OBJECTIVE: We developed and evaluated the feasibility of a physiotherapist-led blended subacute-phase intervention. METHODS: In this mixed-methods feasibility study, participants were recruited from two emergency departments in Region Zealand, Denmark, within one week of acute knee trauma. They attended a weekly goal-oriented subacute-phase intervention combining progressive exercise, education, self-directed Acceptance and Commitment Therapy-based psychological support, and peer narratives delivered through a digital platform. Primary feasibility targets at 6 weeks were acceptability ≥75%, recruitment ≥5/month, retention ≥75%, and outcome completion ≥80%. Post-intervention interviews explored participant experiences and perceived value, expanding on the acceptability domain in an explanatory sequential mixed-methods approach. RESULTS: Twenty participants were enrolled (11 women, 9 men; median age 20 years), yielding recruitment of 2 participants/month. Sixty-seven per cent of participants attributed important improvement due to study participation. Fourteen participants (70%) completed the subacute-phase intervention, and 60% completed 6-week outcomes. Eight interviews revealed high perceived value through early support, meaningful rehabilitation, and promotion of future knee health. CONCLUSION: Although predefined quantitative feasibility criteria were not met, the intervention showed clinical promise and high participant value. Recruitment and retention barriers highlight the need for alternative early-care delivery pathways.

Melioidosis is an infection caused by Burkholderia pseudomallei with varied clinical manifestations, particularly in patients with diabetes mellitus. Hepatic involvement usually occurs as part of multifocal disease, while a solitary liver abscess is uncommon. We report a 49-year-old man with poorly controlled type 2 diabetes mellitus who presented with fever and right upper quadrant pain. Ultrasonography showed a right lobe liver abscess, and empirical treatment with ceftriaxone and metronidazole was started. Despite treatment, he developed persistent fever, increasing leukocytosis, hypotension, metabolic acidosis, altered mentation, and acute painful swelling of the left knee. Contrast-enhanced computed tomography showed a solitary multiloculated liver abscess measuring 5.3 × 3.8 × 3.2 cm with a honeycomb appearance. Percutaneous drainage was performed, and culture of the liver abscess grew Burkholderia pseudomallei. Ultrasound-guided aspiration of the knee yielded purulent hemorrhagic fluid with a leukocyte count of 35,000/mm[3] and low glucose. Gram stain and culture of the joint fluid were negative, and the findings were considered consistent with culture-negative septic arthritis associated with melioidosis. The patient was treated with intravenous ceftazidime with marked clinical improvement within 36-48 hours, followed by oral trimethoprim-sulfamethoxazole eradication therapy. He remained clinically well at approximately one-year follow-up. This case highlights that melioidosis should be considered in patients with diabetes with a solitary liver abscess, particularly when there is poor response to empirical therapy and evidence of another infective focus.

Human leukocyte antigen B*27 (HLA-B*27) is a major risk factor for autoimmune diseases such as axial spondyloarthritis (axSpA), acute anterior uveitis (AAU), and psoriatic arthritis (PsA). HLA-B*27 presents bacterial and self-antigens to disease-associated CD8+ T cells, however, how this leads to a pathogenic IL-17-mediated disease remains unclear. We performed mutational experiments in an established disease-associated TCR and demonstrated that the pathogenic motif encompasses a wider range of TCR sequences than previously appreciated. We next leveraged computational pairing of alpha/beta TCR sequencing (TCR-seq) to demonstrate that the broadened pathogenic motif distinguishes axSpA and AAU patients from healthy controls. Paired single-cell RNA sequencing and single-cell TCR sequencing datasets demonstrated that the pathogenic cells have a distinct transcriptional signature. We find a coupling of pathogenic TCRs to this transcriptional signature in public datasets from axSpA and PsA joint fluid and AAU ocular fluid. Finally, we detect the pathogenic CD8+ T cells in the gut and demonstrate that they express a Type 17 program. Our findings suggest that HLA-B*27+ axSpA, AAU, and PsA are initiated by HLA-B*27-restricted pathogenic CD8+ T cells that undergo Type 17 differentiation in response to intestinal antigens.

