INTRODUCTION OR BACKGROUND:Hydrogels are three-dimensional polymeric networks capable of absorbing substantial amounts of water while maintaining structural stability. In the biomedical field, hydrogels are widely used because of their high water content, flexibility, and the ability to be chemically modified for diverse applications. Their biocompatibility, biodegradability, porosity, and environmental sensitivity enable them to mimic the extracellular matrix, supporting cell growth and tissue regeneration. SOURCES OF DATA:This review integrates information from existing studies, classifying hydrogels based on their molecular origin, and analyses various reports on their synthesis methods, mechanical properties, and biomedical applications. AREAS OF AGREEMENT:Hydrogels (natural, synthetic, and hybrid) exhibit different mechanical properties, bioactivity levels, and degradation patterns. Functional hydrogels with self-healing, injectable, and stimulus-responsive properties have significantly improved drug delivery and therapeutic performance. AREAS OF CONTROVERSY:Although a standardized framework to evaluate different hydrogel types exists, it remains incomplete. The lack of universally accepted classification criteria and inconsistencies in performance evaluation across studies continue to pose challenges the field. GROWING POINTS:Recent advances in molecular design have led to produce protein/peptide-based, polysaccharide-based, DNA-based, and synthetic hydrogels. These developments highlight the growing importance of integrating molecular-level design with application-driven functionalities. AREAS TIMELY FOR DEVELOPING RESEARCH:Future research should focus on refining hydrogel classification systems, standardizing evaluation methodologies, and exploring multifunctional, responsive hydrogel systems tailored to advanced biomedical applications such as precision drug delivery, tissue engineering, and regenerative medicine.
INTRODUCTION:Ulnar variance is a radiographic measurement that describes the relative heights of the distal ulna and radius. Youth athletes who repetitively load their wrist can develop stress injury at the distal radial physis, which may alter longitudinal growth resulting in positive ulnar variance (PUV). This dynamic bony relationship may predilect athletes for wrist pain and/or ulnar-sided pathology; however, the prevalence and clinical significance of ulnar variance in youth athletes is not completely understood. SOURCES OF DATA:PubMed, CINAHL, EMBASE, and SPORTDiscus were queried in November 2025 without time constraints. AREAS OF AGREEMENT:Ulnar variance is best measured in skeletally immature athletes on posteroanterior radiographs using Hafner's method. Youth athletes exhibit more PUV values on average than non-athlete predicted norms. Its magnitude is not significantly associated with training volume or wrist pain. Positive ulnar variance is a potential end stage of stress injury to the radial growth plate complex. Symptomatic PUV becomes clinically meaningful and may warrant surgical intervention in select cases. AREAS OF CONTROVERSY:Reported prevalence of PUV in youth athletes varies widely across studies (0%-50%), reflecting substantial heterogeneity in the existing literature. Inconsistent associations of ulnar variance with multiple anthropometric variables, biological data, and training characteristics prevent clear delineation between the effects of genetics vs repetitive mechanical stress to the distal radial physis on its development. Treatment of symptomatic PUV remains controversial. GROWING POINTS:Body composition may uniquely impact ulnar variance magnitude. Distal radial physis stress injury, rather than PUV, may be a primary driver of wrist pain. AREAS TIMELY FOR DEVELOPING RESEARCH:Newer prospective investigations incorporating dynamic imaging techniques are warranted to evaluate ulnar variance under physiologic weight-bearing conditions. Future work should include athletes from multiple upper extremity weight-bearing sports (gymnastics, cheerleading, diving, and wrestling) across all levels of participation to better account for the effects of training exposure on ulnar variance. Serial radiographic evaluation may also help define the relationship between progressive PUV and the development of wrist pain and dysfunction.
