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IMPORTANCE: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. OBJECTIVE: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. MAIN OUTCOMES AND MEASURES: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). RESULTS: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = −0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = −0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

Radiography is the appropriate initial imaging modality to assess for midfoot and forefoot pathology before turning to advanced imaging techniques. While most lesions of the mid- and forefoot can be diagnosed clinically, the exact nature and severity of the pathology is often unclear. This review addresses the use of the ultrasound, as well as the added value of magnetic resonance imaging, in diagnosing conditions of the midfoot and forefoot. Ultrasound allows a dynamic assessment as well as enabling imaging-guided interventions for diagnostic and therapeutic purposes. Practical tips for optimal examination of this area with ultrasound and magnetic resonance imaging are provided. Metatarsal stress fracture, Chopart’s injury, Lisfranc injury, as well as the 1stmetatarsophalangeal joint injury and lesser metatarsophalangeal plantar plate injury are injuries unique to the mid- and forefoot. The imaging anatomy of the 1stand lesser metatarsophalangeal joints is reviewed, as such knowledge is key to correctly assessing injury of these joints. Characteristic imaging features of masses commonly encountered in the mid- and forefoot, such as ganglion cyst, Morton neuroma, gouty tophus, plantar fibroma, foreign body granuloma, and leiomyoma are reviewed. The use of ultrasound and magnetic resonance imaging in assessing degenerative and inflammatory joint disorders, and in particular rheumatoid arthritis, of the mid- and forefoot region is also reviewed. In summary, when necessary, most lesions of the mid-and forefoot can be adequately assessed with ultrasound, supplemented on occasion with radiographs, computed tomography, or magnetic resonance imaging.

This review outlines a practical approach to the everyday assessment of both non-neoplastic and neoplastic soft tissue tumors, focusing on ultrasound examination, though emphasizing the added benefit of magnetic resonance imaging in certain instances. Ultrasound approach and assessment, practical scenarios, reporting, biopsy, and follow-up are covered, as well as the criteria used to distinguish benign from malignant tumors. The potential benefits and current limitations of elastography and contrast-enhanced ultrasound in assessment are also addressed. Examples of commonly encountered soft tissue tumors are shown. Ultrasound can characterize most soft tissue masses based on their ultrasound appearance alone. Following ultrasound examination, three potential scenarios usually exist in clinical practice: (a) confident regarding diagnosis, (b) indeterminate mass with no evidence of malignancy, and (c) indeterminate mass with possibility of malignancy. A diagnostic pathway for each of these scenarios is provided. Magnetic resonance imaging is generally not helpful in further characterizing masses which are indeterminate on ultrasound assessment, though it is helpful in addressing other issues such as exact tumor location and neurovascular bundle involvement that may not be fully resolved on ultrasound examination. In these situations, magnetic resonance imaging examination can be tailored to address those specific questions that have not been adequately addressed on ultrasound examination. In this sense, both examinations are highly complementary. Tips for undertaking magnetic resonance imaging examinations are provided.

Lithium-ion capacitors (LIC) combine the energy storage mechanisms of lithium-ion batteries and electric double layer capacitors (EDLC) and are supposed to promise the best of both worlds: high energy and power density combined with a long life. However, the lack of lithium cation sources in the carbon cathode demands the cumbersome step of prelithiation of the graphite anode, mainly by using sacrificial lithium metal, hindering the mass adoption of LICs. Here, in a conceptually new class of devices termed lithium metal capacitors (LMC), we replace the graphite anode with a lithium metal anode stabilized by a complex yet stable solid-electrolyte interface (SEI). Via a specialized formation process, the well-explored synergetic reaction between the LiNO3additive and controlled amounts of polysulfides in an ether-based electrolyte stabilizes the SEI on the lithium metal electrode. Optimized devices at the coin cell level deliver 55 mAh g–1at a fast 30C discharge rate and maintain 95% capacity after 8000 cycles. At the pouch-cell level, energy densities of 13 Wh kg–1are readily achieved, indicating the transferability of the technology to practical scales. The LMC, a new class of capacitive device, eliminates the prelithiation process of the conventional LIC, allowing practical production at scale and offering exciting avenues for exploring versatile cathode chemistries on account of using a lithium metal anode.