The lymphatic system comprises a network of tissues and organs that plays a significant role in supporting immune function by removing toxins, waste products, and excess materials from the body through lymphatic fluid. The system removes fluid and protein from the extracellular space and interstitium, thereby helping maintain appropriate osmotic balance. Acute inflammation produces changes within the lymphatic system as the body responds to injury or infection and attempts to preserve physiologic homeostasis. See "Physiology, Lymphatic System" for further information. Dr. Andrew Taylor Still placed substantial importance on the lymphatic system when developing the foundational tenets of osteopathy. In his book The Philosophy and Mechanical Principles of Osteopathy, he asserted that "We (humans) suffer from 2 causes: want of supply and the burdens of dead deposits." Dr. Still recognized the importance of lymphatic function in clearing detritus that could contribute to disease. Contemporary medicine recognizes lymphatic failure as a contributing factor in the development of chronic conditions. Inflammation represents a normal homeostatic response to injury or infection and reflects the body's attempt to promote healing. Substantial quantities of cytokines and other inflammatory mediators are released to signal and recruit appropriate immune cells. Lymphatic drainage plays an essential role in removing these inflammatory markers and supporting resolution of the inflammatory response. Understanding lymph formation and removal from the interstitium represents a crucial physiologic principle underlying osteopathic treatment. Osteopathic philosophy emphasizes the importance of lymphatic drainage in rheumatoid arthritis, in which immune complexes form and contribute to substantial inflammatory exudates. These exudates can produce pain and joint tissue destruction, while studies have demonstrated increased lymph production and drainage in affected patients. Dysfunction within the lymphatic system and related structures may contribute to lymph accumulation, diminished immune responses, fat accumulation, tissue swelling, and connective tissue accumulation. Among the factors that can restrict lymphatic drainage, somatic dysfunction represents one of the more readily addressable contributors. Osteopathic manipulative treatment (OMT) addresses somatic dysfunction by enhancing neuromuscular connections, improving biomechanical balance, reducing pain, and increasing range of motion. Although many bodywork professionals use techniques that may appear similar to OMT, physician-performed OMT incorporates extensive knowledge of anatomy and physiology, allowing osteopathic physicians to tailor treatment according to each patient's individual physiologic conditions. OMT encompasses a range of techniques specifically designed to increase lymphatic flow. Other techniques were not developed specifically for lymphatic treatment but may contribute to lymphatic management when clinicians apply a comprehensive understanding of human anatomy. Clinicians must remain attentive to structures that can impinge on lymphatic vessels, including fascia, muscles, ligaments, and other areas of somatic dysfunction. Many OMT techniques can address a broad range of clinical conditions, including disorders involving the lymphatic system. Despite physiologic and clinical evidence supporting the role of lymphatic manipulation in modulating inflammation and maintaining fluid balance, many clinicians under-recognize appropriate indications for lymphatic OMT, contributing to gaps in care and underutilization of this therapeutic approach.

This study describes a standardized ultrasound-guided double-needle lavage technique for acute calcific periarthritis of the hand and reports its technical feasibility and preliminary clinical outcomes. Five consecutive patients underwent ultrasound-guided percutaneous lavage. Clinical characteristics, affected joint, calcification size, sonographic features, complications, and visual analog scale (VAS) scores at baseline, 1 week, and 1 month were recorded. Four cases involved the metacarpophalangeal joints, whereas one involved the interphalangeal joint. Mean calcification size was 14.4 ± 6.0 mm. All deposits were mature and showed no posterior acoustic shadowing. Mean VAS decreased from 8.8 ± 1.8 at baseline to 0.4 ± 0.5 at 1 week and 0.2 ± 0.4 at 1 month, corresponding to mean pain reductions of 94.2% and 96.7%, respectively. No complications occurred. Ultrasound-guided lavage appears feasible, safe, and minimally invasive, providing rapid and substantial pain relief. Larger prospective studies are needed to confirm these preliminary findings.