INTRODUCTION:Globally, millions suffer from bone fractures every year, with substantial clinical consequences. Intervention is crucial when healing mechanisms are ineffective. Leukocyte-platelet rich fibrin (L-PRF), by its rapid, simple, and cost-effective preparation methodology alongside a calcium phosphate-based compound such as nanohydroxyapatite may favorably impact clinical practice. SOURCE OF DATA:A critical-sized radius bone defect was produced in 25 White New Zealand rabbits divided into five groups (n = 5 per group) including untreated, autograft, nanohydroxyapatite scaffold, bovine lyophilized L-PRF, and nanohydroxyapatite and L-PRF simultaneously. The defects were evaluated 7 days postsurgery by histopathological, molecular, and Raman spectroscopy evaluations. AREAS OF AGREEMENT:Platelet and growth factor content of lyophilized L-PRF powder stimulate cell proliferation and differentiation, and extracellular matrix production. Nanohydroxyapatite scaffold and lyophilized L-PRF powder could effectively enhance early bone regeneration. AREAS OF CONTROVERSY:While the autograft group was expected to perform best, as the gold standard of repair, the lyophilized L-PRF group performed best in some indicators of extracellular matrix production, such as matrix-to-mineral ratio and carbonate-to-phosphate ratio. GROWING POINTS:Nanohydroxyapatite scaffold played as a mechanical strength provider and had a lesser role in stimulating biological repair responses, in the short term, while L-PRF significantly enhanced cell proliferation and differentiation and extracellular matrix production by releasing osteogenic factors. AREAS TIMELY FOR DEVELOPING RESEARCH:The long-term effects of lyophilized L-PRF on bone repair, duration of platelet growth factor release from L-PRF, injecting fresh L-PRF at periodic intervals, and using lyophilized L-PRF alongside other bone-stimulating scaffolds should be addressed in future studies.
INTRODUCTION:Aseptic loosening is the leading cause of revision after total hip (THA) and knee (TKA) arthroplasty, accounting for 33%-50% of revisions. Variable individual susceptibility suggests genetic contributions. SOURCES OF DATA:Five databases searched to 9 June 2026. Studies reporting genetic associations with aseptic loosening or osteolysis in THA/TKA were included. Quality was assessed via Q-Genie. Pooled odds ratios (random-effects) were computed for loci with ≥3 independent studies (TNF-α -308G > A, IL-6 -174G > C). Meta-analysis for MMP-1 rs5854 was not possible because of insufficient replication. AREAS OF AGREEMENT:Twenty-six studies (7419 participants) examined THA or mixed cohorts; none studied TKA alone. Seventeen gene loci were implicated (cytokines, bone remodelling, matrix degradation, etc.). Pooled analysis: TNF-α -308G > A OR 1.94 (95% CI 1.28-2.93; I2 = 38%; 3 studies); IL-6 -174G > C OR 1.61 (95% CI 1.07-2.42; I2 = 51%; 3 studies). IL-1RN VNTR 498 bp allele conferred ~ 4-fold risk in atopic patients. Variants in RANK, KREMEN2, OPG, SFRP1, TIRAP, and BCL2 were also associated. GNAS1 and CALCA showed no association. Quality was low to moderate. No genome wide association studies (GWAS) was identified. AREAS OF CONTROVERSY:Evidence is dominated by small, single-centre, candidate-gene studies in Caucasian THA cohorts, with heterogeneity in surgery, implants, and phenotype definitions. GROWING POINTS:IL1RN-atopy interaction enables pre-surgical screening. IL-6 genotyping may personalize monitoring. Biobank-registry linkage now permits adequately powered GWAS. AREAS TIMELY FOR DEVELOPING RESEARCH:A well-powered GWAS using registry-biobank linkage; independent replication of RANK/OPG/Wnt and IL1RN findings; first TKA-specific genetic studies; standardized phenotype definitions.
