Search

Immediate implant-supported rehabilitation of atrophic maxillae with a fixed screw-retained prosthesis has to deal with the fixtures’ disparallelism and a high risk of fracture of the fixture-abutment connecting screw. After the flapless placement of six implants, with the distal ones inclined at more than 30° to bypass the sinus cavities and reduce the cantilever effects, the provisional prosthesis was immediately connected. The low-profile OT Equator attachment system enabled a trustworthy anchorage of the superstructure without the connection-screws allocation on the rear fixtures. Three months later, all implants were definitively loaded. The patient was monitored for two years follow-up. No problem arose during the whole treatment. The prosthesis maintained its stability and anchorage with complete functional and aesthetic results. No signs of periimplantitis or radiographically evident bone loss were noted. The OT Bridge system successfully simplified the immediate loading of all implants regardless of the inclination of the rear fixtures, avoiding a provisional mobile denture.

Abstract The primary objective of this study is to precisely characterize the behavior of double bracket-to-circular Hollow Section (CHS) column joints due to combined internal forces resulting from double tensile loading in opposite directions. In order to accomplish this goal, an experimental program consisting of eight test specimens has been carried out and numerical finite element modeling has been employed for the same specimens to analyze the stresses and deformations that occur within the vicinity of bracket-to-CHS joints. A total of 15 finite element models were constructed to simulate the initial study, addressing boundary conditions and facilitating verification and results comparison. The study included an investigation of various parameters, including the spacing between brackets in the longitudinal direction, as well as the depth-to-thickness ratio of the CHS columns and adding a T-stiffener to the bracket configuration. The study determined that an increase in the diameter-to-thickness ratio of the CHS columns significantly reduced the overall strength of the joint. Furthermore, findings suggested that increasing the longitudinal spacing between brackets resulted in an increase in single-bracket joint strength and a minor reduction regarding joint strength considering the effect of line loading. Moreover, adding a T-stiffener shape for the brackets enhanced the joint strength and prevented bracket tip fracture. In addition, a distinct behavior arises when considering joints with positive eccentricity, where the forces’ line of action extends beyond the circular cross-section of the CHS. In such cases, a reduction in joint strength is observed. Finally, a modification factor “A” is applied to the X-type branch plate-to-CHS strength equation presented by the AISC360-22 to account for the longitudinal spacing between brackets.

The iron-based powder metallurgy materials were sintered and brazed with the water atomized Ancorbraze 72 (AB72) powders. The wettability and penetration depth of the brazing materials were studied by brazing material pretreatment and changing sintering atmosphere. The results show that, with the increase of pretreatment temperature, the maximum diameter of brazing residue on the matrix surface decreases obviously, and the diffusion range of brazing material at 1000 μm away from the wetting surface decreases gradually. When the pretreatment temperature is 800 ℃, the brazing residue is the least, the diffusion range is the least at 1000 μm away from the wetting surface, and the pretreatment effect is the best. When the pretreatment temperature is 800 ℃, the treatment time is 2 h, and the treatment atmosphere is 75%N2+25%H2 (volume fraction), the residue on the brazing surface is less, and the diffusion range of the brazing materials is the smallest at 1000 μm away from the wetting surface. A certain amount of endothermic atmosphere during the sintering brazing can obviously improve the penetration of brazing materials in the matrix. When the flow rate of endothermic atmosphere is 20 m3∙h−1, the improvement of wetting angle and penetration depth is the best.

Purpose: Growing interest surrounds the role of human gut microbiome in the development of degenerative pathologies such as osteoarthritis (OA), but microbes have recently been detected also in other sites previously considered to be sterile. Evidence emerged suggesting that even native and osteoarthritic knee joints may host several microbial species possibly involved in the osteoarthritic degeneration. This is the first systematic review critically collecting all the available evidence on the existence and composition of knee intra-articular microbiome. Methods: A systematic research on the PubMed, Cochrane and Google Scholar databases was performed. Human clinical studies investigating the presence of intra-articular microbiome in native osteoarthritic knee joints with next-generation sequencing techniques were collected. Results: A total of eight studies were included reporting data on 255 knees. All the included studies reported evidence supporting the existence of an intra-articular microbiome in native knee joints, with detection rates varying from 5.8% to 100%. Bacteria from the Proteobacteria phylum were found to be among the most identified followed by the Actinobacteria, Firmicutes, Fusobacteria, and Bacteroideta phyla. Proteobacteria phylum were also found to be more common in osteoarthritic knees when compared to healthy joints. Furthermore, several pathways correlating those microbes to knee OA progression have been suggested and summarized in this review. Conclusions: Evidence collected in this systematic review suggests that the native knee joint, previously presumed to be a sterile environment, hosts a peculiar intra-articular microbiome with a unique composition. Furthermore, its alteration may have a link with the progression of knee osteoarthritis.

Abstract Background Fungal periprosthetic joint infection (FPJI) is an infrequent but devastating complication that imposes a heavy burden on patients. At present, a consensus regarding the most optimal surgical option for patients with FPJI, the ideal duration of systemic antifungal treatment, and many other issues has not been reached. Methods A comprehensive literature search was performed on the PubMed and Embase databases. The search criteria employed were as follows: (fungal OR candida OR mycotic) AND periprosthetic joint infection. Initially, the titles and abstracts were screened, and subsequently, studies deemed irrelevant or duplicative were eliminated. Following this, the complete texts of remaining articles were thoroughly examined. According to the inclusion and exclusion criteria, 489 joints in 24 articles were screened out. We further extracted the demographic characteristics (age, gender, body mass index, etc.), clinical presentation, fungal species, presence of bacterial coinfection, surgical methods, systemic and local antifungal therapy, and treatment outcomes. Subgroup data were analyzed according to fungal species and bacterial coinfection. Univariate logistic regression analysis was conducted to ascertain the risk factors associated with the infection recurrence. Results A total of 506 fungi were identified within 489 joints. The most prevalent fungal species were Candida albicans (41.5%). Out of 247 joints (50.5%) presenting with concurrent fungal and bacterial infections. Among the initial surgical interventions, two-stage exchange was the most common (59.1%). The infection recurrence rates of DAIR, resection arthroplasty, two-stage, one-stage, and three-stage exchange were 81.4%, 53.1%, 47.7%, 35.0%, and 30%, respectively. The mean duration of systemic antifungal therapy was 12.8 weeks. The most common drugs used both in intravenous (55.9%) and oral therapy (84.0%) were fluconazole. The proportion of patients who used antifungal drugs after replantation (two-stage and three-stage) was 87.6%. 33.2% of cement spacer or fixed cement contained antifungal drugs, of which amphotericin B was the main choice (82.7%). FPJI caused by candida albicans (OR = 1.717, p = 0.041) and DAIR (OR = 8.433, p = 0.003) were risk factors for infection recurrence. Conclusions Two-stage exchange remains the most commonly used surgical approach. The reliability of one- and three-exchange needs further evaluation due to the small sample size. Antifungal-loaded cement spacers, and direct intra-articular injections of antimycotics after reimplatation should be strongly considered. Medication is not standardized but rather individualized according to microbiology and the status of patients.

Purpose: The aim of this study was to investigate the efficacy of calcitonin (CT) in animal models of experimental osteoarthritis (OA) and rheumatoid arthritis (RA), as new stabilized CT formulations are currently being introduced. Methods: A comprehensive and systemic literature search was conducted in PubMed/MEDLINE and Embase databases to identify articles with original data on CT treatment of preclinical OA and RA. Methodological quality was assessed using the Systematic Review Centre for Laboratory Animal Experimentation’s risk of bias tool for animal intervention studies. To provide summary estimates of efficacy, a meta-analysis was conducted for outcomes reported in four or more studies, using a random-effects model. Subgroup analyses were employed to correct for study specifics. Results: Twenty-six studies were ultimately evaluated and data from 16 studies could be analyzed in the meta-analysis, which included the following outcomes: bone mineral density, bone volume, levels of cross-linked C-telopeptide of type I collagen, histopathological arthritis score, and mechanical allodynia. For all considered outcome parameters, CT-treated groups were significantly superior to control groups (P = 0.002; P = 0.01; P < 0.00001; P < 0.00001; P = 0.04). For most outcomes, effect sizes were significantly greater in OA than in RA (P ≤ 0.025). High in-between study heterogeneity was detected. Conclusion: There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage-and bone-protective effect of CT in RA and OA. Given these effects, CT presents a promising agent for the treatment of both diseases, although the potential seems to be greater in OA.

