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Medial tibial stress fractures occur secondary to failure in shear. It has been proposed that the use of functional foot orthotics (FFOs) may decrease their incidence by positioning the subtalar joint in the neutral position at heel strike. The purpose of this study was to evaluate the scientific basis of this concept by in-vivo measurement of tibial principal strain, the principal strain angle and shear strains during treadmill walking from rosette strain gauges bonded to the tibia of a male subject at two sites prone to stress fracture. Recordings were made while wearing Rockport walking shoes without orthotics, with non-posted graphite orthotics, with neutral rearfoot posted polypropylene orthotics, with 4° varus rearfoot posted polypropylene orthotics, and with neutral rearfoot posted kinetic wedge polypropylene orthotics designed to treat hallux limitus. None of the various modifications of FFOs tested in this study had a statistically significant effect on the compression strains during treadmill walking compared to the walking shoe alone, indicating that they were not affective in attenuating the ground reaction force. Their use was associated with a 22–51% increase in principal (p <.001) and a 9–35% increase in tibial shear strains (p =.003). The compression and shear strains and the angle of the principal strains (p <.001) were higher at the distal than at the proximal recording site, (p <.001 for all). The findings do not support the use of FFOs in any of the posting configurations tested as a means for lowering tibial shear strains or the concept of the biomechanical importance of the neutral position of the subtalar joint at heel strike. [ABSTRACT FROM AUTHOR]

Background and Aims: We retrospectively assessed the clinical Pfizer's mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients. Patients and Methods: One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and were stratified into two groups: (1) 37 LT recipients after SARS-CoV-2 infection before vaccine era and (2) 130 LT recipients vaccinated with 2 doses without earlier SARS-CoV-2 exposure. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed 7 days following vaccination (Liaison assay). Results: In addition to the 37 nonvaccinated cases (22.2% of total group) who experienced SARS-CoV-2 infection (34 symptomatic and 3 asymptomatic), another 8 vaccinated symptomatic recipients (4.8%) were infected (5 from the third and three from the fourth waves). Three of the 45 infected cases died (6.7%) before the vaccine program. Vaccinated group: of the 130 LT vaccinated recipients, 8 (6.2%) got infected postvaccination (added to the infected group) and were defined as clinical vaccine failure; 38 (29.2%) were serological vaccine failure (total failure 35.4%), and 64.6% cases were serological vaccine responders (anti-S =19 AU/mL). Longer post-LT interval and lower consumption of immunosuppressants (steroids, FK506, and mycophenolate mofetil) correlated with favorable SARS-CoV-2 vaccine response. Mammalian target of rapamycin inhibitors improved vaccine outcomes associated with lower FK506 dosages and serum levels. Patients with anti-S levels <100 AU/mL risked losing serologic response or being infected with SARS-CoV-2. A booster dose achieved an effective serologic response in a third of failures and most responders, securing better and possibly longer protection. Conclusion: Pfizer's BNT162b2 vaccine seems to lessen SARS-CoV-2 morbidity and mortality of LT recipients even with weak serological immunogenicity. Switching mycophenolate mofetil to mammalian target of rapamycin inhibitors might be effective before boosters in vaccine failure cases. A booster vaccine should be considered for nonresponders and low-responders after the second dose. [ABSTRACT FROM AUTHOR]