INTRODUCTION OR BACKGROUND:Meniscal tears are a common cause of knee morbidity and a frequent indication for arthroscopy. Whether clinical examination, magnetic resonance imaging (MRI), or both should be the first-line diagnostic test remains contested. SOURCES OF DATA:We searched PubMed, CINAHL Complete, Medline, and Web of Science for paired-design studies in adults in which every patient underwent both composite clinical examination and MRI, with arthroscopy as the reference standard. Ten studies (1643 knees) met our inclusion criteria. Risk of bias was assessed with QUADAS-2; estimates were pooled with a random-effects model. AREAS OF AGREEMENT:For medial meniscal tears, MRI achieved pooled sensitivity of 90% and specificity of 91%; composite clinical examination achieved 85% sensitivity and 95% specificity. For lateral meniscal tears, MRI yielded 81% sensitivity and 82% specificity; composite clinical examination yielded 75% sensitivity and 93% specificity. AREAS OF CONTROVERSY:Whether composite clinical examination is interchangeable with MRI as a first-line test; reduced MRI specificity in degenerative meniscal lesions and osteoarthritic knees; and the operator-dependence of clinical examination and the lack of a standardized composite-examination protocol. GROWING POINTS:Composite clinical examination by an experienced clinician retains diagnostic value alongside MRI. Paired-design synthesis with arthroscopic verification gives less biased estimates of comparative accuracy than unpaired designs. AREAS TIMELY FOR DEVELOPING RESEARCH:Standardization of composite clinical examination protocols; consistent reporting of examiner experience; stratification of MRI accuracy by field strength and pulse sequence; and cost-effectiveness evaluation of clinical-examination-first diagnostic pathways.
INTRODUCTION:The Global Positioning System (GPS)-based metabolic power model for soccer, proposed by di Prampero and applied by Osgnach, rests on a fixed energy cost (EC) of running of 4.6 J·kg-1·m-1 and a biomechanical equivalence between accelerated level and constant-speed uphill running. SOURCES OF DATA:A narrative review was conducted via PubMed, Scopus, and Web of Science using terms like metabolic power, EC of running, GPS soccer, sprint biomechanics, equivalent slope, and running economy (2005-2025). AREAS OF AGREEMENT:Running EC is relatively speed-independent across submaximal velocities typical of football (~6-18 km·h-1). The geometric principle underlying the accelerated-to-inclined running equivalence is accepted, and GPS metabolic power provides a useful metric for relative load comparisons. AREAS OF CONTROVERSY:A universal fixed EC ignores interindividual variability (~20%), fatigue, surfaces, and drag. The equivalence model has vector orientation inconsistencies, employs the imprecise term 'equivalent mass', and derives its postural reference from sprint-start conditions unrepresentative of match-play accelerations (~2-4 m·s-2). Validation studies show systematic underestimations of 29%-85% relative to indirect calorimetry. Refinements exist but remain unimplemented in most commercial platforms. GROWING POINTS:Individually calibrated EC values, inertial measurement unit integration, and hybrid models combining GPS kinematics with cardiorespiratory data are promising. Force-velocity profiling offers a biomechanically grounded alternative for individual sprint characterization. AREAS TIMELY FOR DEVELOPING RESEARCH:Priorities include calorimetric validation under match conditions; player-specific EC models incorporating fatigue, surface, and role; implementing model updates in commercial software; and comparing alternative load metrics for injury-risk prediction.
BACKGROUND:Wearable fabrics embedding crystalline semiconductor materials (e.g. germanium, silicon) are promising biomedical devices for their therapeutic potential in musculoskeletal disorders, including osteoarthritis, tendinopathies, and chronic pain, and for supporting tissue healing and regeneration. These fabrics exert their bioactive functions without applying mechanical pressure or drug delivery systems, offering a non-invasive and comfortable therapeutic alternative that operates through mild thermal stimuli at body temperature. SOURCES OF DATA:Recent peer-reviewed literature on semiconductor-based wearable textiles, far-infrared-emitting biomaterials, bioelectric signalling in tissue repair, and their clinical application in musculoskeletal disorders. AREAS OF AGREEMENT:At body temperature, semiconductor-containing fabrics consistently emit far-infrared radiation, experimentally associated with improved microcirculation and modulation of inflammation. Limited clinical studies report improvements in pain and functional outcomes in chronic musculoskeletal conditions, with good tolerability during prolonged wear. AREAS OF CONTROVERSY:Proposed mechanisms include thermally induced electron release, ion generation, and piezoelectric or piezoresistive activity during movement, but direct biological evidence remains limited. The specific contribution of far-infrared emission is difficult to distinguish from thermal or placebo effects. GROWING POINTS:Advances in bioelectric signalling research and textile engineering provide a framework to investigate electroactive interactions between semiconductor fabrics and biological tissues. AREAS TIMELY FOR DEVELOPING RESEARCH:Well-designed randomized trials, quantitative characterization of emitted physical stimuli, and mechanistic cellular studies are needed to establish clinical efficacy and inform regulatory classification.