Psoriatic arthritis (PsA) is a heterogeneous, chronic, inflammatory musculoskeletal disease that can lead to peripheral and axial damage and loss of function. A clear difference between PsA and other forms of inflammatory arthritis is the different forms of bone remodeling seen in PSA which incorporates not only increased bone resorption with bone erosions, osteolysis, and loss of bone mineral density but also increased bone formation with periostitis, syndesmophytes, enthesiophytes, and ankylosis. PsA, if diagnosed late, will lead to significant structural damage, the most severe form of which is known as arthritis mutilans, and loss of physical function. Imaging plays a crucial role in diagnosing and monitoring both peripheral and axial conditions associated with PsA. Radiography is currently the main modality used to monitor structural damage in PsA though commonly used scoring systems do not include bony proliferation as a criterion. Besides, radiography is limited in determining the presence and cause of periarticular soft tissue thickening, which may arise from tendinosis, tenosynovitis, synovial proliferation, bursitis, or enthesitis. Recently, much more attention has been paid to determining the imaging characteristics of PsA, which enables more precise identification of disease and severity assessment. Newer imaging technologies also enable variations in normal bone microstructure to be distinguished from disease-related abnormality. This review discusses the current state of innovative imaging modalities in PsA, specifically concentrating on their roles in PsA diagnosis and treatment, improving the early detection of PsA, and identifying patients with skin psoriasis at risk of developing psoriatic arthritis.

This pilot study evaluated the efficacy of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) versus hyaluronic acid (HA) in surgically naïve patients with knee osteoarthritis (OA).

AbstractA major concern of military leaders, health scientists, and policymakers has been increased suicides among U.S. military personnel. Few studies have examined how risk-taking conveys suicide risk. The present study examined survey data (12,612 soldiers in 180 company-sized units) obtained from an under-studied military population, the Army National Guard (ARNG). One-fifth to one-third of the soldiers reported risk-taking behaviors, such as alcohol misuses, unauthorized work absences, criminal behaviors, and unsafe sex practices. Risk-taking behaviors were simultaneously related to suicidal thoughts, plans, and attempts, namely: unauthorized work absences (Odds-Ratio = 6.38, 95% CI 4.06-10.02), alcohol misuses (6.12, 4.56-8.20), such as driving under the influence (DUI), committing illegal acts while drinking, etc., and criminal behaviors (3.00, 2.05-4.39) to suicide thoughts; unauthorized work absences (7.63, 4.28-13.59), alcohol misuses (4.36, 2.73-6.96), and criminal behaviors (4.30, 2.60-7.11) to suicide plans; and unauthorized work absences (41.40, 19.40-88.38) and criminal behaviors (6.10, 2.95-12.60), and unsafe sex practices (2.37, 1.29-4.35) to suicide attempts. Risk-taking behaviors that showed stronger associations with suicide risk are interpreted as likely reducing inhibitions against violence and self-harm, namely, criminal behaviors and unauthorized work absences with alcohol misuses. Several practical implications of risk-taking findings are offered for suicide prevention.

•Three recognized pain mechanisms are present in Urologic Pelvic Pain Syndrome.•Different patterns of clinical presentation and treatment utilization are apparent.