Background and aims: With possible treatments for a variety of musculoskeletal disorders, stem cell therapy has become a highly promising field in orthopaedics. By utilizing the body's natural ability to heal, stem cell treatment provides a regenerative method for repairing and regenerating damaged tissues. The function of stem cells in orthopaedics and sports injuries is thoroughly reviewed in this review paper, which also discusses future possibilities for clinical research and practice as well as possible applications and mechanisms of action. Methods: The literature was searched using the keywords “Stem Cells” AND “Orthopedics” OR “Orthopaedics” OR “Sports Medicine” in the databases of PubMed, Scopus, and Google Scholar. This review included the pertinent literature was included in this review. Results: We have summarised the up-to-date knowledge about various aspects of stem cells in Orthopaedics and Sports injuries viz. stem cell types, mechanism of action, clinical applications, recent advances, research, ethical aspects and future directions. We have identified the potential research areas and research gaps in stem cell science related to musculoskeletal problems. Conclusion: Stem cell therapy represents a paradigm shift in orthopaedic medicine, offering regenerative solutions for a range of musculoskeletal conditions and sports injuries. From regenerating damaged tissues to enhancing athletic performance and recovery, stem cell therapy offers novel solutions to age-old challenges. The integration of stem cell technologies into orthopaedic practice holds promise for improving patient outcomes, reducing healthcare costs, and addressing unmet clinical needs in the management of musculoskeletal disorders.

Solitary fibrous tumors (SFTs) are classified as fibroblastic/myofibroblastic tumors that originate from CD34-positive dendritic cells and usually occur in the pleura. In this paper, we describe a case of SFT within the joint cavity of the left knee. A 60-year-old man was admitted to hospital due to swelling in the left knee for the past 8 months without relevant trauma history. X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–computed tomography (PET-CT) presented a large, ill-circumscribed, hypervascular, and highly enhanced mass with eccentric calcification and peripheral, intra-lesional vessels. Subsequently, the patient underwent surgical resection. Postoperative pathology confirmed the neoplastic cells to be positive for CD34, Bcl-2, and SATA6, therefore was finally diagnosed as malignant SFT. The patient developed bone metastases within 1 year after surgery. SFT in the joint cavity is rare, and it is difficult to make a preoperative diagnosis.

Background: Recurrent hemarthrosis and resultant hemophilic arthropathy are significant causes of morbidity in persons with hemophilia, despite the marked evolution of hemophilia care. Prevention, timely diagnosis, and treatment of bleeding episodes are key. However, a physical examination or a patient’s assessment of musculoskeletal pain may not accurately identify a joint bleed. This difficulty is compounded as hemophilic arthropathy progresses. Objectives: Our system aims to utilize artificial intelligence and ultrasonography (US; point-of-care and handheld) to enable providers, and ultimately patients, to detect joint bleeds at the bedside and at home. We aimed to develop and assess the reliability of artificial intelligence algorithms in detecting and segmenting synovial recess distension (SRD; an indicator of disease activity) on US images of adult and pediatric knee, elbow, and ankle joints. Methods: A total of 12,145 joint exams, comprising 61,501 US images from 7 international healthcare centers, were collected. The dataset included healthy participants and adult and pediatric persons with hemophilia, with and without SRD. Images were manually labeled by 2 experts and used to train binary convolutional neural network classifiers and segmentation models. Metrics to evaluate performance included accuracy, sensitivity, specificity, and area under the curve. Results: The algorithms exhibited high performance across all joints and all cohorts. Specifically, the knee model showed an accuracy of 97%, sensitivity of 96%, specificity of 97%, and an area under the curve of 0.97 in SRD. High Dice coefficients (80%-85%) were achieved in segmentation tasks across all joints. Conclusion: This technology could assist with the early detection and management of hemarthrosis in hemophilia.

ObjectiveThis study aimed to compare the imaging features of bilateral knees, ankles, and the first metatarsophalangeal joint using high-frequency ultrasonography in male patients with familial and sporadic primary gout and sought to elucidate the relationship between the presence of tophi and various clinical indicators.MethodMale patients with primary gouty arthritis (GA) in the acute phase presenting to the Department of Rheumatology and Immunology at the First Affiliated Hospital of Chengdu Medical College from November 2020 to June 2022 were enrolled and classified into familial and sporadic gout groups. Comparative analyses of their clinical data and ultrasonographic imaging findings of the knees, ankles, and first metatarsophalangeal joints were performed between the groups. Univariate and multivariate logistic regression analyses, as well as receiver operating characteristic (ROC) analysis, were conducted to determine the effectiveness of significant factors in the prediction of tophi.ResultIn comparison to male patients with sporadic gout, those with familial primary gout exhibited lower age, body mass index, disease duration, and serum uric acid (SUA) levels. However, they demonstrated higher incidences of tophi and bone erosion (54.6% in familial gout vs. 35.1% in sporadic gout, p

Abstract Background Several studies have compared the pros and cons of simultaneous bilateral versus staged bilateral hip and knee replacement but the outcomes of these two surgical options remains a matter of controversy. This study aimed to evaluate demographic features, incidence and hospitalization rates of bilateral one stage total hip and knee arthroplasty in Italy. Methods The Italian Ministry of Health’s National Hospital Discharge Reports (SDO) were used to gather data. This study referred to the adult population (+ 20 years of age) from 2001 to 2015 for hip arthroplasty and from 2001 to 2016 for knee arthroplasty. Results Overall, 1,544 bilateral simultaneous hip replacement were carried out. The incidence rate was 0.21 cases per 100,000 adult Italian residents. Male/female ratio was 1.1. The average days of hospital stay was 11.7 ± 11.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, pelvic region and thigh (ICD code: 715.15). 2,851 bilateral simultaneous knee replacement were carried out. The incidence rate was 0.37 cases per 100,000 adult Italian residents. Male/female ratio was 0.6. The average days of hospital stay was 7.7 ± 5.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, lower leg (ICD code: 715.16). Conclusions The burden of hip and knee osteoarthrosis as a leading cause of bilateral joint replacement is significant in Italy. The national registers’ longitudinal analysis may provide data for establishing international guidelines regarding the appropriate indications for one stage bilateral simultaneous hip or knee replacement versus two stage.

Coxofemoral luxation or hip joint luxation is the most commonly occurring injury in dogs and cats. There are different methods in treating this case with different outcomes, toggle pin stabilization technique is one of them. This study aimed to evaluate metal suture with fabricated toggle pin as prosthetic round ligament (teres ligament) for the treatment of hip joint luxation in dogs. The experimental study was conducted of five adult mongrel dogs induced coxofemoral luxation (hip luxation) under general anesthesia, then the induced luxation was reduced by using a fabricated toggle pin from a Steinman pin with metal suture passed through a femero-acetabular tunnel created by electrical drill started from third trochanter and exits at the acetabular fossa passing through the fovea capitis. All experimental animals were followed up clinically for six weeks at two intervals (day 14th, and day 42nd), and radiologically for six weeks at three intervals at day zero, day 28th, and day 42nd. All experimental animals were bearing weight on the affected limb the next day after surgery. The lameness score of all cases was 0/5 representing normal gait at both two- and six-week intervals. The radiological results showed a good reduction in luxated limb along the period of the study. In conclusion, a fabricated toggle pin with metal suture is a good stabilizer for hip luxation cases and provides a rigid fixation for the joint.