BACKGROUND:Exercise-induced leg pain is a common and often disabling complaint in young and physically active individuals. Chronic exertional compartment syndrome (CECS) remains one of the most debated diagnoses within this spectrum due to persistent uncertainty regarding its pathophysiology, diagnostic criteria, and treatment strategies. SOURCES OF DATA:This review draws on the authors' previous systematic reviews, original cohort studies, international consensus work, and updated PubMed-indexed literature on diagnostic approaches, intracompartmental pressure (ICP) measurement, and treatment outcomes. AREAS OF AGREEMENT:CECS presents with a characteristic pattern of exertional pain and tightness that resolves with rest. Clinical history remains central, supported by a positive symptom provocation test. Conservative management, particularly structured rehabilitation with activity modification and gait retraining, is increasingly considered first-line therapy. Surgical decompression is effective in patients with persistent, typical symptoms who fail conservative treatment and opt for surgical management. AREAS OF CONTROVERSY:The diagnostic value of ICP measurement remains highly debated. Common thresholds lack robust validation and show limited sensitivity and specificity, with considerable methodological variability. Additional controversies include heterogeneity in surgical techniques, postoperative care, and the absence of clear criteria for surgical timing. GROWING POINTS:Emerging research focuses on alternative diagnostic strategies, including non-invasive imaging, dynamic functional testing, and symptom-based clinical algorithms. AREAS TIMELY FOR DEVELOPING RESEARCH:Future research should address the central question of symptom aetiology. CECS has traditionally been viewed as a perfusion-related disorder, yet this remains unproven. Improved understanding of underlying mechanisms is essential, alongside with refinement of conservative treatment, patient selection for surgery, and development of validated diagnostic pathways and outcome measures.
INTRODUCTION:Calf muscle injuries are common in running and sprint-based sports, but remain too often grouped under a single label despite important differences between gastrocnemius, soleus and, less commonly, plantaris-related injuries. This review evaluates current evidence on anatomy, diagnosis, imaging, classification, prognosis, return to play, and recurrence. SOURCES OF DATA:A structured narrative review was undertaken using PubMed/MEDLINE and Scopus, with searches updated to 23 February 2026. After deduplication and screening, 82 articles were included, including eight seminal pre-window studies. AREAS OF AGREEMENT:Calf injuries generate substantial time-loss and recurrence burden. Age and previous calf injury are the most consistent risk factors. The soleus has been underdiagnosed, while imaging is most useful when it clarifies anatomy and tissue involvement rather than replacing clinical judgement. Connective tissue disruption, particularly involving aponeurosis or intramuscular tendon, appears more prognostically relevant than oedema alone. AREAS OF CONTROVERSY:General muscle injury classifications improve terminology but incompletely capture the complexity of distal calf injuries. The precise prognostic value of MRI findings, isolated anatomical location and serial imaging remains uncertain, and return-to-play endpoints are inconsistently defined across studies. GROWING POINTS:The field is moving from oedema-based grading towards tissue-based, muscle-specific classification, especially for soleus and distal medial gastrocnemius injuries. Rehabilitation is increasingly understood as progressive re-exposure to running, elastic loading, and sport-specific demands rather than symptom resolution. AREAS TIMELY FOR DEVELOPING RESEARCH:Priorities include harmonized definitions of recurrence and return to play, integrated prognostic models combining clinical, imaging and load data, and comparative trials of calf-specific rehabilitation.
