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Empirical/geometric methods rely on simple geometrical connections between some landslide parameters and the runout distance reached by the displaced material. Despite the extreme simplification of the dynamic of this landslide typology, those methods can provide useful information about the propagation of this shallow and fast landslide typology, joining the reliability of the results with easiness of use. The objective of this work is to compare the efficacy of different geometric relationships for the identification of the runout distances in a debris- and mud-flows-prone test area located in Sicily, southern Italy, where several events were analyzed, and a consistent set of data was collected and processed. Notwithstanding some uncertainties in the methodological approach and not negligible scattering between expected and observed runout distances, the use of such geometric approaches, together with the evaluation of kinematic parameters such as velocity and kinetic energy, can significantly boost the implementation of site-specific analyses for a more detailed definition of landslides susceptibility at a local scale. [ABSTRACT FROM AUTHOR]

Purpose: Surgical training is crucial for orthopedics residents during their educational careers. Residents who follow classic training courses are less skilled than those trained with simulators. Virtual simulators are reported to be global learning tools for knee arthroscopy. The primary purpose of our study is to evaluate the current state of use of arthroscopic knee simulators and their actual effectiveness in transfer the skills learned in training to the operating theatre. The secondary purpose is to evaluate if the virtual simulators are better than the others in improve arthroscopic skills. Methods: Studies involving knee arthroscopy training with virtual reality simulators were included: a search of the literature from 2009 to September 2019 was performed on MEDLINE(PubMed) using PRISMA guidelines. Exclusion criteria were systematic review articles, aims and topics not related to the purpose of the study, single case and technical reports, biomechanical analysis, articles not in the English language, and editorial commentaries. Results: The literature review selected, nine studies and they included results on 93 residents, three expert surgeons and 189 medical students. All studies report improved arthroscopic skills after training with a simulator. Only four studies evaluated the transfer of arthroscopic skills of knee simulators to the operating theatre. Conclusions: Benchtop and Virtual Reality simulators are excellent tools for accelerating and improving arthroscopic training and skills acquisition. The second ones, high-cost, and fidelity simulators, seem to be the best of the two. A greater diffusion of Virtual Reality in universities is to be considered to improve residents' training and patients' clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Hofmann et al., in 1995, first described an articulating spacer made by cleaning and autoclaving the original femoral component, which is then re-implanted with a new tibial polyethylene. This systematic review aims to assess the state of existing evidence on the intraoperative autoclaving and re-use of an infected prosthesis, as a spacer, during a two-stage revision following Periprosthetic Joint Infections (PJI). Methods: A systematic review was conducted with methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched from 1995 to April 2020 to identify relevant studies. Results: Fourteen studies were included in this systematic review: two prospective case series; six retrospective comparative studies and six retrospective case series. The reviewed studies included 567 patients (571 knees): 394 patients treated with autoclaved components and 173 with a spacer made of new components. The cumulative re-infection rate in patients treated with re-used autoclaved components was 13.7% (54 re-infections in 394 patients), whereas in control patients the re-infection rate was 13.3% (23 re-infections in 173 patients). The final Range of Movement in patients treated using the autoclaved components as a spacer, compared with patients receiving static spacers, was significantly higher in three out of four comparative studies. Conclusion: There is a moderate level of evidence that the intraoperative autoclaving and re-use of an infected prosthesis as a spacer, during a knee resection arthroplasty, is an effective procedure in the management of knee PJI. [ABSTRACT FROM AUTHOR]

Aim: To assess the outcome of augmentation techniques, i.e., percutaneous vertebroplasty (PVP), balloon kyphoplasty (BKP), vertebral body stenting (VBS) and fixation techniques in the management of vertebral fragility fractures (VFFs). Methods: OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Springer Link, Web of Science, Google Scholar and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The methodological qualities of the studies were evaluated and relevant data were extracted. Results: Thirteen randomized controlled trials, recruiting 1963 patients, were included. PVP, compared with conservative management (CM), showed a greater pain relief and an improved vertebral body height (VBH) restoration. Moreover, PVP revealed superior to a sham procedure for pain relief in acute VFFs. BKP, compared with CM, rapidly reduces pain and improves quality of life without increasing the risk of additional VFFs. BKP, compared with PVP, has fewer cement leakage rates and is more effective in VBH restoration. BKP should also be preferred to VBS, since it is associated with less material-related complications. Pedicle screw fixation associated with PVP, compared with PVP alone, revealed effective in preventing secondary VFFs. Conclusions: BKP showed better clinical and radiological outcomes compared with CM and PVP. BKP revealed as effective as VBS in VBH restoration with less material-related complications. [ABSTRACT FROM AUTHOR]

