy availability, macronutrient distribution, hydration, and sleep) when balancing the preservation of long-term training adaptations with the need for acute recovery.

Background: Symptomatic malunion following distal radius fracture can adversely impact wrist function. Corrective osteotomy, utilising volar, dorsal or dual approaches, is a common treatment option. This study aimed to review the literature and compare the outcomes of these different surgical approaches. Methods: A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted, including studies comparing volar, dorsal or dual approaches in patients aged ≥16 years. Data on patient-reported outcome measures (PROMs), pain scores, grip strength, range of motion (ROM), radiographic alignment, graft use, union rates and complications were extracted and analysed via an exploratory network meta-analysis. Results: A total of 20 studies encompassing 517 wrists were included. All approaches demonstrated improvements in PROMs, functional outcomes and radiographic alignment. Analysis suggested comparable effectiveness of dorsal and volar approaches in improving ROM and pain. Dual approaches showed similar Disabilities of the Arm, Shoulder and Hand (DASH) scores to volar. No statistically significant differences were observed between approaches in improving radiographic alignment. Subgroup analysis revealed potential benefits of the dual approach over the volar for intra-articular malunions, particularly correction of radial inclination and ulnar variance. Conversely, the volar approach may be more effective than the dorsal in correcting ulnar variance in extra-articular malunions. Graft utilisation did not significantly impact union rates across any approach. Overall complication rates were low, but the dorsal approach exhibited a higher rate of hardware removal. Conclusions: This exploratory analysis found no definitive evidence to favour one surgical approach over another, though methodological limitations preclude firm comparative conclusions. Current evidence supports individualised approach selection based upon malunion configuration, patient factors and surgeon experience. Prospective comparative studies are needed to establish definitive comparative effectiveness. Level of Evidence: Level III (Therapeutic).