BACKGROUND:The routine use of augmentation in the surgical management of primary acute Achilles tendon rupture remains controversial. Biological, mechanical, and synthetic augmentation strategies have been adopted in clinical practice, yet their superiority over standard repair has not been established. SOURCES OF DATA:A narrative review of peer-reviewed comparative studies, randomized controlled trials, systematic reviews, and meta-analyses retrieved from PubMed and MEDLINE, supplemented by the authors' clinical expertise. AREAS OF AGREEMENT:Standard surgical repair of acute Achilles tendon rupture, whether open or minimally invasive, reliably achieves high patient satisfaction, restoration of function, and acceptable return-to-sport rates. Patient-reported outcome measures and re-rupture rates are consistently comparable between augmented and non-augmented repairs across available randomized and controlled studies. AREAS OF CONTROVERSY:Individual studies have occasionally reported statistically significant improvements in surrogate parameters following augmentation, but these rarely exceed minimally clinically important difference thresholds. Complication rates may be higher with augmentation, and endoscopic flexor hallucis longus transfer for acute ruptures has been associated with elevated re-rupture risk. GROWING POINTS:Minimally invasive percutaneous repair techniques continue to evolve and provide reliable outcomes without augmentation. The intrinsic regenerative capacity of the Achilles tendon remains the dominant determinant of outcome regardless of operative strategy. AREAS TIMELY FOR DEVELOPING RESEARCH:Well-powered randomized controlled trials with patient-centered outcomes are needed to evaluate whether any augmentation strategy offers clinically meaningful benefit in defined subgroups, such as patients with pre-existing tendinopathy, delayed presentation, or large-gap defects.
Introduction Musculoskeletal disorders frequently cause work disability. For low back pain, a de-medicalized approach is advocated, whereas a biomedical approach is taken for shoulder and elbow/forearm pain.Sources of data PubMed, Cochrane Library, Google Scholar.Areas of agreement Guidelines for the management of low back pain recommend de-medicalization, rapid mobilization, avoidance of imaging, second-line use of pharmacological treatments, and an emphasis on self-management and remaining in or rapidly returning to work.Areas of controversy Despite evidence for many treatment modalities, shoulder pain and elbow/forearm pain are still managed using a biomedical model that separates conditions into distinct diseases and treats them accordingly.Growing points Should pain at the shoulder and elbow/forearm be de-medicalized, with greater emphasis on maintaining mobility and work participation?Areas timely for developing research Testing integrated occupational and health interventions for musculoskeletal disorders, focusing on their effectiveness in work rehabilitation and reducing disability.
BACKGROUND:Residential greenness has been associated with health, but exposure to visible, functional, and accessible green may be associated with different health outcomes. SOURCES OF DATA:We searched Web of Science, PubMed, Scopus, and Embase for quantitative studies evaluating health in relation to specific green space exposures. AREAS OF AGREEMENT:There is evidence for associations between visible, functional, and accessible green space exposures and health, but most evidence is derived from observational studies. AREAS OF CONTROVERSY:High heterogeneity was found across studies with the possibility of publication bias. Some studies suggest stronger associations in low socioeconomic status and urban neighborhoods, but the evidence is inconclusive. GROWING POINTS:Quantitative and clinical evidence for health impacts of interventions focusing on improving visible, functional, and accessible green space exposure is limited and therefore causal relationships can usually not be inferred. AREAS TIMELY FOR DEVELOPING RESEARCH:Further research should include randomized controlled trials and consider different green space types, private green, spatial configuration, street network distances, and quality and use.