The Pfizer‐BioNTech coronavirus disease 2019 (COVID‐19) vaccine has been offered to nonallergic ≥16‐year‐old Israeli adults since December 19, 2020. Data regarding factors associated with vaccine ineffectiveness are limited. The aim of this study is to assess the impact of hepatic fibrosis on the efficacy of the BioNTech vaccine. Serum severe acute respiratory syndrome coronavirus 2 spike immunoglobulins (S IgG) obtained at least 7 days following vaccination completion was correlated with the prevaccine calculated Fibrosis‐4 (FIB‐4) score among 719 employees in the Hadassah Medical Center, Jerusalem. Positive vaccine response (S IgG levels ≥ 19 AU/mL) was found in 708 of 719 individuals (98.5%). Vaccine failure (S IgG levels < 19) was found in 11 (1.5%); of these, 7 were immunosuppressed. Mean FIB‐4 available in 501 of 708 vaccine responders was 1.13 ± 0.66, mean age 51.4 ± 12.4 years (29.3% males), and mean S IgG titers 239.7 ± 86.1 AU/mL. Similar to the general population, 70.5% had normal FIB‐4 (<1.3), 26.8% undetermined FIB‐4 (1.3‐2.67), and 2.7% advanced FIB‐4 (>2.67). When divided into response subgroups, 158 of 501 individuals (30.1%) with IgG titers 19‐100 AU/mL had a mean FIB‐4 of 1.48 ± 0.82; 198 (39.5%) with IgG titers 101‐200 AU/mL had mean FIB‐4 of 1.22 ± 0.76; 83 (16.6%) with titers 201‐300 AU/mL had mean FIB‐4 of 1.04 ± 0.48; 38 (7.6%) individuals with IgG titers 301‐400 AU/ml had a mean FIB‐4 of 1.08 ± 0.63; and 121 (24.2%) with IgG titers >400 AU/mL had mean FIB‐4 of 1.18 ± 0.87. Increased FIB‐4, age, and male gender significantly correlated with lower postvaccine IgG titers (P < 0.001). FIB‐4 results were confirmed using FibroScan data displaying advanced fibrosis impact on weakened COVID‐19 vaccine response. Conclusion: Immune suppression, older age, male gender, and advanced chronic liver disease are risk factors for lower vaccine response. The FIB‐4 provides a simple tool to prioritize candidates for third‐dose vaccine booster. [ABSTRACT FROM AUTHOR]

Summary: Background: Namodenoson, an A3 adenosine receptor (A3AR) agonist, improved liver function/pathology in non‐alcoholic steatohepatitis (NASH) preclinical models. Aim: To evaluate the efficacy and safety of namodenoson for the treatment of non‐alcoholic fatty liver disease (NAFLD) with or without NASH Methods: This phase 2 study included 60 patients with NAFLD (ALT ≥60 IU/L) who were randomised (1:1:1) to oral namodenoson 12.5 mg b.d. (n = 21), 25 mg b.d. (n = 19), or placebo (n = 20) for 12 weeks (total follow‐up: 16 weeks). The main efficacy endpoint involved serum ALT after 12 weeks of treatment. Results: Serum ALT decreased over time with namodenoson in a dose‐dependent manner. The difference between change from baseline (CFB) for ALT in the namodenoson 25 mg b.d. arm vs placebo trended towards significance at 12 weeks (P = 0.066). Serum AST levels also decreased with namodenoson in a dose‐dependent manner; at 12 weeks, the CFB for 25 mg b.d. vs placebo was significant (P = 0.03). At Week 12, 31.6% in the namodenoson 25 mg b.d. arm and 20.0% in the placebo arm achieved ALT normalisation (P = 0.405). At week 16, the respective rates were 36.8% and 10.0% (P = 0.038). A3AR expression levels were stable over time across study arms. Both doses of namodenoson were well tolerated with no drug‐emergent severe adverse events, drug‐drug interactions, hepatotoxicity, or deaths. Three adverse events were considered possibly related to study treatment: myalgia (12.5 mg b.d. arm), muscular weakness (25 mg b.d. arm), and headache (25 mg b.d. arm). Conclusion: A3AR is a valid target; namodenoson 25 mg b.d. was safe and demonstrated efficacy signals (ClinicalTrials.gov #NCT02927314). [ABSTRACT FROM AUTHOR]

