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Abstract Background Knee osteoarthritis (OA) is a chronic disease associated with a severe impact on quality of life. However, unfortunately, there are no evidence-based guidelines for the non-surgical management of this disease. While recognising the gap between scientific evidence and clinical practice, this position statement aims to present recommendations for the non-surgical management of knee OA, considering the available evidence and the clinical knowledge of experienced surgeons. The overall goal is to offer an evidenced-based expert opinion, aiding clinicians in the management of knee OA while considering the condition, values, needs and preferences of individual patients. Methods The study design for this position statement involved a preliminary search of PubMed, Google Scholar, Medline and Cochrane databases for literature spanning the period between January 2021 and April 2023, followed by screening of relevant articles (systematic reviews and meta-analyses). A Società Italiana Ortopedia e Traumatologia (SIOT) multidisciplinary task force (composed of four orthopaedic surgeons and a rheumatologist) subsequently formulated the recommendations. Results Evidence-based recommendations for the non-surgical management of knee OA were developed, covering assessment, general approach, patient information and education, lifestyle changes and physical therapy, walking aids, balneotherapy, transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, pharmacological interventions and injections. Conclusions For non-surgical management of knee OA, the recommended first step is to bring about lifestyle changes, particularly management of body weight combined with physical exercise and/or hydrotherapy. For acute symptoms, non-steroidal anti-inflammatory drugs (NSAIDs), topic or oral, can be used. Opioids can only be used as third-line pharmacological treatment. Glucosamine and chondroitin are also suggested as chronic pharmacological treatment. Regarding intra-articular infiltrative therapy, the use of hyaluronic acid is recommended in cases of chronic knee OA [platelet-rich plasma (PRP) as second line), in the absence of active acute disease, while the use of intra-articular injections of cortisone is effective and preferred for severe acute symptoms.

Fracture-related infections (FRIs), as shown in the literature, represent one of the main complications of trauma surgery. They are a consequence of an implant-related “biofilm” formation and are a challenge for surgeons, microbiologists, and infectious disease specialists. For a correct diagnosis, careful clinical evaluation, to look for signs/symptoms attributable to an infectious condition, and instrumental examinations, to highlight the site of infection, its extent, and its severity, are both essential. Unfortunately, due to the lack of data in the literature, there is no consensus about guidelines on the diagnosis and treatment of FRIs. The purpose of this study is to present an up-to-date concept evaluation of the diagnostic procedures and treatment options available in the management of fracture-related infections.

Osteoarthritis is a degenerative joint disease caused by the wear and tear of joint cartilage. The definitive and resolving treatment is prosthetic replacement of the articular surface, the demand of which is on the rise for patients with mild to moderate severity. However, a conservative strategy may be considered that aims to reduce and contain pain symptoms by postponing surgical treatment in the case of worsening that can no longer be otherwise controlled. Intra-articular infiltrations, like other therapeutic strategies, are not without complications, and among these the most feared is joint infection, especially in anticipation of future prosthetic replacement. Is important to avoid periprosthetic joint infections because they represent one of the third most common reasons for revision surgery. Using cases found in the literature, the aim of this article is to determine if there is a real correlation between the type of injections, the number of doses injected and the time between infiltrations and the surgical procedure.

(1) Background: Periprosthetic joint infections (PJIs) are severe and frightening complications in orthopaedic surgery, and they are generally divided into three categories: early infections (those occurring within the first 4–6 weeks), delayed infections (those occurring between 3 and 24 months), and late infections (those occurring more than 2 years after surgery). PJI treatment comprises “debridement, antibiotics, and implant retention” (DAIR), single-stage revision, and double-stage revision. Nowadays, to improve the chances of retaining an infected implant and to improve the traditional DAIR method, a modified surgical technique has been developed, named DAPRI (debridement, antibiotic pearls, and retention of the implant). Our study aims to present an up-to-date concept evaluation of the DAPRI technique and its success rate. (2) Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed, applying a protocol defined by the authors: a total of 765 articles were identified, and at the end of the screening process only 7 studies were included. (3) Results: Currently, the DAPRI procedure can be performed only on patients who have had PJI symptoms for less than 4 weeks, and in order to achieve the highest success rate, indications are quite strict: it is appropriate in patients with acute, superficial infections without sinus tract presence, and well-fixed implants with known sensitive bacteria. The DAPRI surgical method follows a step-by-step process consisting of a first phase of biofilm identification with intra-articular injection of methylene blue, followed by biofilm removal (thermic, mechanical, and chemical aggression), and a last step consisting of prevention of PJI recurrence by using calcium sulphate antibiotic-added beads. (4) Conclusions: The DAPRI approach improves the traditional DAIR technique. It is a correct treatment for acute and early haematogenous PJI, and improves the DAIR success rate.