BACKGROUND:Muscle herniae are an uncommon distinct clinical entity within the broad spectrum of exercise-induced leg pain (EILP). Given the symptomatic overlap with other prevalent conditions and physicians' lack of familiarity, muscle herniae are frequently misdiagnosed, leading to ineffective therapeutic strategies. SOURCES OF DATA:We conducted a comprehensive review of the literature to analyze the pathophysiological mechanisms, diagnostic pitfalls, and therapeutic paradigms associated with muscle herniation in athletes. AREAS OF AGREEMENT:Standard static magnetic resonance imaging yields a high rate of false negatives. Dynamic ultrasonography is the diagnostic gold standard, allowing for real-time visualization of the fascial defect under load. AREAS OF CONTROVERSY:A 'surgical paradox' exists regarding surgical management: direct repair (closure) of the fascial defect increases intracompartmental pressure and risks to precipitate acute compartment syndrome, whereas surgeons historically debated the morbidity of open decompression. GROWING POINTS:Decompression fasciotomy, especially minimally invasive fasciotomy, have emerged as the safest and most effective solution for symptomatic patients, prioritizing functional decompression over anatomical restoration. AREAS TIMELY FOR DEVELOPING RESEARCH:Current guidelines rely predominantly on Level IV-V evidence. Future prospective comparative studies are needed to further standardize surgical indications and long-term outcomes.
INTRODUCTION:Scaffolds are being increasingly employed to enhance tissue regeneration, after the development of scaffold fabrication methods and utilization of different biomaterials in the manufacturing process. Blood derivatives are used to enhance tissue regeneration. We summarize recent advances in the field of biomaterials, fabrication methods of scaffolds, and platelet concentrates (PCs) as a source of regenerative blood compounds. We also evaluate the separate and combined use of biomaterials and PCs, and address the challenges of their future use. SOURCE OF DATA:PubMed, Scopus, and Google Scholar. AREAS OF AGREEMENT:The role of scaffolds and their development to enhance bone regeneration is well researched. Also, the cellular and macromolecular contents of PCs promote bone regenerative processes. AREAS OF CONTROVERSY:Lack of a universal preparation protocol for the production of first-generation PCs, contradictory results of animal studies for the second generation of PCs, and conflicting results of the effectiveness of some types of the third PCs generation on tissue regeneration. GROWING POINTS:More advanced techniques of scaffold fabrication, exploration of scaffold biomaterials to increase therapeutic characterization and to minimize unwanted effects, development of new PCs should promote bone regeneration in vivo and in vitro. The effects of combined use of scaffolds and PCs on bone regeneration should be investigated. AREAS TIMELY FOR DEVELOPING RESEARCH:Advanced generations of scaffold biomaterials and PCs are important to stimulate bone regeneration and minimize unwanted negative effects. Further research is needed in the production of scaffold biomaterials and PCs development, as well as their combined use.
INTRODUCTION OR BACKGROUND:Residual fatigue following resistance exercise can impair neuromuscular performance. The back squat (BSQ) and deadlift (DL) are key lower-limb exercises but may differ in their fatigue and recovery profiles. Identifying phase-specific markers during the countermovement jump (CMJ) may improve monitoring and guide recovery strategies. SOURCES OF DATA:Fifty-four resistance-trained adults (≥1 year experience) were randomly assigned to BSQ, DL, or control (CON) groups. After one-repetition maximum (1RM) estimation, BSQ and DL completed a fatiguing protocol (3 × 12 repetitions at 70% 1RM). CMJ performance was assessed at baseline, immediately, 30 min, and 24 h post-exercise using a force platform. Phase-specific force-time variables and the modified reactive strength index (RSImod) were calculated; muscle soreness was recorded at 24 and 48 h. AREAS OF AGREEMENT:Both BSQ and DL caused significant decrements in CMJ-derived metrics, as indicated by a linear mixed-effects model, and greater soreness than control, according to a two-way mixed analysis of variance (ANOVA). BSQ produced larger and earlier impairments across force, displacement, and work variables, whereas DL showed smaller but more persistent reductions in braking rate of force development (RFD) and RSImod. AREAS OF CONTROVERSY:Despite similar soreness, recovery patterns differed, indicating distinct neuromuscular demands and time courses between exercises. GROWING POINTS:Phase-specific CMJ metrics particularly braking and unloading RFD, eccentric/concentric work, and RSImod are sensitive indicators of residual fatigue. AREAS TIMELY FOR DEVELOPING RESEARCH:Future studies should integrate electromyographic and biochemical markers and extend observation beyond 48 h to describe full recovery trajectories.