The vascular and lymphatic systems are integral to maintaining skeletal homeostasis and responding to pathological conditions in bone and joint tissues. This review explores the interplay between blood vessels and lymphatic vessels in bones and joints, focusing on their roles in homeostasis, regeneration, and disease progression. Type H blood vessels, characterized by high expression of CD31 and endomucin, are crucial for coupling angiogenesis with osteogenesis, thus supporting bone homeostasis and repair. These vessels facilitate nutrient delivery and waste removal, and their dysfunction can lead to conditions such as ischemia and arthritis. Recent discoveries have highlighted the presence and significance of lymphatic vessels within bone tissue, challenging the traditional view that bones are devoid of lymphatics. Lymphatic vessels contribute to interstitial fluid regulation, immune cell trafficking, and tissue repair through lymphangiocrine signaling. The pathological alterations in these networks are closely linked to inflammatory joint diseases, emphasizing the need for further research into their co-regulatory mechanisms. This comprehensive review summarizes the current understanding of the structural and functional aspects of vascular and lymphatic networks in bone and joint tissues, their roles in homeostasis, and the implications of their dysfunction in disease. By elucidating the dynamic interactions between these systems, we aim to enhance the understanding of their contributions to skeletal health and disease, potentially informing the development of targeted therapeutic strategies.

Objective: Osteoarthritis prevalence differs between women and men; whether this is the result of differences in pre-morbid articular or peri-articular anatomical morphotypes remains enigmatic. Albeit sex within humans cannot be reduced to female/male, this review focusses to the sexual dimorphism of peri-articular tissues, given lack of literature on non-binary subjects. Methods: Based on a Pubmed search and input from experts, we selected relevant articles based on the authors’ judgement of relevance, interest, and quality; no “hard” bibliometric measures were used to evaluate the quality or importance of the work. Emphasis was on clinical studies, with most (imaging) data being available for the knee and thigh. Results: The literature on sexual dimorphism of peri-articular tissues is reviewed: 1) bone size/shape, 2) subchondral/subarticular bone, 3) synovial membrane and infra-patellar fad-pad (IPFP), 4) muscle/adipose tissue, and 5) peri-articular tissue response to treatment. Conclusions: Relevant sex-specific differences exist for 3D bone shape and IPFP size, even after normalization to body weight. Presence of effusion- and Hoffa-synovitis is associated with greater risk of incident knee osteoarthritis in overweight women, but not in men. When normalized to bone size, men exhibit greater muscle, and women greater adipose tissue measures relative to the opposite sex. Reduced thigh muscle specific strength is associated with incident knee osteoarthritis and knee replacement in women, but not in men. These observations may explain why women with muscle strength deficits have a poorer prognosis than men with similar deficits. A “one size/sex fits all” approach must be urgently abandoned in osteoarthritis research.

Background The objective of this study was to compare and analyze the representative opening and closing movement of Tai Chi elastic band exercise with the reverse fly movement of elastic band resistance training. The aim was to explore the biomechanical differences between the two exercises and provide theoretical support for the application of Tai Chi elastic band exercise in health intervention. Methods A total of 26 male participants were recruited and randomly divided into two groups in a 1:1 ratio. There were 13 participants in each Tai Chi elastic band exercise group and elastic band resistance training group. Both groups of participants used an elastic band to perform movement in the experiment. Experimental data were collected using the Vicon infrared motion capture system and Delsys surface EMG system. The AnyBody software was utilized to simulate the creation of a musculoskeletal model for both exercises. Result The study found that the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angle and flexion angle of the shoulder joint, as well as normalized RMS of the anterior deltoid and triceps brachii, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited greater elbow flexion angle, elbow flexion torque, and muscle strength of the infraspinatus, coracobrachialis, biceps brachii, brachialis and brachioradialis, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angular velocity of the shoulder joint and a lower normalized RMS of the posterior deltoid, compared to the elastic band resistance training group (P < 0.05). Conclusion (1) The opening and closing movement of Tai Chi elastic band exercise is characterized by a large elbow flexion angle, a small shoulder joint horizontal angle and flexion angle, and a slow and uniform speed of movement. The reverse fly movement of elastic band resistance training is characterized by a large horizontal abduction angle of the shoulder joint, a large flexion angle of the shoulder joint, a small flexion angle of the elbow joint, and a fast and uneven speed. (2) The opening and closing movement exerts a greater torque on the elbow flexion, while the reverse fly movement exerts a greater torque on the shoulder joint horizontal abduction and external rotation. (3) The opening and closing movement provide greater stimulation to the infraspinatus, coracobrachialis, and elbow flexor, while the reverse fly movement provides greater stimulation to the posterior deltoid, anterior deltoid, subscapularis, and elbow extensor. In summary, the variation in joint angle, joint angular velocity, and hand position could be the factor contributing to the differences in joint torque and muscle activity between the opening and closing movement of Tai Chi elastic band exercise and the reverse fly movement of elastic band resistance training.

Mammalian cells produce and metabolize almost exclusively L-lactate, bacterial species have the capacity to produce both D-lactate and L-lactate. The aim of this study was to evaluate the intrinsic production of D- and L-lactate in the most common pathogenic microorganisms causing septic arthritis (SA) and periprosthetic joint infection (PJI) as a potential biomarker for the diagnosis of infection. Following microorganisms were grown according to ATCC culture guides and tested for production of D- and L-lactate: Staphylococcus aureus (ATCC 43300), Staphylococcus epidermidis (ATCC 35984), Enterococcus faecalis (ATCC 19433), Streptococcus pyogenes (ATCC 19615), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Cutibacterium acnes (ATCC 11827), and Candida albicans (ATCC 90028). Pathogens were inoculated in 8 ml of appropriate liquid media and incubated as planktonic or biofilm form in either aerobic, anaerobic or CO2 atmosphere up to 312 h. D- and L-lactate measurements were performed at different time points: 0, 6, 9, 12 and 24 h, then once per day for slow-growing pathogens. Samples were serially diluted and plated for colony counting. Liquid culture media without microorganisms served as a negative control. Production of D-lactate was observed in all tested microorganisms, whereas no L-lactate was detected in E. coli, P. aeruginosa, and C. albicans. Maximal concentration of D-lactate was produced by S. aureus (10.99 mmol/L), followed by E. coli (1.22 mmol/L), and S. epidermidis (0.48 mmol/L). Maximal L-lactate concentration was observed in S. pyogenes (10.12 mmol/L), followed by S. aureus (9.71 mmol/L), E. faecalis (2.64 mmol/L), and S. epidermidis (2.50 mmol/L). S. epidermidis bacterial biofilm produced significantly higher amount of D- and L-lactate compared to planktonic form (p = 0.015 and p = 0.002, respectively). Our study has demonstrated that the most common pathogenic microorganisms causing SA and PJI have the capability to generate measurable amounts of D-lactate in both planktonic and biofilm form, highlighting the practical value of this biomarker as an indicator for bacterial and fungal infections. In contrast to D-lactate, the absence of L-lactate production in certain tested bacteria, as well as in fungi, suggests that L-lactate is not eligible as a biomarker for diagnosing microbial infections.

Background and objective: Osteoarthritis (OA) is the most common age-related disease of joints with increasing global prevalence. Persistent inflammation within the joint space is speculated to be the cause of OA. Resveratrol is an anti-inflammatory and antioxidant compound which can influence cartilage metabolism through multiple signalling pathways. This systematic review and meta-analysis aimed to summarize the therapeutic effects of resveratrol in animal models of OA. Methods: A comprehensive literature search was performed using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Wanfang and VIP databases in May 2023. Studies on the effects of resveratrol in animal models of OA written in English or Mandarin, published from the inception of databases until the date of the search were considered. Results: Fifteen eligibility studies were included and analysed. Resveratrol was shown to inhibit the secretion of interleukin-1β, tumour necrosis factor-α, interleukin-6, nitric oxide, and apoptosis of articular chondrocytes. Joint structure as indicated by Mankin scores was restored with resveratrol in animal OA models. Conclusion: Resveratrol is a potential therapeutic agent for OA based on animal studies. Further evidence from well-planned human studies would be required to validate its clinical efficacies.