Background:To identify contributors to non-traumatic incident fractures on rheumatic disease patients who are on long term glucocorticoids (LTGC)Methods:Two hundred and twenty patients on LTGC (110 with vertebral fracture and 110 without vertebral fracture) who participated in a cross-sectional study in 2014-2015 were invited to have repeated assessments on 1) aBMD using dual-energy X-ray absorptiometry (DXA), 2) volumetric BMD (vBMD), microstructure and bone strength assessment of the wrist and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) and 3) spine radiographs in the 5th year. Clinical covariates were recorded on questionnaires, and Fracture Risk Assessment Tool (FRAX) score was calculated accordingly. Non-traumatic incident fracture over the 5-year were documented. Receiver operating characteristic curve (ROC) analysis was performed to compare the strength of fracture prediction tools.Results:Out of the 140 patients who completed the 5th year assessments, 47 (33.6%) developed incident fractures. History of previous fracture, aBMD at hip and lumbar spine, T-score, trabecular vBMD, trabecular bone volume fraction and estimated bone strength at the tibia at baseline remained significantly different after adjusting for age between the group with and without incident fractures. The area under curve (AUC) of a prediction model comprised of age, history of previous fracture and average trabecular vBMD at tibia was comparable with that of the FRAX score (0.710 vs 0.679-0.702), and slightly outperformed than the AUC of DXA aBMD at hip and lumbar spine (0.628-0.668) under ROC analysis.Conclusion:Age, history of previous fracture and average trabecular vBMD at tibia could be the main contributors in building a prediction model for non-traumatic incident fracture in rheumatic disease patients on LTGC.

BackgroundThis study aimed to ascertain the effect of secukinumab on erosion and enthesiophyte progression in psoriatic arthritis (PsA) by high-resolution peripheral quantitative computed tomography (HR-pQCT).MethodsThis was a one-year double-blind, randomized, placebo-controlled trial (NCT0362386740). Patients with erosion in the metacarpophalangeal joints (MCPJ) 2-4 were randomised in a 1:1 ratio to either the secukinumab or placebo group. HR-pQCT of the MCPJ 2-4 were performed at baseline, week-24 and 1-year. Progression of enthesiophyte were defined as changes in enthesiophyte volume exceeding smallest detectable change (SDC) (0.12mm3) or the identification of any new enthesiophyte. Partial repair of erosion was defined as a reduction in erosion volume greater than SDC (0.1mm3).ResultsForty patients (age: 51.9± 13.4 years, 20 [50%] male) were recruited. Thirty-four patients who completed study treatment were included in the per-protocol analysis. The erosion volume at baseline, week-24 and week-48 revealed significant reduction in the secukinumab group while no differences in the placebo group (Figure-3A). There was a trend suggesting that fewer patients developed new-erosions in the secukinumab group (one-erosion in one-patient) compared to the placebo group (six-erosions in five-patients) (p=0.078) (Figure-3B). A significantly higher proportion of erosions with partial healing was observed in the secukinumab group compared with the placebo group [51%vs30%, p=0.029] (Figure-3C). Regarding enthesiophyte, a total of 25-enthesiophytes were identified in both the secukinumab and placebo groups at baseline. The enthesiophyte volume at baseline, week-24 and week-48 revealed significant differences in the secukinumab group while no differences in the placebo group (Figure-3D). While one (one-enthesiophyte in one-patient) and four-enthesiophytes (four-enthesiophytes in three-patients) were newly identified in the secukinumab group and placebo group respectively (Figure-3E), the proportion of enthesiophyte progression was numerically higher in the placebo group than the secukinumab group [40%vs16%, p=0.114] at week 48 (Figure-3F). GEE results showed that the odds ratio (OR) for enthesiophyte progression in the secukinumab group was 0.264 (95% CI: 0.080-0.878, p=0.030), while the OR for partial erosion healing in the secukinumab group was 2.816 (95% CI: 1.109 to 7.153, p=0.029), adjusting for tender-joint-counts.ConclusionsSecukinumab demonstrates a potential benefit in facilitating partial erosion repair and preventing enthesiophyte progression in PsA.