INTRODUCTION:Bone healing is a multifaceted, true regenerative process that involves a dynamic interplay of molecular signals, cellular responses, and extracellular matrix remodeling. This review explores the critical roles of osteogenic culture medium components-including glutamine, β-glycerophosphate, L-ascorbic acid, pyruvate, and dexamethasone-to enhance osteogenesis. These components contribute to cell metabolism, differentiation, mineralization, and modulation of inflammation, making them essential for both in vitro bone tissue engineering and in vivo regeneration. SOURCE OF DATA:PubMed, Scopus, and Google Scholar. AREAS OF AGREEMENT:Recent studies have highlighted the superior osteoinductive potential of osteogenic medium over individual growth factors and its capability to stimulate endogenous repair when applied directly to fracture sites. Furthermore, we examine the molecular basis of bone healing and the translational significance of localized osteogenic medium delivery in critical-size bone defects. The synergistic interaction of these medium constituents not only facilitates stem cell differentiation and bone matrix formation but also promotes angiogenesis, mechanotransduction, and tissue remodeling. AREAS OF CONTROVERSY:While several studies have investigated the effects of osteogenic medium on bone healing, no conclusive or consistently reported controversial outcomes have been documented to date. GROWING POINTS:This integrative review underscores the therapeutic potential of osteogenic medium in regenerative medicine and encourages further investigation into its clinical application as a cost-effective, targeted alternative to conventional treatments. AREAS TIMELY FOR DEVELOPING RESEARCH:Continued research into optimized delivery systems and scaffold combinations may pave the way for more effective and novel therapies in complex skeletal injuries and orthopedic surgery.
BACKGROUND:Moral injury (MI), characterized by psychological distress from morally transgressive events, has been predominantly studied in military personnel but has gained increased attention in healthcare workers (HCWs) since the COVID-19 pandemic. SOURCES OF DATA:In this review, we narratively synthesize literature on the causes, risks, consequences, and interventions of MI in HCWs. AREAS OF AGREEMENT:There is consensus that the COVID-19 pandemic presented HCWs with unique challenges such as fear of infection and patients dying without family, which increased the risk of MI in HCWs. AREAS OF CONTROVERSY:Broader healthcare experiences, not unique to a pandemic, are less well understood. In this review, we discuss evidence of such experiences including restrictive practices in psychiatric settings and experiences of discrimination. GROWING POINTS:Recent studies have highlighted the importance of addressing MI through organizational change, training, and peer support initiatives. Emerging evidence also underscores the need to consider broader systemic factors, such as workplace culture and leadership, in mitigating MI. AREAS TIMELY FOR DEVELOPING RESEARCH:Future research should focus on longitudinal studies to explore in more detail risk factors for MI in HCWs. Additionally, there is a need for robust evaluations of interventions to prevent and treat MI and related disorders, including randomized controlled trials. Investigating the morally injurious effects of systemic issues like understaffing is particularly urgent as the field evolves beyond pandemic-specific challenges.