Several criteria exist to diagnose pulmonary aspergillosis with varying degrees of certainty in specific populations, including oncohaematological patients (EORTC/MSG), ICU patients (mAspICU) and COVID-19 patients (ECMM). At the beginning of the pandemic, however, the diagnosis of COVID-19-Associated Pulmonary Aspergillosis (CAPA) could not be performed easily, and the decision to treat (DTT) was empirical. In this cross-sectional retrospective study including patients with SARS-CoV-2 infection and suspicion of CAPA, we studied the concordance between the DTT and the three diagnostic criteria using Cohen’s coefficient, and then we identified the factors associated with the DTT and corrected them by treatment to study the influence of the diagnostic criteria on survival. We showed good concordance of the DTT and mAspICU and ECMM criteria, with “compatible signs”, “positive culture” and “positive galactomannan” influencing the DTT. Treatment also showed a positive effect on survival once corrected for a putative, possible or probable diagnosis of CAPA using mAspICU and ECMM criteria. We conclude that EORTC/MSGERC are not considered applicable in clinical practice due to the lack of inclusion of signs and symptoms and do not lead to improved survival. mAspICU and ECMM criteria showed a good degree of agreement with the DTT and a positive correlation with patient recovery.

Background: Frailty associated with aging increases the risk of falls, disability, and death. The aim of this study is to explore gender-related disparities in the survival outcomes of pathological femoral fractures in older frail patients, while analyzing potential specific prognostic factors. Methods: This study is a retrospective observational analysis conducted at a single medical center. It enrolled all patients aged 65 and above who were admitted to our emergency department between 2016 and 2020 with a diagnosis of pathological femur fracture requiring surgical intervention. The primary study endpoint was evaluating gender-related differences in survival outcomes. The secondary endpoint involves investigating gender-specific prognostic factors through the analysis of clinical and laboratory parameters. Results: The average Charlson Comorbidity Index (CCI) was slightly lower in men, but the difference was not statistically significant (p = 0.53). The Clinical Frailty Scale (CFS) showed similar results, with men and women 5.23 (SD 1.46), also not significant (p = 0.83). An evaluation comparing patients aged 75 years or younger to those older than 75 years found significant differences in health metrics. The average CCI was higher in the over 75 group compared to the under 75 group, with a p-value of 0.001. Similarly, the CFS average was also greater in the over 75 group than in the under 75 group, with a p-value of 0.0001. Complications were more frequent in patients over 75 and those with lower educational qualifications. The evaluation analyzed cardiac patients compared to a control group, revealing that the average age of cardiac patients was 75.22 years, while the control group was younger at 73.98 years (p = 0.5119). The CCI for cardiac patients averaged 6.53, significantly higher than 4.43 for non-cardiac patients (p = 0.0003). Conclusion: Frailty assessment is therefore essential in patients with pathological fracture of the proximal femur and is an important predictor of both gender differences and hospital complications. Enhancing gender analysis in this field is crucial to gather more robust evidence and deeper comprehension of potential sex- and gender-based disparities. [ABSTRACT FROM AUTHOR]

Fracture-related infections (FRIs), as shown in the literature, represent one of the main complications of trauma surgery. They are a consequence of an implant-related "biofilm" formation and are a challenge for surgeons, microbiologists, and infectious disease specialists. For a correct diagnosis, careful clinical evaluation, to look for signs/symptoms attributable to an infectious condition, and instrumental examinations, to highlight the site of infection, its extent, and its severity, are both essential. Unfortunately, due to the lack of data in the literature, there is no consensus about guidelines on the diagnosis and treatment of FRIs. The purpose of this study is to present an up-to-date concept evaluation of the diagnostic procedures and treatment options available in the management of fracture-related infections. [ABSTRACT FROM AUTHOR]

Osteoarthritis is a degenerative joint disease caused by the wear and tear of joint cartilage. The definitive and resolving treatment is prosthetic replacement of the articular surface, the demand of which is on the rise for patients with mild to moderate severity. However, a conservative strategy may be considered that aims to reduce and contain pain symptoms by postponing surgical treatment in the case of worsening that can no longer be otherwise controlled. Intra-articular infiltrations, like other therapeutic strategies, are not without complications, and among these the most feared is joint infection, especially in anticipation of future prosthetic replacement. Is important to avoid periprosthetic joint infections because they represent one of the third most common reasons for revision surgery. Using cases found in the literature, the aim of this article is to determine if there is a real correlation between the type of injections, the number of doses injected and the time between infiltrations and the surgical procedure. [ABSTRACT FROM AUTHOR]

La dimensione glocale, non solo come fenomeno socio-economico ma soprattutto come risorsa culturale ed educativa, costituisce un esempio virtuoso di sostenibilità antropologica del nostro tempo. Essa può essere pensata come una pacificazione identitaria tra globalismi e localismi, dando vita a un nuovo modo di percepire il concetto di cittadinanza mondiale che probabilmente costituirebbe una soluzione e un compromesso nobile alle tensioni sociali che in ambito internazionale la dicotomia locale/globale genera.

Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons' confidence in their use. [ABSTRACT FROM AUTHOR]

(1) Background: Periprosthetic joint infections (PJIs) are severe and frightening complications in orthopaedic surgery, and they are generally divided into three categories: early infections (those occurring within the first 4–6 weeks), delayed infections (those occurring between 3 and 24 months), and late infections (those occurring more than 2 years after surgery). PJI treatment comprises "debridement, antibiotics, and implant retention" (DAIR), single-stage revision, and double-stage revision. Nowadays, to improve the chances of retaining an infected implant and to improve the traditional DAIR method, a modified surgical technique has been developed, named DAPRI (debridement, antibiotic pearls, and retention of the implant). Our study aims to present an up-to-date concept evaluation of the DAPRI technique and its success rate. (2) Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed, applying a protocol defined by the authors: a total of 765 articles were identified, and at the end of the screening process only 7 studies were included. (3) Results: Currently, the DAPRI procedure can be performed only on patients who have had PJI symptoms for less than 4 weeks, and in order to achieve the highest success rate, indications are quite strict: it is appropriate in patients with acute, superficial infections without sinus tract presence, and well-fixed implants with known sensitive bacteria. The DAPRI surgical method follows a step-by-step process consisting of a first phase of biofilm identification with intra-articular injection of methylene blue, followed by biofilm removal (thermic, mechanical, and chemical aggression), and a last step consisting of prevention of PJI recurrence by using calcium sulphate antibiotic-added beads. (4) Conclusions: The DAPRI approach improves the traditional DAIR technique. It is a correct treatment for acute and early haematogenous PJI, and improves the DAIR success rate. [ABSTRACT FROM AUTHOR]

The proximal femur is the long bone most commonly affected by metastatic disease. There are many treatment options, such as hip megaprostheses. A topic still widely debated in literature is the use of cemented or uncemented megaprostheses in this kind of patients. The purpose of this review is to examine both these surgical options to understand which of them should be preferred in metastatic patients. Twelve articles were finally included in the review. Eight authors used cemented mega - prostheses, two cementless megaprostheses and two authors used both techniques. Better functional outcomes and lower infection rates were found in cementless mega - prostheses. More studies have to be performed to choose the better technique and improve patients’ quality of life.

Several criteria exist to diagnose pulmonary aspergillosis with varying degrees of certainty in specific populations, including oncohaematological patients (EORTC/MSG), ICU patients (mAspICU) and COVID-19 patients (ECMM). At the beginning of the pandemic, however, the diagnosis of COVID-19-Associated Pulmonary Aspergillosis (CAPA) could not be performed easily, and the decision to treat (DTT) was empirical. In this cross-sectional retrospective study including patients with SARS-CoV-2 infection and suspicion of CAPA, we studied the concordance between the DTT and the three diagnostic criteria using Cohen's coefficient, and then we identified the factors associated with the DTT and corrected them by treatment to study the influence of the diagnostic criteria on survival. We showed good concordance of the DTT and mAspICU and ECMM criteria, with "compatible signs", "positive culture" and "positive galactomannan" influencing the DTT. Treatment also showed a positive effect on survival once corrected for a putative, possible or probable diagnosis of CAPA using mAspICU and ECMM criteria. We conclude that EORTC/MSGERC are not considered applicable in clinical practice due to the lack of inclusion of signs and symptoms and do not lead to improved survival. mAspICU and ECMM criteria showed a good degree of agreement with the DTT and a positive correlation with patient recovery. [ABSTRACT FROM AUTHOR]

The expansion of financial capitalism towards the "lower levels" of economic life (or the foundational economy [Bowman et al. 2014]) is fostered by the privatisation of utilities and outsourcing of pub-lic services, under the encouraging banner of liberalisation. Our paper aims to describe some aspects of this transformation and its implications for social life, referring to the case of Italian railways. The conditions of use of the transport service have radically changed. At least three aspects must be emphasised: 1. The overall volume of services provided is reduced, increasing costs for the community; 2. The less profitable lines are sacrificed, isolating the most marginal areas of the country and exacerbating the socio-economic divide; 3. The services can be accessed only at market rates, and the objective of providing citizens with full mobility is pursued with progressively less vigour. We argue that the result of the liberalisation of Italian railways is not a competitive market populated by efficient economic actors. Not only has the monopoly been preserved, but the monopolist - i.e. the state: the railways are 100% owned by the Treasury - gets sensational profits without any risk, since the costs of maintenance and investment are borne by public finance