Background:Sacroiliac joints (SIJ) radiography has lower sensitivity and specificity compared to magnetic resonance imaging (MRI) and low-dose CT (ldCT) of the SIJ for detecting axial spondyloarthritis. Whether this is also true for axial psoriatic arthritis (axPsA) remains uncertain. This study aimed to evaluate the performance of ldCT, MRI, and conventional radiography of SIJ and spine in distinguishing axial involvement in PsA patients.Methods:Fifty-one consecutive PsA patients (70.6% male, age 41 ± 13 years) meeting the CASPAR classification criteria, regardless of back pain, were included. All patients underwent SIJ and whole-spine radiography, SIJ MRI as well as SIJ ldCT, while 25 (49%) of 51 patients also underwent whole-spine MRI and ldCT. One rheumatologist with expertise in imaging and one trained reader evaluated images. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. The sensitivity, specificity, and diagnostic accuracy of the three modalities for discriminating axPsA were compared.Results:AxPsA was diagnosed in 33.3% (17) of 51 patients. In discerning axial involvement in PsA patients, MRI exhibited superior sensitivity (92.9%) compared with ldCT (83.3%) and radiography (67.9%), while ldCT demonstrated higher specificity (97.1%) than MRI (86.4%) and radiography (72.7%). LdCT achieved the highest diagnostic accuracy (92%) among the three modalities, surpassing radiography (71%) and being comparable to MRI (89%). In the subgroup of patients with whole spine imaging, the combination of MRI and ldCT SIJ had the best diagnostic accuracy, reaching 93%. Including SIJ ldCT in addition to SIJ MRI further improved specificity (86.7% vs. 73.3%) with unchanged sensitivity (100%), while incorporating SIJ MRI alongside SIJ ldCT further improved sensitivity from 83% to 100%, with a modest decrease in specificity (86.7% vs. 93.3%). However, incorporating spine MRI/ldCT alongside SIJ MRI/ldCT did not further improve sensitivity or specificity in discriminating axial involvement in PsA patients.Conclusion:LdCT demonstrated superior diagnostic performance in distinguishing axial involvement in PsA patients compared to MRI or radiography, although MRI was more sensitive for detecting active sacroiliitis. The highest diagnostic performance was achieved with both MRI and ldCT of the SIJ. Additional spine imaging did not further increase diagnostic performance.

Background:Unlike axial spondyloarthritis (axSpA), no classification criteria are currently available for axial psoriatic arthritis (axPsA). This study aimed to evaluate the performance of the proposed cut-offs from the Assessment of Spondyloarthritis International Society (ASAS) data-driven definitions for active and structural magnetic resonance imaging (MRI) lesions typical of axSpA in distinguishing axial involvement in patients with psoriatic arthritis (PsA).Methods:Seventy-two consecutive PsA patients (67% male, aged 45± 14 years) meeting the CASPAR classification criteria, regardless of the presence of back pain, were included. All patients underwent radiography of the pelvis and spine, as well as sacroiliac joint (SIJ) MRI, while 52 (72%) of 72 patients also underwent whole-spine MRI. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. One rheumatologist with expertise in imaging and one trained reader evaluated the radiography and MRI images.Results:AxPsA was diagnosed in 27/72 (38%) patients. The proposed cut-offs for active sacroiliitis demonstrated high specificity (95.6%) but relatively low sensitivity (51.9%) in distinguishing patients with and without axPsA. When structural lesions of the SIJ were included in addition to active lesions, the sensitivity significantly improved (96.3% vs. 51.9%) with a modest decrease in specificity (86.7% vs. 95.6%). Incorporating MRI spine lesions (using the proposed cut-offs for positive spine MRI from the SPACE cohort) alongside SIJ lesions did not further change sensitivity or specificity compared with assessing SIJ alone.Conclusion: The ASAS-proposed cut-offs for identifying active and structural lesions of SIJ demonstrated satisfactory performance in discriminating axial involvement in PsA patients.