BACKGROUND:Marathon running has evolved into a global phenomenon, with rising participation across age and experience groups. Training for a marathon requires adherence to well-established principles involving pacing, training volume, and periodization. With the increasing integration of artificial intelligence (AI) into healthcare and fitness, it remains unclear whether AI can reliably prescribe evidence-based training programs for such demanding endurance events. SOURCES OF DATA:We conducted a descriptive study using outputs from leading AI models: Claude 3.5 Sonnet, Claude 3.5 Haiku (Free), ChatGPT 4.0 (o-model), ChatGPT 0.1, ChatGPT 4 (free), Gemini 2.0 Flash, Gemini 2.0 Flash Thinking, and DeepSeek R1. Each was prompted to generate a 6-month marathon training plan tailored to three athlete levels: Beginner, Intermediate, and Advanced. Outputs were compared with peer-reviewed literature on the determinants of marathon training. AREAS OF AGREEMENT:Most AI systems identified key training components: weekly mileage progression, tapering, and intensity distribution (>80% at low intensity), which aligns with current endurance training theory. AREAS OF CONTROVERSY:AI responses varied in accuracy and completeness. Some engines omitted key details (e.g. weekly mileage), failed to differentiate clearly between athlete levels (intermediate and advanced have been merged as if they were the same level), or offered inconsistent pacing data, especially for advanced runners. This descriptive analysis evaluated qualitative adherence to evidence-based training principles rather than quantitative outcomes requiring statistical inference. GROWING POINTS:AI demonstrates strong potential in accessible, structured training content. When properly prompted, outputs often align with contemporary training principles, though significant limitations regarding personalization and professional oversight necessitate further validation before clinical implementation. AREAS TIMELY FOR DEVELOPING RESEARCH:Future studies should evaluate the real-world outcomes of AI-generated programs in randomized trials including the integration of personal physiological data. Inizio moduloFine modulo.
BACKGROUND:Cystic echinococcosis (CE) poses a significant medical and socio-economic burden worldwide, particularly in highly endemic, low-income regions with resource-limited settings, where control efforts are hindered by limited access to diagnostics and appropriate treatment options. In contrast, low prevalence settings, such as high-income countries, often face challenges related to low awareness of the disease, which can lead to misdiagnosis and inappropriate treatments including potentially harmful invasive procedures. Therefore, it is recommended that an interdisciplinary approach be adopted to prevent misdiagnosis and treatment failure in CE, a chronic, but mostly benign and preventable zoonosis. This review provides an updated synthesis of current research on CE, focusing on its epidemiology, clinical management, and recommended strategies for improving outcomes in diverse healthcare settings. SOURCES OF DATA:Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases from the year 1980-2025. AREAS OF AGREEMENT:The World Health Organization (WHO) classification system for CE is based on ultrasound to assess cyst activity and size, thus facilitating the correct use of treatment options, including benzimidazole therapy, surgery and/or the PAIR technique.It is imperative to rule out CE before undertaking any invasive diagnostic procedures in order to prevent cystic dissemination. AREAS OF CONTROVERSY: GROWING POINTS:Given the lack of current updated guidelines this review gives a standardized overview over current recommendations for diagnosis and therapy. AREAS TIMELY FOR DEVELOPING RESEARCH:There is a need for more accurate, standardized diagnostic protocols and development of effective medical therapy and/or vaccines.
BACKGROUND:The 'walking Achilles tendon' technique can be safely adopted when the initial percutaneous repair fails to achieve sufficient grip in the proximal stump of the ruptured tendon. In such instances, two additional stab wounds are produced proximal to the initial most proximal ones to increase the tendon area available for suture grip. SOURCES OF DATA:A total of 36 patients had who sustained Achilles tendon rupture were included in the present study, divided in two groups: 'the walking on the Achilles tendon group' and 'traditional repair' group. AREAS OF AGREEMENT:There was no difference in the mean Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), calf circumference, isometric strength, time to return to sport, European Foot and Ankle Society Score (EFAS Score), and Patient-Reported Outcome Measures (PROMs) Piedade, between the patient group who underwent 'the walking on tendon technique' and the traditional suture. AREAS OF CONTROVERSY:Percutaneous management Achilles tendon rupture remains challenging with mixed results reported in the literature. GROWING POINTS:The results of the present investigation show that these additional steps, resulting in a total of nine stab wounds, add some time to the actual procedure, but produce comparable results to the seven stab wounds technique. AREAS TIMELY FOR DEVELOPING RESEARCH:The 'walking on the Achilles tendon' technique allows to easily and effectively overcome the poor hold in the proximal stump of the torn Achilles tendon which surgeon may occasionally encounter and continue to perform minimally invasive percutaneous Achilles tendon repair without the need to shift to open procedures.