Treating COVID-19 patients can affect anxiety. To compare the anxiety of internal medicine residents treating COVID-19 patients at a level-3 hospital with a level-2 hospital. A questionnaire related to COVID-19 and anxiety using the State-Trait Anxiety Inventory (STAI-S) was sent to internal medicine residents of a COVID-19 referral level-3 hospital and a level-2 hospital from which all diagnosed COVID-19 cases are transferred to the COVID-19 referral hospital. Responses were received from 76.3% of the internal medicine residents. There was no difference in the anxiety scores between residents from the level-3 center (44.4) and the level-2 center (44.4), p = 0.9. There was a significant difference between the number of residents from the level-3 center, 22/56 (63%) and the number of residents from the level-2 center, 1/10 (10%) who were concerned about better protective gear (p = 0.003) and between residents from the level-3 center19/35 (54%) and those from the level-2 center, 1/10 (10%) who were concerned about infecting their families (p = 0.01). The internal medicine resident anxiety scores were not a function of hospital level, but safety was less of a concerns in the level-2 center with only emergency room COVID-19 services. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease affects women during their reproductive years and thus pregnancy outcomes. IBD MOM is a multidisciplinary, single-center clinic established to benefit women with IBD and their neonates.Aim: The aim of this study was to evaluate the perinatal outcomes of the IBD MOM clinic patients compared to patients who attended antenatal and gastrointestinal disease community clinics (IBD CC).Methods: This single-center, prospective study was conducted from 2011 to 2015. The primary outcome was cesarean delivery; secondary was adverse perinatal outcomes. In parallel, a new pregnancy-oriented, disease severity score was evaluated for its association with perinatal risk (score low = 0 to severe = 5).Results: We identified 90 women in the IBD MOM clinic and 206 in the IBD CC. Maternal age, smoking habits, pregnancy complications, and type of IBD (CD/UC) were similar between groups. Rates of labor induction and birth weight were also similar between IBD MOM and IBD GI. The IBD MOM overall preterm delivery (PTD) rate (< 37 weeks) was significantly higher 18.9 versus 9.7% (P = 0.028). The IBD MOM group had a significantly higher IBD MOM disease severity score that correlated with a higher rate of PTD. The overall IBD MOM score and scores > 3 were significantly associated with PTD risk in both groups (P = 0.013 and P = 0.004, respectively).Conclusion: Women with moderate and severe IBD who attended a multidisciplinary clinic may benefit from this unique center. Healthcare planning policies can assume that costly, multidisciplinary clinics for women with IBD should be reserved for those with moderate and severe disease. [ABSTRACT FROM AUTHOR]

Background We previously identified the positive result of the supine apprehension test after completion of rehabilitation following a first dislocation as a possible predictor of high risk for redislocation. We extend the follow-up of a previous cohort of patients with first-time shoulder dislocations to better assess this test. Methods Fifty-three men aged 17 to 27 years who sustained a first traumatic shoulder dislocation were treated by shoulder immobilization for 4 weeks and then rehabilitated with a standard physical therapy protocol. At 6-week follow-up, a supine anterior apprehension test was performed to assess the risk of redislocation. The patients were observed prospectively for a minimum of 75 months. Results Of the 53 participants, 52 (mean age, 20.2 years) completed the study follow-up. Of the 52 subjects, 41 (79%) were combat soldiers. Follow-up was between 75 and 112 months. Of the 52 subjects, 31 (60%) redislocated at a range of 3 to 70 months after the initial dislocation. Eleven of 14 subjects (79%; confidence interval, 52%-92%) with a positive anterior apprehension test result redislocated, compared with 20 of 38 patients (53%; confidence interval, 37%-68%) with a negative test result. Patients with a positive test result redislocated more and earlier ( P = .02, PROC LIFETEST, SAS). Conclusions The results of the supine apprehension test after a first shoulder dislocation and rehabilitation can help predict risk for recurrent instability. It potentially may be included as a variable in decision analysis models. [ABSTRACT FROM AUTHOR]

The article examines whether the transition from civilian life through 6 months of military training as elite infantry recruits would result in an increased cross-sectional area of the Achilles tendon. It discusses the measurement of the participants' height and weight before they start their training, the results of ultrasound performed on the participants' legs before, during and after their training and the use of a load cell strain gauge to assess Achilles tendon geometry and mechanics.