Abstract Introduction Evaluate the real-world efficacy of a single intra-articular injection of carboxymethyl-chitosan (CM-chitosan), a new product class for knee osteoarthritis (OA). Methods This post-marketing study included adult patients with knee OA, who received a single injection of 60 mg CM-chitosan (currently marketed as KioMedinevsone) according to the instructions for use. Follow-up was performed at weeks 1, 12, 24, and 36. Efficacy was evaluated using a Visual Analog Scale (VAS) score for pain, the Knee injury and Osteoarthritis Outcome Score (KOOS), Patient’s Global Assessment (PGA), and overall patient satisfaction. Results Forty-nine patients were included in the study. VAS pain score significantly decreased from a median of 49.0 mm at baseline to 24.0 mm at week 1 and to 18 mm at week 36. Pain improvement was stable since at week 36; 91.8% of patients confirmed pain reduction. All KOOS subscales (symptoms, pain, activities of daily living, sports and recreational activities, quality of life) improved significantly compared to baseline at all time points. KOOS pain improved progressively from a median of 58.3% at baseline (mean 56.2 ± 18.8%) to 86.1% (mean 74.1 ± 24%) at week 36 compared to baseline. Overall, more than 70% of patients reported a condition gain (PGA), matching well with the more than 75% of patients being satisfied with the treatment. At 6 months, 72.7% of the patients could be classified as responder according to the OMERACT-OARSI proposed set of responder criteria. Conclusion CM-chitosan showed a rapid onset of pain relief after 1 week and with a duration of 9 months. In a real-world setting, treatment with CM-chitosan would appear to be a potentially effective option to reduce pain and improve physical function and global condition in patients with knee OA, opening new perspectives in patients who are considered as refractory to current symptomatic therapies and where the unmet need is high. Trial Registration Number NCT04757051 (ClinicalTrials.gov).

This study experimentally investigated the effects of selected factors on the bending moment capacity (BMC) of case furniture joints. The main aim was to explore mixed applications of wood-based materials and fasteners in manufacturing case furniture to reduce material costs. The study examined the effects of the face member material—particle board (PB), plywood (PL), and block board (BB)—edge member material (PB, PL, and BB), and joint shape (T-shape and L-shape) on BMC. Additionally, the study evaluated the effects of joint type (two eccentrics (TE), two dowels (TD), and one eccentric and one dowel (ED)), and material type (PB, PL, and BB) on BMC for L-shaped joints. The results showed that joint shape and face member material significantly affected the BMC of case furniture joint. The BMCs of T-shaped joints were significantly greater than those of L-shaped joints, regardless of the material of the face and edge members, except when the face member was made of PL. For L-shaped joints with PL face members, the BMCs were significantly higher compared to others. Joints constructed with TE exhibited significantly higher BMC compared to ED and TD for the same material type. For PB, TE joints exhibited an increase of approximately 3.0 Nm and 2.0 Nm compared to TD and ED, respectively. For PL, TE showed an increase of 9.1 Nm and 4.1 Nm compared to ED and TD, respectively. For BB, the increases were 7.0 Nm and 6.6 Nm compared to ED and TD. The BMC of joints made with PL and constructed with TE and ED was significantly greater than those of BB, followed by PB. However, for joints assembled with TD, there was no significant difference among the three materials. The ratios of BMC for joints constructed with ED compared to the half-sum of TE and TD were 0.73, 1.04, and 0.79 for PB, PL, and BB, respectively. These results suggest that the face member material predominantly influences the BMC of case furniture joints, indicating the potential to reduce costs by combining different materials and joint types.

This paper addresses the problem of mitigating unknown partial path overlaps in communication systems. This study demonstrates that by utilizing the front-end insight of communication systems along with the sum–product algorithm applied to factor graphs, it is possible not only to track these overlapping components accurately, but also to detect all multipath channel impairments simultaneously. The proposed methodology involves discretizing channel parameters, such as channel paths and attenuation coefficients, to ensure the most accurate computation of means of Gaussian observations. These parameters are modeled as Bernoulli random variables with priors set to 0.5. A notable aspect of the algorithm is its integration of the received signal power into the calculation of noise variance, which is critical for its performance. To further reduce the receiver complexity, a novel implementation strategy, based on provided pre-defined look up tables (LOTs) to the reciver, is introduced. The simulation results, covering both distributed and concentrated pilot scenarios, reveal that the algorithm performs almost equally under both conditions and surpasses the established upper bound in performance.

Tuberculosis is a chronic infectious disease, caused by Mycobacterium tuberculosis, that seriously endangers human health. Skeletal tuberculosis is the most common type of extrapulmonary tuberculosis and tuberculous arthritis is the second most common type of skeletal tuberculosis. We report a case series of patients with tuberculous arthritis, two of whom had no joint disease in the past and presented as monoarthritis. The final patient had a history of rheumatoid arthritis, with polyarthritis that was aggravated during treatment with glucocorticoids and immunosuppressive drugs. This series of cases can contribute to early diagnosis and treatment with appropriate infection control measures.

ABSTRACT Cancer cases and survival have increased significantly in recent decades. Objective: In this study, we sought to evidence whether bone, joint and cartilage neoplasms are increasing with the aging of the Brazilian population, using the analysis of the DATASUS and IBGE databases, between 1979 and 2020. Methods: We compared the means and the proportion of death in Brazil, to observe the confidence interval overlaps, separated by region. Comparison between genders, age group, death and specific rate were compared via proportion tests and the trend was investigated via time series analysis. Results: Through the analyses, we can see that there is an increasing trend of cases, about 2.5 times in the period. Separated by region, the Southeast stands out, with a number of deaths about 6 times higher than other regions. Conclusion: Metastatic carcinoma is the most common neoplasm treated by orthopedic surgeons, and it is essential to adapt to this future projection, with cases of pathological bone involvement resulting from metastatic carcinomas, increasingly present in the routine of orthopedic surgeons. Level of Evidence IV, Cross-Sectional Observational Study.

The drawing force of the steel wire rope in the joint area of the conveyor belt is an important indicator to measure the bearing capacity of the joint. At present, research on the joint of steel wire rope core conveyor belt mainly focuses on the structural parameters of the joint, vulcanization process, and adhesive performance of the rubber material. It has not pointed out the influence of lap length on the load-bearing capacity of the joint. To study the influence of lap length on the load-bearing capacity of steel wire rope core conveyor belt joints, the st1250 steel wire rope core conveyor belt is taken as the research object. A joint model is established by taking a single steel wire rope part at the conveyor belt joint. The bilinear cohesive zone model is used to simulate the bonding state between the steel wire rope and rubber. The model parameters are obtained through tangential tensile shear tests and normal tensile tests. By combining the bilinear cohesive zone model with the steel wire rope rubber contact interface, a simulation analysis is conducted on the damage evolution process of a single steel wire rope detached from rubber in a joint. It is found that the joint damage evolution process can be divided into four stages: linear loading, damage initiation, damage propagation, and complete failure. Moreover, the joint damage failure curve is consistent with the traction displacement curve of the bilinear cohesive zone model. It verifies that the bilinear cohesive zone model can effectively simulate the damage failure process of steel wire rope core conveyor belt joints. Simulation is conducted on joint models with different lap lengths. It is found that as the lap length increases from 350 mm to 750 mm, the overall stiffness of the joint shows a non-linear increase, and the maximum shear stress on the joint rubber shows a decreasing trend. Therefore, it is determined that the range of lap length should be controlled within 350 mm to 750 mm. The influence of lap length on joint bearing capacity under different wire rope diameters is simulated. The results show that the drawing force of wire rope increases nonlinearly with the increase of lap length. The larger the diameter of the steel wire rope, the greater the increase in the drawing force of the joint steel wire rope with the increase of the lap length. The functional relationship between joint lap length and single wire rope drawing force under different wire rope diameters is fitted, providing a theoretical basis for the rational selection of joint lap length under different bearing capacity requirements.

Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.

Background: The purpose of our study was to compare the outcomes and complications after a two- vs. six-week duration of sling immobilization following reverse total shoulder arthroplasty (rTSA). Methods: We conducted a retrospective review from our institutional database on 960 patients treated by primary rTSA between 2011 and 2021. Patients were separated into two cohorts of postoperative sling immobilization (a two-week and six-week group). Multivariate analysis was conducted to evaluate what factors were associated with patients experiencing either a postoperative complication or requiring reoperation. Results: A total of 276 patients were instructed to keep their operative arm in a sling for six weeks postoperatively, and 684 patients discontinued use at two weeks. There was no difference in postoperative complication rate (15.0% vs. 12.0%, P = .21), dislocation rate (P = .79), acromion stress fractures (P = .06), implant loosening (P = .15), and periprosthetic joint infections (P = .48) between the six- and two-week sling cohorts. In the immediate 90-day postoperative time period, no difference was seen in the reoperation rates (P = .73). Discussion: Shorter duration of sling immobilization (two weeks) does not incur additional risk of complications compared to standard duration (six weeks) of sling immobilization following rTSA.

Due to its properties, glass is a material that is increasingly used in technical practices in cluding construction and architecture. Products that combine both glass and metal are often used in the construction industry. Nowadays, modern methods of joining these materials are being sought, which include gluing. Bonding is a multi-step process that is affected by both internal and external factors. The resulting quality of the joint, which can be evaluated by destructive and non-destructive tests, is important for the application of a glued joint that is exposed to external stress. The presented article deals with the analysis of the effect of pre-treatment on selected properties of the bonded glass-metal pair using selected methods of destructive testing.

Background and Study Aim. Neuromuscular and joint deep sensation adaptations have been linked to functional alterations and skill acquisition after body vibration training via muscular recruitment, coordination of motor units, and enhanced neural activation. The aim of the current study is to explore the effect of upper body vibration on shoulder joint active position sense in healthy female university students. Material and Methods. Sixty healthy female university students were distributed into two equal groups; 30 subjects in the control group (mean age 21 ± 2.2) and 30 subjects in the experimental group (mean age 20.9 ± 2.3). The shoulder joint active position sense was evaluated using Biodex Isokinetic Dynamometer Multi-Joint System 4 pro. In addition, the Power Plate ® Whole Body Vibration device was used as an intervention method from the push-up position. Results. After three vibration exposures of 60 seconds for each, the MANOVA test showed statistically significant differences in the average error scores of active joint position senses of shoulder external rotation only in the pre-post-test of the experimental group (p= .000). Moreover, the statistically significant difference was detected in the average error scores of shoulders external rotation in post-treatment intervention between both groups (p= .000). Conclusions. These results suggested that short-term vibration training may reveal an improvement in shoulder joint active position sense, particularly the shoulder external rotation. The use of vibration training to improve shoulder awareness and reduce the risk of injury when the shoulder externally rotates during different functions may therefore be advocated to physiotherapists.

Prosthesis loosening due to lack of osteointegration between an implant and surrounding bone tissue is one of the most common causes of implant failure. Further, bacterial contamination and biofilm formation onto implants represent a serious complication after surgery. The enhancement of osteointegration can be achieved by using bioconductive materials that promote biological responses in the body, stimulating bone growth and thus bonding to tissue. Through the incorporation of antibacterial substances in bioconductive, biodegradable calcium phosphate (CaP) coatings, faster osteointegration and bactericidal properties can be achieved. In this study, Cu-doped CaP supraparticles are spray-dried and suspension-sprayed CaP ceramic coatings with antibacterial properties are prepared using high-velocity suspension flame spraying (HVSFS). The objective was to increase the coatings’ porosity and investigate which Cu-doped supraparticles have the strongest antibacterial properties when introduced into the coating layers. Biocompatibility was tested on human Osteosarcoma cells MG63. A porosity of at least 13% was achieved and the supraparticles could be implemented, enhancing it up to 16%. The results showed that the addition of Cu-doped supraparticles did not significantly reduce the number of viable cells compared to the Cu-free sample, demonstrating good biocompatibility. The antimicrobial activity was assessed against the bacterial strains Escherichia coli and Staphylococcus aureus, with Safe Airborne Antibacterial testing showing a significant reduction in both Gram-positive and Gram-negative strains on the Cu-doped coatings.

Scintigraphy and Positron Emission Tomography (PET) are both nuclear medicine imaging techniques, providing functional information of the imaged areas. Scintigraphy is a two-dimensional projected imaging technique that was introduced in equine imaging in the late 1970s. Scintigraphy allows imaging of large body parts and can cover multiple areas, remaining the only technique commonly used in horses for whole body imaging. PET is a cross-sectional imaging technique, first used in horses in 2015, allowing higher resolution three-dimensional functional imaging of the equine distal limb. This manuscript will cover current use and values of these two modalities in equine lameness diagnosis.

Abstract Background Rheumatoid arthritis (RA) has a variable impact on different synovial joints, with inflammation being more commonly observed in some joints than others. Emerging evidence suggests that the anatomical variation in pathophysiology could result in differential responses to treatments across the joints, both within and between modes of action. This analysis aimed to characterize joint-specific responses to tofacitinib and methotrexate monotherapy in patients with RA. Methods This was a post hoc analysis of data from the phase III trial ORAL Start (NCT01039688), in methotrexate-naïve patients with RA. A paired joint pathology score (PJPS), derived from bilateral tender/swollen joint counts, was calculated. The percentage change from baseline in PJPS (%∆PJPS) and treatment-specific responses (tofacitinib 5 and 10 mg twice daily [BID] vs methotrexate; tofacitinib 5 vs 10 mg BID) for each patient joint pair, except for those with baseline/post-baseline PJPS = 0, were calculated at month 3, month 6, and month 12. Radiographic progression was similarly assessed using the Modified Total Sharp Score at month 6 and month 12. Results In methotrexate-naïve patients, differences in %∆PJPS demonstrated greater responses with tofacitinib vs methotrexate in most joint locations. Lesser responses with tofacitinib vs methotrexate were observed in most joints of the feet, particularly at month 12. Despite this, radiographic progression at month 12 was significantly worse in the foot (and metacarpophalangeal) joints of patients receiving methotrexate vs tofacitinib. Conclusion We observed variation in joint-specific responses with tofacitinib and methotrexate monotherapy. Despite a proximal–distal efficacy gradient, with better clinical responses in the feet, patients receiving methotrexate monotherapy demonstrated more radiographic progression in the foot joints compared with those receiving tofacitinib. These findings suggest that body site- and therapy-specific characteristics may interact to produce differential treatment responses. Trial registration ClinicalTrials.gov, NCT01039688.

Holes and joints are widespread and coexisting flaws in natural rock. The spatial distribution of combined flaw significantly affects the instability process of fractured rock. To study the influence of ligament length and joint angle on failure characteristics, uniaxial compression experiments are carried out on specimens containing hole-joint combined flaw assisted by acoustic emission (AE) and digital image correlation (DIC) technologies. As the ligament length increases, the mechanical parameter curves decrease first and then rise, showing a U-shape or V-shape. DIC results show that the hole performs a strong inhibition on the crack propagation from the inner joint tips, which will be weakened with the increase of ligament length. The driving displacement field of wing cracks and the type of cracks outside the joint are affected by joint angle variation. The cracks in rock bridge area are generally tensile-shear or shear type. According to AE analysis, the proportion of tensile signals decreased from the pre-peak failure stage to the post-peak stage, and the tensile signal is lower than 50% in the late loading stage, indicating that the shear crack dominates the final failure of specimens.