Background: Preventing transition to chronic back pain (CBP) is a long-sought strategy that could rescue patients from prolonged suffering. Recent rodent and human brain imaging studies suggest involvement of sexually dimorphic, dopaminergic-motivational, mesolimbic circuits in the transition to chronic pain (tCBP), and hint that the combination of carbidopa/levodopa and naproxen (LDP + NPX) may block tCBP. Here we evaluated, in people with recent-onset back pain, whether a 3-month treatment with LDP + NPX is safe, blocks tCBP, and whether its efficacy is sex-dependent. Methods: A total of 72 participants were enrolled and stratified by risk for tCBP using brain-imaging biomarkers. Low-risk participants entered a no-treatment arm. Others were randomized to placebo + naproxen or LDP + NPX for 3 months. Results: Both treatments resulted in more than 50% pain relief for approximately 75% of participants. A strong sex by treatment interaction was observed for daily pain intensity (phone NRS, P= 0.007), replicated on 4-week average pain (Pain/4w, P= 0.00001), and in intent-to-treat analysis (Pain/4w, P= 0.000004). Nucleus accumbens functional connectivity with medial prefrontal cortex, a predefined objective biomarker, showed sex dependence at baseline (P= 0.03) and sex-by-treatment interaction effect 3 months after treatment cessation (P= 0.031). Treatment modified the psychological profile of participants, and disrupted brain modeling-based predicted back pain intensity trajectories. Forty participants were queried 3.3 years from trial start; back pain ratings were similar between end of treatment and at 3.3 years (P= 0.62), indicating persistence of relief for this duration. Conclusions: These results provide the first evidence for preventing transition to chronic back pain using sex-specific pharmacotherapy. These provocative observations require confirmation in a larger study. ClinicalTrials.gov identifier: NCT01951105.

A leaf is a free-standing photocatalytic system that can effectively harvest solar energy and convert CO2and H2O into carbohydrates in a continuous manner without the need for regeneration or tedious product extraction steps. Despite encouraging advances achieved in designing artificial photocatalysts, most of them function in bulk solution or on rigid surfaces. Here, we report on a 2D flexible photocatalytic system based on close packed Janus plasmene nanosheets. One side of the Janus nanosheets is hydrophilic with catalytically active palladium, while the opposite side is hydrophobic with plasmonic nanocrystals. Such a unique design ensures a stable nanostructure on a flexible polymer substrate, preventing dissolution/degradation of plasmonic photocatalysts during chemical conversion in aqueous solutions. Using catalytic reduction of 4-nitrophenol as a model reaction, we demonstrated efficient plasmon-enhanced photochemical conversion on our flexible Janus plasmene. The photocatalytic efficiency could be tuned by adjusting the palladium thickness or types of constituent building blocks or their orientations, indicating the potential for tailor-made catalyst design for desired reactions. Furthermore, the flexible Janus plasmene nanosheets were designed into a small 3D printed artificial tree, which could continuously convert 30 mL of chemicals in 45 minutes.

AbstractSince 2002, the U.S. military has seen a dramatic rise in suicides. Risk was thought to be associated with having been deployed, although little or no association has been found. This association may be obscured by the omission of important aspects of deployment, such as time since return from deployment and combat exposure. Survey data obtained from Army National Guard soldiers who had been deployed to Iraq during 2010 were examined (N = 4567 soldiers in 50 company-sized units). Overall, the relationship of suicidal thoughts to time since having returned was not statistically significant. However, among soldiers who reported more than one combat event, twice as many soldiers who had returned over a year ago reported suicidal thoughts than soldiers who returned 1 year or under. In addition, about twice as many soldiers who had participated in a traumatic combat event or in direct combat reported suicidal thoughts after having returned over 1 year than soldiers who returned more recently. Findings are discussed relative to future studies of suicide risk among reserve personnel, especially, a year or more since having returned.

Fracture risk in patients on long-term glucocorticoid (LTGC) is only partially explained by impaired areal bone mineral density (aBMD). HR-pQCT derived bone microstructure and bone strength indices could improve fracture prediction beyond aBMD or FRAX in the general population. Abnormalities in these indices could discriminate rheumatic disease patients on LTGC with and without fragility fracture in cross-sectional studies.