To evaluate the effect of the extremes of long term high and low physical activities on musculoskeletal heath in middle age, a historical cohort study was performed. The MRI knee and back findings of 25 randomly selected subjects who were inducted into the armed forces in 1983 and served at least 3 years as elite infantry soldiers were compared 25 years later, with 20 randomly selected subjects who were deferred from army service for full time religious studies at the same time. Both cohorts were from the same common genome. The two primary outcome measures were degenerative lumbar disc disease evaluated by the Pfirrmann score and degenerative knee changes evaluated by the WORMS score. At the 25-year follow up, the mean Pfirrmann score (8.6) for the L1 to S1 level of the elite infantry group was significantly higher than that of the sedentary group (6.7), (P = 0.003). There was no statistically significant difference between the WORMS knee scores between the two cohorts (P = 0.7). In spite of the much greater musculoskeletal loading history of the elite infantry cohort, only their lumbar spines but not their knees showed increased degenerative changes at middle age by MRI criteria. [ABSTRACT FROM AUTHOR]

Background: In a previous military study a custom-made tri-layer polyurethane shoe orthotic was shown to be effective in lowering the incidence of stress fractures in infantry recruits. Stress fractures are caused by repetitive high strains. Objective: To compare the effect of tri-layer polyurethane orthotics with other types of orthotics on in vivo strains at sites where stress fractures are common. Design: Subjects underwent surgical implantation of strain gauged staples to the dorsal surface of the midshaft 2nd metatarsal and to the medial surface of the midshaft tibia. Setting: University Hospital. Patients: Two male members of the research staff aged 40 and 54. Measurements: In vivo simultaneous peak-to-peak axial compression-tension strains during treadmill walking at 5 km/h while wearing standard army boots and Nike Air Max running shoes with and without either a non custom pre-fabricated orthotic with a three-quarter length thermocork module, a semirigid custom-made orthotic, with a three-quarter length polypropylene module made from nonweightbearing neutral subtalar position casts, a soft full length custom-made orthotic fabricated from 60 durometer plastazote, and a soft full length custom-made orthotic with a neutral heel post molded from three layers of polyurethane of different density (grade 80 upper layer, grade 60 middle layer and grade 80 lower layer). Results: Only the custom polyurethane composite orthotic was affective in lowering both peak-to-peak compression-tension 2nd metatarsal and tibia strains for both subjects when worn with army boots. When worn with Nike Air Max shoes the polyurethane composite orthotic lowered the peak-to-peak compression-tension 2nd metatarsal but not tibia strains. Limitations: Small subject number, each with a different foot type. Conclusions: The lower peak-to-peak compression-tension tibial and 2nd metatarsal strains while wearing army boots with custom polyurethane composite orthotics can explain the observed lower incidence of stress fractures among military recruits who used these orthotics. [ABSTRACT FROM PUBLISHER]

The original version of the article unfortunately contained tagging error in first and family name of authors Ariella Bar-Gil Shitrit and Ami Ben Ya'acov. This has been corrected with this erratum. [ABSTRACT FROM AUTHOR]

Background & Aims: Sense of coherence (SOC) is a theoretical concept reflecting a person's resources and orientation, which enable individuals to cope with stressors in a health-promoting manner. In several multifactorial chronic diseases, such as diabetes mellitus and systemic lupus erythematosus, SOC was correlated with disease development. It was also related with the emotional distress in patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the possible correlation between low SOC scores and the presence of IBD. Methods: A total of 183 Crohn's disease (CD) and 71 ulcerative colitis (UC) patients completed questionnaires including demographic data and the 13 items for the SOC questionnaire. The IBD patients were matched to 124 healthy people according to age, gender, education, employment status and marital status. Results: In the CD cohort, 96 patients were matched to the healthy cohort according to the propensity score value, and in the UC cohort 57 were matched. Patients with Crohns' disease had a median SOC score of 63 (IQR 56-71), and healthy matching controls of 62.5 (IQR 55.25-68.75) p=0.369. Patients with ulcerative patients had a median SOC score of 66 (IQR 56-73) and healthy controls 62 (IQR 55-69) p=0.354. Conclusions: In our study SOC was not related to the development of IBD. The question of whether SOC is associated with the development of chronic disease and particularly with IBD remains open. [ABSTRACT FROM AUTHOR]