Rheumatoid arthritis (RA) is an autoimmune, chronic, and genetically linked inflammatory lesion of joint tissues that is accompanied by extra-articular systemic pathologies. The disease progression leads to joints immobilization, and eventually, the patient's disability occurs approximately ten years from the first clinical manifestation. RA pathogenesis involves various mechanisms: specific joint-related damage, nonspecific adaptive, and vessel-related pathological changes. Our research aimed to study the role of peripheral blood lymphocyte apoptosis in RA pathogenesis. We have analyzed research data from Google Scholar, PubMed, Web of Science, and Scopus databases to investigate the role of lymphocyte apoptosis in RA progression. Clinical manifestations in RA are caused by autoreactive T- and B-lymphocyte activity supported by humoral and cellular immune factors activity. Disease pathogenesis is caused by an imbalance in the process of programmed cell death (apoptosis): a proportion of immune cells are rapidly destroyed. In contrast, apoptosis is inhibited in the other classes of immune cells. High infiltration of the joint by autoreactive sensitized lymphocytes worsens the patient's condition. Apoptosis inhibition is especially noticeable in the early stages of RA and correlates with the concentration of the anti-apoptotic molecule Bcl-2 in the synovia. Activating the apoptotic destruction of lymphocytes (by drug action) allows a positive therapeutic effect and sustained remission. However, it should be noted that genetic factors play a significant role in the onset, progression and drug response of RA. In addition, environmental and behavioral factors can activate RA progression and influence treatment efficacy.

Continuous fiber reinforced and toughened ceramic matrix composites (CMCs) are key thermal structural materials in aerospace and other fields. Mechanical connectivity, as one of the most reliable connectivity methods, is an essential method to achieve connectivity of large and complex CMCs components. At present, research on CMCs joints is rapidly developing, but there is few comprehensive review literature on CMCs joints. Based on the research work in the field of CMCs joints in recent years, the preparation and mechanical property characterization methods of CMCs fasteners were summarized in this paper, the damage and failure mechanism of CMCs fasteners were systematically stored and discussed, and focusing on the influencing factors and laws of mechanical properties of CMCs fasteners from the perspective of material properties and external environment. The research work on CMCs mechanical joints was presented, and the damage law, failure mechanism, finite element simulation and reliability of CMCs connectors were prospected.

Osteoarthritis (OA) is a chronic degenerative joint disease characterized by progressive cartilage degradation, synovial membrane inflammation, osteophyte formation, and subchondral bone sclerosis. Pathological changes in cartilage and subchondral bone are the main processes in OA. In recent decades, many studies have demonstrated that activin-like kinase 3 (ALK3), a bone morphogenetic protein receptor, is essential for cartilage formation, osteogenesis, and postnatal skeletal development. Although the role of bone morphogenetic protein (BMP) signalling in articular cartilage and bone has been extensively studied, many new discoveries have been made in recent years around ALK3 targets in articular cartilage, subchondral bone, and the interaction between the two, broadening the original knowledge of the relationship between ALK3 and OA. In this review, we focus on the roles of ALK3 in OA, including cartilage and subchondral bone and related cells. It may be helpful to seek more efficient drugs or treatments for OA based on ALK3 signalling in future.

With the increase in ambient temperature around the world in summer, the working environment of cable joints is deteriorating. Based on the finite element method, a simulation model for temperature analysis in a 10 kV three-core cable and the joints is established. The temperature distribution is analyzed under different ambient temperatures and different currents. Firstly, the temperature rise experiments are carried out to obtain a steady temperature on the surface of the cable joint, which verifies the accuracy of the simulation model. Then, the relationships between the surface temperature and the current of the high voltage current carrying conductor of the joint under different ambient temperatures are fitted. The ultimate safe current carrying capacity of the joint under the different ambient temperatures can be calculated by using these related functions. The results show that the increase of ambient temperature has little effect on the temperature distribution trend of the high voltage conductor surface of the joint, which also meets this rule on the outer surface of the outer sheath. The relation of the surface temperature on the high voltage conductor of the joint to the current is approximately a quadratic function. When the current amplitude is 480 A and the ambient temperature is 75 ℃, the highest temperatures on the surface of the high-voltage current-carrying conductor and the outer surface of the outer sheath are 1.57 and 1.69 times higher respectively than at an ambient temperature of 30 ℃. When the ambient temperature exceeds 55 ℃, the continuous allowable current carrying capacity specified in the national standard can make the high voltage copper conductor of the joint exceed the maximum permitted operating temperature of 90 ℃. Considering the continuous increase in summer ambient temperature since 2020, the continuous allowable current carrying capacity of the intermediate joint of 10 kV copper conductor three-core cross-linked polyethylene insulated cables in the GB needs to be improved and perfected.

With the advancement of building technology, the pile-plate structure, which originated in railway engineering, has been adopted into highway engineering. This study presents a new pile-plate structure connecting node. The addition of energy-dissipating components at the nodes and the use of non-shrinkage concrete at the joints demonstrate its novelty. The node’s ability to enter the plastic stage is enhanced, resulting in increased seismic performance. In this study, the seismic performance and energy consumption capacity of the pile plate joint were studied by numerical model, and the results showed that the stagnation curve of the pipe pile under low cycle reciprocating load was full and had good energy consumption capacity. Under the action of random seismic vibration, the displacement of the pile plate structure in one direction is up to 0.023 m, which meets the requirements of the specification. The innovative pile-plate joints are used in a nonlinear dynamic time-history analysis of the constructed bridge structure.

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which immune cells and inflammatory cytokines are abnormally activated, leading to immunoregulatory dysfunction in the body and triggering systemic inflammatory responses. The interaction between CXC chemokine receptor 4 (CXCR4) and heterotrimeric G-protein α-subunit Gαq (Gnαq) activates phospholipase Cβ (PLCβ), which influences the expression of downstream effectors and participates widely in the onset and development of various diseases, thus suggesting the potential involvement of these molecules in RA pathogenesis. Therefore, the present study aimed to determine whether the CXCR4-Gnαq-PLCβ signaling pathway participates in the onset and development of RA. Using a collagen-induced arthritis (CIA) rat model, we found that compared with the control (healthy) rat group, CIA rats exhibited highly time-dependent arthritis, with the maximum arthritis score occurring in week 3. In contrast to the splenic and joint tissue of control rats, CIA rats showed obvious hyperplasia in the lymphoid white pulp and main germination centers of the spleen, narrowing of joint cavities, and inflammatory cellular infiltration on articular surfaces. The serum levels of expression of IL-1β, IL-4, IL-6, and TNF-α were significantly elevated (P

Intra-articular adeno-associated virus (AAV) gene therapy has been explored as a potential strategy for joint diseases. However, concerns of low transduction efficacy, off-target expression, and neutralizing antibodies (Nabs) still need to be addressed. In this study, we demonstrated that AAV6 was the best serotype to transduce joints after screening serotypes 1 to 9. To develop a more effective AAV vector, a set of novel AAV capsids were rationally engineered. The mutant AAV62 created by swapping variable region I (VRI) of AAV2 into AAV6 induced a higher transduction efficiency per AAV genome copy number. To further investigate the roles of specific amino acids in the transduction of AAV62 and AAV6, we found out that AAV6D with the deletion of threonine at residue 265 induced a 2-fold higher transduction than AAV6, while the transduction efficiency from AAV6M with the mutation of alanine to glutamine at residue 263 was 10-fold lower. AAV6D efficiently transduced both synoviocytes and chondrocytes with low AAV genome copy numbers in other tissues and less Nab formation. This study demonstrates that novel AAV mutants with rational engineering may enhance joint transduction after intra-articular administration in mice, with the potential to evade AAV Nabs and minimize off-target effects in the liver.

The aim of this research was to investigate on bolted joints characterized by steel screws and aluminum nuts by means of numerical simulation. 2D and 3D CAD/FEM parametric models were developed in order to determine the preload distribution in joints with and without a Wired Threaded Inserts (WTI), so as to compare the trend of the stress distributions and the amount of load applied to each thread. The operating mechanisms and the effectiveness of a WTI were investigated in a parametric study by means of which the most important factors of the joint (materials, class, diameter, Engagement Ratio (ER), tolerance bands) were varied.