Punk of ideology. Pop iconography of Slavoj Žižek. Slavoj Žižek can be thought as a punk philosopher? Probably yes. His irreverent analysis of contemporary societies have helped to build a method of investigation of ideology completely original. Ideology is examined through the narratives of Hollywood cinema and grafted on the theories of Hegel, Marx, Lacan. The result is not only a new way of working in philosophy, but also a new kind of intellectual who transforms himself into a pop icon.

This article discusses the use of ultrasound (US) as an alternative method for evaluating driveline infections (DLIs) in patients with left ventricular assist devices (LVADs). DLIs are common infections that occur around the driveline of LVADs and can be classified as superficial or deep depending on the depth of tissue involvement. Traditionally, computer tomography (CT) scans have been used to stage DLIs, but this study explores the use of US as a potential alternative. The authors found that US accurately showed localized purulent collection around the driveline and ruled out deep tissue involvement, with results that were concordant with CT scans. The advantages of using US include the absence of ionizing radiation exposure and the ability to repeat the exam during follow-up. [Extracted from the article]

Assessment is one of the basic issues in both formal and informal educational contexts. Current online courses are massive and online, thus it is important to find new strategies for improve the effectiveness of evaluation. In MOOCs (Massive Open Online Courses), indeed, there is also the certification of knowledge and skills acquisition that requires more formal and trustworthy methods. Researchers should work to combine pedagogical and technological solutions to guarantee the effectiveness of learning measures. In this context, the Computer Adaptive Testing (CAT) could be useful to better measure the knowledge acquisition using a quiz, as usually happens in MOOCs. These are the premises of this research work that, in order to understand if CAT could be suitable for assessment in MOOCs, proposes a first algorithm to measure the acquired knowledge using a quiz-game. The pilot study attests the appreciation of users.

In the classical mythology and in greek tragedy, there are some metaphor concepts which, all along, represent and propose again the essential nucleus of human sensitivity. Among these, the concept of hybris, probably, deserves a place of crucial modernity and preeminence. Hybris is arrogance, the feeling of the excess, of prevarification, of pride, the crossing limits of human acting. As for Homeric mythology, among the most representative personalities in terms of arrogance, we can find the Suitors of Penelope (The Proci) – 109 young noblemen from Ithaca who aim at achieving Penelope’s hand and Ulysses’ kingdom during his absence - have an essential role. Following the Lacanian lesson, the Suitors are the metaphor of “jouissance mortelle”, the opposite of the Law of “symbolic castration”that is the awareness of human acting perimeter.

Purpose: In orthopedics and traumatology, as a direct consequence of the COVID-19 first wave, there was a massive reorganization and a stop to all elective activities, which were postponed. In this study, we aimed to analyze the impact of the COVID-19 pandemic on orthopedic surgery in Apulia during the second wave, from March to June 2021 (when Apulia was under social distancing restrictions), and during the third wave, from September to December 2021 (when Apulia was under no restrictions). We compared these months to the same periods in 2019 for an evaluation of the surgical decrease during the pandemic period. Methods: We performed a retrospective analysis of major orthopedic procedures, day-surgery procedures and urgent procedures (trauma and non-traumatic amputation) performed during the second and third waves of the pandemic in our clinic, and we compared these data with the same procedures performed in the corresponding periods of 2019, before the pandemic. Results: Surgical activity was significantly decreased during both periods; the only increase in surgical activity in 2021 compared to 2019 was in total hip, knee and shoulder arthroplasty, with a surge of +7.69% registered in the period September–December 2021. Conclusions: Longer waiting lists and limited healthcare resources were the big challenges for the orthopedic community, and they still represent a substantial issue to confront today. [ABSTRACT FROM AUTHOR]

Management of nonunion in the elderly patient are always a challenge for the orthopedic surgeon. The patient's clinical condition is often critical, and normal nonunion management strategies are burdened with a high rate of failure. Megaprostheses have been designed for the management of bone tumors, but in the literature many cases of use in non-neoplastic conditions are described. They are, however, burdened by a high rate of complications, and in particular dislocations and periprosthetic infections. Proximal and distal femur replacement should therefore be considered as a salvage strategy to be used in the most severe cases of nonunion in the elderly patient. [ABSTRACT FROM AUTHOR]