Background: To investigate the relationship between disease-related parameters and joint space width (JSW) on high-resolution peripheral quantitative computed tomography (HR-pQCT) in psoriatic arthritis (PsA) patients. Methods: PsA patients who underwent HR-pQCT examination of the second to fourth metacarpophalangeal joint (MCPJ 2–4) were recruited in this cross-sectional study. The joint space metrics included joint space volume (JSV), mean, minimum, and maximum JSW, JSW asymmetry, and distribution. Correlation analysis and multivariable linear regression models were used to determine the association between disease-related variables and JSW. Results: Sixty-seven patients [37 (55.2%) males; median (IQR) age: 57.0 (53.0, 63.0); median disease duration: 21 (16, 28) years] were included in this analysis. Multivariable linear regression analysis demonstrated that males had larger JSV (MCPJ 2–4), mean (MCPJ 4), and maximum JSW (MCPJ 3). Longer disease duration (MCPJ 2–3) and higher ESR values (MCPJ 3) were negatively associated with mean and maximum JSW, while higher damage joint count was negatively associated with mean and minimum JSW (MCPJ 2). Use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was negatively associated with minimum JSW (MCPJ 3) while use of biologic DMARDs (bDMARDs) was positively associated with minimum JSW (MCPJ 2). Conclusion: Higher inflammatory burden as reflected by longer disease duration, higher ESR levels, and damage joint count was negatively associated with mean, maximum, and minimum JSW, while suppression of inflammation using bDMARDs seems to limit the decline in JSW.

Supplemental Digital Content is available in the text.This article introduces the Consumer Ear Disease Risk Assessment (CEDRA) tool. CEDRA is a brief questionnaire designed to screen for targeted ear diseases. It offers an opportunity for consumers to self-screen for disease before seeking a hearing device and may be used by clinicians to help their patients decide the appropriate path to follow in hearing healthcare. Here we provide highlights of previously published validation in the context of a more thorough description of CEDRA’s development and implementation. CEDRA’s sensitivity and specificity, using a cut-off score of 4 or higher, was 90% and 72%, respectively, relative to neurotologist diagnoses in the initial training sample used to create the scoring algorithm (n = 246). On a smaller independent test sample (n = 61), CEDRA’s sensitivity and specificity were 76% and 80%, respectively. CEDRA has readability levels similar to many other patient-oriented questionnaires in hearing healthcare, and informal reports from pilot CEDRA-providers indicate that the majority of patients can complete it in less than 10 min. As the hearing healthcare landscape changes and provider intercession is no longer mandated, CEDRA provides a measure of safety without creating a barrier to access.

Epithelial barrier loss is a driver of intestinal and systemic diseases. Myosin light chain kinase (MLCK) is a key effector of barrier dysfunction and a potential therapeutic target, but enzymatic inhibition has unacceptable toxicity. Here, we show that a unique domain within the MLCK splice variant MLCK1 directs perijunctional actomyosin ring (PAMR) recruitment. Using the domain structure and multiple screens, we identify a domain-binding small molecule (divertin) that blocks MLCK1 recruitment without inhibiting enzymatic function. Divertin blocks acute, tumor necrosis factor (TNF)-induced MLCK1 recruitment as well as downstream myosin light chain (MLC) phosphorylation, barrier loss, and diarrhea in vitro and in vivo. Divertin corrects barrier dysfunction and prevents disease development and progression in experimental inflammatory bowel disease. Beyond applications of divertin in gastrointestinal disease, this general approach to enzymatic inhibition by preventing access to specific subcellular sites provides a new paradigm for safely and precisely targeting individual properties of enzymes with multiple functions.