Background: A shift toward performance, cost, outcomes, and patient satisfaction has occurred with healthcare reform promoting value-based programs. The purpose of this study was to evaluate the relationship between patient satisfaction and value with treatment in a cohort of patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods: Value was determined by the relationship of treatment outcome with episodic cost. Measurements included both clinical outcomes and patient-reported outcomes. Participating surgeons took part in the modified Delphi method resulting in an algorithm measuring patient value. Treatment outcome, cost, and resultant value (outcome/cost) of both TKA and THA were evaluated using binomial logistic regression by adjusting for age, gender, body mass index, Charlson comorbidity index, tobacco, education, and income with patient-reported satisfaction as the outcome. Results: This study had a total of 909 patients (TKA n = 438; THA n = 471), with an average age of 67 (TKA) and 65 (THA) years. Patient satisfaction shared a significant positive relationship with treatment outcome for TKA (odds ratio [OR] = 1.53, confidence interval [CI] = 1.35-1.73, P < .001) and THA (OR = 1.93, CI = 1.62-2.29, P < .001). Higher value was associated with a significantly higher odds of patient satisfaction for both TKA (OR = 1.39, CI = 1.25-1.54, P < .001) and THA (OR = 1.70, CI = 1.47-1.97, P < .001). Conclusions: This study showed a positive relationship between treatment outcome but not cost with subsequent value and patient satisfaction. This method provides a promising approach to comprehensively evaluate outcomes, cost, and value of total joint arthroplasty procedures. This approach can help predict the probability of value-driven patient satisfaction.

As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.

Objectives: Arthroscopic meniscectomy is a treatment with good short-term results. To prevent the long-term adverse effects of meniscal tear injuries, it is necessary to study the unique features, such asthedemographic characteristics of the injury, the cause of the occurrence, and the type and location of the tear. Methods: We conducted the hospital-based prospective study and involved 103 patients who underwent arthroscopic knee surgery at The National Trauma Orthoped ic Research Center and Grandmed Hospital in Mongolia between 2020 and 2022. We classified Cooper’s classification based on MRI results. Moreover, the type and location of the meniscal tear were finally determined by the diagnosis after arthroscopic surgery. Results: Out of 103 patients, the mean age of the participants was 34.4±8.6 (18-48 years); males were 61.2% (n=63), and 87.7% (n=93) of tears were located in the medial meniscus, respectively. Among the types of tears, the most frequent were the vertical tears, especially the Radial/Transverse and Vertical/Longitudinal 20% (n=18) tears. Conclusion: The causes of meniscal tears are mainly injuries. Men are injured more by sports injuries and women by domestic injuries. The type and location of the isolated meniscal tears differ from those of the meniscal tears.

Objectives. Evaluation and therapeutic management of pediatric patients having Henoch-Schönlein purpura with renal and joint involvement and the importance of their follow-up in preventing complications. Material and Methods: The present study follows cases of two patients, diagnosed with Henoch-Schönlein purpura, with different degrees of compliance, in which the therapeutic approach was determined by the severity of the patient’s conditions. Outcomes. Two male children with Henoch-Schönlein purpura, aged 11 and 9, shared the same clinical features, including skin lesions and joint involvement. The first case may be distinguished from the second one, due to renal injury, a significantly worsen general condition, more widespread purpura, and lower treatment conformity. Laboratory analyses revealed elevated D-Dimers between inflammatory markers, therefore corticotherapy and anticoagulants were initiated. Under the prescribed treatment, both children’s shapes improved, but the first one decided to be discharged on request before being fully recovered. Conclusions. In addition to symptomatic treatment, leisure, corticotherapy administration, and monitoring levels in blood pressure and renal function, patient compliance is highly important related to the prevention of chronic kidney disease at a later stage.

The current direction of scientific research in recent years has been the study of the immunobiological properties of vitamin D. The purpose of this work was to analyze the results of oral administration of cholecalciferol in order to prevent infection with the SARS-CoV-2 virus in the first wave of the COVID-19 pandemic. The study was performed in the period from October 07 to December 29, 2020, when there were no immunobiological drugs for specific prevention of COVID-19. The total number of respondents was 73 people; all had been ill with coronavirus only once. The etiological diagnosis of the disease included molecular genetic testing of samples of two localizations obtained by the conventional method (nasopharynx, oropharynx). The concentration of antibodies to the virus was determined on average 2 months after the disease using a set of reagents SARS-CoV-2-IgG quantitative-ELISA-Best (JSC Vector-Best, Russia). An approximate assessment of IgM concentration was carried out using a set of SARS-CoV-2-IgM-ELISA-Best from the same manufacturer. Among the study participants were those who used immunobiological drugs for the prevention of infection (riamilovir, umifenovir hydrochloride monohydrate, human recombinant interferon alpha-2b, zinc acetate, vitamin C). In particular, 28 people (38.4%) took cholecalciferol (group No. 1) and 45 people (61.6%) did not use this (group No. 2). Statistical processing of the obtained data was performed using the statistical package STATISTICA v.12.5.192.5 (StatSoft, Inc., USA). We applied the analysis of basic statistics, Linear Discriminant Analysis, Kolmogorov–Smirnov test, Chi-Square test, Wald–Wolfowitz Runs Test, Kruskal– Wallis test. Differences in the incidence of respiratory distress syndrome of the two studied groups were revealed: in patients taking cholecalciferol, the syndrome did not develop at all; in group No. 2, it was registered in 20.0% of cases (Chi-Square = 5.242, p = 0.02). In addition, in patients of group No. 1, the concentration of IgG 2 months after the disease was 3.8 times higher than the values in group No. 2 (Chi-Square = 9.268, p = 0.003). Similar differences were found for the IgM level (Wilks' Lambda: 0.659 approx. F (7.32) = 2.367 p < 0.045). It was known that in both groups there were respondents who used other immuno-active substances for preventive purposes. In the first group there were 18 people (24.7% of all); in the second, there were 13 people (17.8% of all). It was found that those who used other immuno-active substances and did not take vitamin D suffered the disease more easily than everyone else. The respondents who did not use any immunoprophylactic agents were the next in terms of the severity of the infection. The respondents who took cholecalciferol mainly assessed the severity of the infection as average. The study participants who took both vitamin D and used other means of prevention suffered the most from COVID-19. Respondents who took cholecalciferol more often than others reported long-term fatigue, exacerbation of chronic and the appearance of new diseases (hypertension, cardialgia, bronchial asthma, allergies, decreased visual acuity), muscle, joint and vertebral pains that appeared for the first time. The phenomenon of arthralgia and other lesions of large joints in COVID-19 was described by us earlier. Studies by other authors also report frequent complaints of increased fatigue and joint pain. At the same time, the role of vitamin D is considered exclusively from the standpoint of vitamin deficiency in a new coronavirus infection and its potential role in inhibiting hyperinflammatory reactions, as well as accelerating the healing process of affected areas, especially in lung tissue. It was found that vitamin D intake did not affect the incidence of fever, the incidence of pneumonia, the volume of lung tissue damage (based on computed tomography data), the duration of hospitalization and the disease as a whole, and also did not prevent the development of anosmia and dysgeusia. The use of vitamin D as a protective agent to prevent infection with the SARS-CoV-2 virus has had an impact on reducing the frequency/ prevention of cases of respiratory distress syndrome during the disease. Also, those who took vitamin D recorded an increase in the formation of IgG to the SARS-CoV-2 virus 2 months after infection 3.8 times higher than the values recorded in respondents who did not take cholecalciferol. The participants who took cholecalciferol suffered the infection more severely, especially if they used any other protective substances. Also, with the preventive intake of vitamin D after COVID-19, increased fatigue persisted longer, the appearance of new and activation of chronic diseases and muscle, joint and vertebral pains that appeared for the first time were reported more often, which correlates with the data we received earlier.

Background & aim: Tennis elbow disease is one of the most common diseases that cause pain in the elbow joint, the prevalence of which is 1-2% before the age of 40, and it increases 4 times in men and 2 times in women in people over 40 years old. Dentists are a group that are more susceptible to this disease due to frequent physical activities, therefore the purpose of the present study was to determine and investigate the level of knowledge, attitude and performance (KAP) of dentists in Shiraz regarding tennis elbow disease. Method: The present cross-sectional descriptive study was conducted in 2018. The statistical population included 51 dentists with a clinical experience of at least three years in Shiraz. Participants without direct clinical activity and people with related underlying diseases were excluded from the study. The data collecting instrument was a questionnaire and the final questionnaire was divided into five sections; Personal information, medical information, knowledge survey, attitude survey and performance survey were designed. The collected data were analyzed using analysis of variance, correlation coefficient and multivariate regression tests. Results: In the studied population, 9.8% of people exhibited symptoms which indicate dtennis elbow disease. On average, the examined dentists were diagnosed with tennis elbow disease 0.13 times in during the previous year. The average score of the ad in the community was 34.9 points out of 100, the average attitude score was 73.1 and the average performance score was 64.1. According to statistical tests, the scores obtained from these three factors were significantly related (p≥0.05). Conclusion: Despite the acceptable level of knowledge, attitude and performance, the results indicated that there was a significant relationship between age, work history and exposure to joint diseases and disability resulting from tennis elbow disease with the score of knowledge, attitude and performance, which was common to stay away from the learning environment with age. It is suggested to raise the level of knowledge, attitude and performance by health policy makers by passing academic units and holding formal trainings in these areas.

Background and purpose: Septic arthritis is a serious orthopedic surgery and delayed management causes irreparable damages. The knee is the most common site involved in septic arthritis. The purpose of this study was to determine mortality rate, adverse joint outcome and prognostic factors in adult patients diagnosed with septic arthritis of the knee who had undergone debridement surgery. Materials and methods: This retrospective cohort study was carried out using the medical records of all adult patients admitted to Sari Imam Khomeini Hospital and Sari BuAliSina Hospital between 2009 and 2019 who were treated with either arthrotomy or arthroscopic irrigation for acute septic arthritis of the knee. Patients with prosthetic joints were excluded. The rate of mortality was determined. Clinical findings, laboratory evidence, knee radiographs, and the Knee injury and Osteoarthritis Outcome Scores (KOOS) were compared through statistical analysis to identify possible prognostic factors. Radiographic severity was classified based on the Kellgren-Lawrence grading. Results: We included 31 patients and there were 41.9% female patients (mean age= 51.1±20.56). The most common underlying diseases were hypertension (29%) and diabetes mellitus (25.8%). Staphylococcus aureus was identified in 16.1% of synovial fluid cultures. The mortality rate was 22.6%. Factors influencing mortality included older age (P=0.003), diabetes mellitus (P=0.031), fever (P=0.038), length of hospital stay (P=0.019), high C-reactive protein levels (P=0.002), low creatinine clearance (P=0.003), and type of pathogenic microorganisms (P=0.028). Age was the only factor significantly associated with higher radiographic severity (P=0.014). Conclusion: Septic arthritis is an infectious orthopedic emergency that is associated with a high mortality rate even after joint surgery and debridement. Therefore, proper management and updating information about this disease and its treatment methods are necessary.

Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.

Salvia miltiorrhiz, commonly known as “Danshen” in Chinese medicine, has longstanding history of application in cardiovascular and cerebrovascular diseases. Renowned for its diverse therapeutic properties, including promoting blood circulation, removing blood stasis, calming the mind, tonifying the blood, and benefiting the “Qi”, recent studies have revealed its significant positive effects on bone metabolism. This potential has garnered attention for its promising role in treating musculoskeletal disorders. Consequently, there is a high anticipation for a comprehensive review of the potential of Salvia miltiorrhiza in the treatment of various musculoskeletal diseases, effectively introducing an established traditional Chinese medicine into a burgeoning field. Aim of the review: Musculoskeletal diseases (MSDs) present significant challenges to healthcare systems worldwide. Previous studies have demonstrated the high efficacy and prospects of Salvia miltiorrhiza and its active ingredients for treatment of MSDs. This review aims to illuminate the newfound applications of Salvia miltiorrhiza and its active ingredients in the treatment of various MSDs, effectively bridging the gap between an established medicine and an emerging field. Methods: In this review, previous studies related to Salvia miltiorrhiza and its active ingredients on the treatment of MSD were collected, the specific active ingredients of Salvia miltiorrhiza were summarized, the effects of Salvia miltiorrhiza and its active ingredients for the treatment of MSDs, as well as their potential molecular mechanisms were reviewed and discussed. Results: Based on previous publications, Salvianolic acid A, salvianolic acid B, tanshinone IIA are the representative active ingredients of Salvia miltiorrhiza. Their application has shown significant beneficial outcomes in osteoporosis, fractures, and arthritis. Salvia miltiorrhiza and its active ingredients protect against MSDs by regulating different signaling pathways, including ROS, Wnt, MAPK, and NF-κB signaling. Conclusion: Salvia miltiorrhiza and its active ingredients demonstrate promising potential for bone diseases and have been explored across a wide variety of MSDs. Further exploration of Salvia miltiorrhiza’s pharmacological applications in MSDs holds great promise for advancing therapeutic interventions and improving the lives of patients suffering from these diseases.

Objective: Arthritic cartilage is primed for mechanical damage. Joint biochemical markers (JBM) could provide insight into the impact of mechanical stimulation on joint tissue turnover in osteoarthritis (OA) of potential use in clinical OA research and practice. However, existing studies of the acute impact of physical activities (PA) on JBM often contain risks of substantial bias. The purpose of this scoping review was to critically review and discuss existing reports of acute joint tissue turnover as reflected in JBM in relation to PA in OA and propose considerations for future research. Design: We searched PubMed, Embase, and Scopus and reference lists for original reports on the acute impact of PA on JBM in human OA. Identified studies were reviewed by two reviewers forming the basis for the discussion of methodology. Results: Search in databases resulted in nine eligible papers after full-text evaluation. Two additional papers were identified through reference lists, resulting in 11 papers included in this review. Ten investigated knee OA and one investigated hand OA. Biomarkers described were related to turnover of type II collagen, aggrecan, and cartilage oligomeric matrix protein. Conclusions: The literature is dominated by small, simplistic studies, but suggests that mechanical stimulation can induce acute changes in joint biomarkers. In order to diminish the existing bias in future studies, it is important to recognize methodological considerations e.g. patient and biomarker selection as well as peri-interventional control. Common potential sources of bias include the acute shift in plasma volume due to cardiovascular stress and postural changes.

This paper aims to study the effect of the normal stress on the shear performance of splicing joints for precast ultrahigh-performance concrete (UHPC) segmental bridges (PUSBs), an oblique-shear joint is designed to decompose the vertical force into a normal force and a shear force for the joint. The effect of the number, height and inclination angle of the keys on the bearing capacity of the joint is studied by 19 oblique-shear joints. Then, the bearing capacity and failure modes are analyzed significantly. The results show that the failure modes of the joints are shear failure, compression-shear failure and splitting failure, all showing primarily brittle failure. Moreover, the proportion of shear stress in the specimens increases with the increase of the inclination angle of the joint, and the shear capacity of the specimens decreases. Additionally, the shear capacity of the specimens increases with the increase of the height of the keys. After that, we derive a new formula for calculating the shear capacity utilizing Mohr’s stress circle theory and Mohr-Coulomb failure criterion, i.e., the interfacial frictional coefficient is 0.94 and the shear capacity of keys is 0.06. One may find the present formula shows a high guarantee by comparing with those from references. The formula established in this paper may be used to calculate the shear capacity of splicing joint of precast ultrahigh-performance concrete segmental bridges.