ABSTRACTAn interest of researchers and practitioners has been postdeployment adjustment of returned soldiers, though the primary focus has been investigating the prevalence of psychiatric conditions. Less attention has been paid to nonclinical conditions, which still have posed significant adjustment problems for soldiers, in particular, for reserve soldiers who revert back to civilian life, family, and employment. The present study examined the occurrence of postdeployment problems among returned Army National Guard soldiers (N= 4,567 in 50 company-sized units). Survey items reliably indicated 7 problem areas. Highest prevalence of problems was being angry (35.9%) and being unable to sleep (43.3%), followed by alcohol abuse (25.1% reported 5 or more drinks in 1 day). Longer deployment lengths were associated with troubled relationships and aggression toward the significant other adult and children in the household. More deployments were associated with aggression toward household children. Self-reported general combat trauma and having killed or wounded someone were associated with all problem areas. Findings are discussed relative to how combat exposure likely alters soldiers’ perceptions and behaviors, including feelings of loneliness and isolation, and risk-taking behaviors of alcohol abuse and aggression toward others.

BackgroundUnlike axial spondyloarthritis, no classification criteria exist for axial psoriatic arthritis (axPsA). In 2021, the Assessment of SpondyloArthritis International Society (ASAS) revised the magnetic resonance imaging (MRI) criteria for active sacroiliitis (2021 criteria: bone marrow edema [BME] present in ≥4 sacroiliac joint [SIJ] quadrants or ≥3 consecutive SIJ slices[1]). This study aimed to compare the utility of this new cut-off in discriminating PsA patients with/without axPsA versus the 2009 ASAS criteria[2] for active-MRI-SIJ (BME ≥2 consecutive slices or >1 location in a single slice).MethodsConsecutive patients who fulfilled the classification criteria for PsA were recruited into this cross-sectional study, regardless of back pain. Sixty-seven patients underwent radiography (including pelvis, cervical/thoracic/lumbar-spine) and MRI-SIJ. Additionally, 47 underwent whole-spine MRI. AxPsA diagnosis was based on clinical information and imaging findings, as determined by an expert rheumatologist and a radiologist, and used as the reference standard. Two independent readers evaluated the MRI images based on two criteria for active sacroiliitis (BME cut-off: ≥4[1] vs ≥2[2]) and spondylitis (BME cut-off: ≥5[3] vs ≥3[4]). The agreement between the two MRI BME cut-offs for active sacroiliitis/spondylitis and the reference standard was evaluated.ResultsSixty-seven patients (mean age: 47±12 years, 44 (65.7%) male, psoriasis and PsA disease duration: 13.5±10.3 and 3.8±6.1 years respectively) were recruited (Table 1). Twenty-three (34.3%) were diagnosed with axPsA, including 13 (56.5%) with radiographic sacroiliitis and 10 (43.5%) with non-radiographic axPsA. 12/67 (17.9%) had active MRI-sacroiliitis based on the 2021 ASAS criteria, while 4/47 (8.5%) had spondylitis based on the 2016 proposed definition[3]. Compared with the reference standard, the agreement increased after applying a more stringent threshold to define active sacroiliitis (BME cut-off: ≥4 vs ≥2; Kappa: 0.514 vs 0.392, respectively; Fig. 1A-B). The agreement with the reference standard further increased by applying a more stringent criteria for active spondylitis in addition to active sacroiliitis (BME cut-off for MRI-SIJ and spine: ≥4 and ≥5 vs ≥2 and ≥3; Kappa: 0.717 vs 0.342, respectively; Fig. 1C-D), resulting in higher specificity (active-sacroiliitis: 97.7% vs 81.8%; active-sacroiliitis and/or spondylitis: 100% vs 72.7%) and higher positive predictive value (91.7% vs 61.9%; 100% vs 50.0%, respectively).ConclusionAt least four BME lesions on MRI-SIJ and five inflammatory lesions on MRI-spine allow acceptable discrimination of axPsA and no axPsA while assuring >95% specificity.

Supplemental Digital Content is available in the text.

Measurement of areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) was able to predict fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) yields additional information about volumetric bone mineral density (vBMD), microarchitecture, and strength that may increase our understanding of fracture susceptibility.