Radial shock waves therapy (RSWT) differs from extracorporeal shock waves therapy (ESWT) in that it produces a non-focused wave that is dissipated radially at the skin. Few studies have yet explored the effects of RSWT on bone tissue. Osteoblasts in culture flasks were studied by polymerase chain reaction after treatment with RSW (500 impulses, 0.05 mJ/mm). An inhibited osteoblastogenesis was observed, with a statistically significant reduction in type 1 collagen, osterix, bone sialoprotein and receptor activator NF kappa ligand expression at 24 and 48 h, of osteocalcin at 24, 48 and 72 h, and osteopontin at 48 and 72 h. These findings show that RSWT is not indicated for treatment of delayed fracture union, pseudoarthrosis, and complex regional pain syndrome. The observed reduction in the receptor activator of nuclear factor-kB ligand/osteoprotegerin ratio suggests that it has an inhibiting effect on osteoclastogenesis, which could make it a useful tool for applications in proliferative diseases. [ABSTRACT FROM AUTHOR]

Background: Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle-induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head.Materials and Methods: In all implants a press-fit cup was used; it was combined with a 32-mm alumina head and with titanium-alloy stems. The mean age at surgery was 50 years. At an average follow-up of 13 years two hips have been revised, one for periprosthetic infection and one for excessive abduction of the cup.Results: No revision for aseptic loosening is recorded; one anatomical cementless femoral stem had radiological evidence of definite aseptic loosening. No dislocations occurred, and no osteolysis was observed.Conclusions: The results support the application of alumina-alumina THA for long-lasting replacements. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Osteoarthritis is a chronic rheumatoid disease mediated by metalloproteinases and inflammatory cytokines. Methylsulfonylmethane (MSM) and boswellic acids (BA) each show promise in the treatment of inflammatory processes, but the efficacy of combined treatment with these substances in the treatment of arthritis has not yet been studied. METHODS: In this prospective randomized clinical trial, MESACA (for 'methylsulfonylmethane and boswellic acids in the treatment of knee arthritis'), 60 subjects affected by arthritis of the knee were randomly assigned to an experimental group treated for 60 days with 5 g of MSM and 7.2 mg of BA daily, or a control group which was administered a placebo. At 2 and 6 months follow-up (FU), the efficacy of combined treatment with these two dietary supplements was assessed using the visual analog pain scale (VAS) and the Lequesne index (LI) for joint function, as well as monitoring the use of anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs and anti-cyclooxygenase-2). RESULTS: Pain, assessed with the VAS scale, was worse in the group treated with MSM and BA as compared with the placebo group at 2 months FU (3.8 vs. 2.7; P=0.04), whereas no difference between the two groups was observed at 6 months FU (2.7 vs. 3.6; P=0.2). No statistically significant differences were found in the LI between the two groups at either FU (2 months: 4.8 vs. 4.2; P=0.51; 6 months: 4.4 vs. 4.5; P=0.91). By contrast, a statistically significant difference in patients need for anti-inflammatory drugs was seen in the experimental as compared to the placebo group, even by 2 months FU (0.2 vs. 0.6 tablets/day; P<0.0001), that persisted up to the end of the study (0.1 vs. 0.6 tablets/day; P<0.0001). CONCLUSIONS: Although the combined administration of MSM and BA in the treatment of gonarthrosis was not shown to be more efficacious than placebo in the management of the clinical and functional picture, it significantly reduced patients need for anti-inflammatory drugs. [ABSTRACT FROM AUTHOR]

Aim of this work was to study the postoperative pain within the first week of a total knee replacement by comparing three different forms of administration of analgesia. We proposed to verify the correspondence between a subjective pain assessment made by the patient on a Visual Analogic Scale (VAS) and an objective assessment made by assaying the serum algogenic cytokines interleukin-1 (IL1), interleukin-6 (IL6), and tumor necrosis factor-alpha (TNF-alpha). Statistical analysis of the data on the VAS and the three cytokine assays done preoperatively and on the third and seventh days postoperatively showed that while the VAS declined progressively postoperatively, IL6 tended to be higher on the third postoperative day and then lower on the seventh. The other two cytokines showed no differences preoperatively and postoperatively. On the basis of our results, we support the validity of IL6 dosage to monitor the postoperative pain during future studies. [ABSTRACT FROM AUTHOR]

Low-grade fibromyxoid sarcoma (LGFMS) was first described by Evans in 1987, and since then, just over 150 cases have been reported, showing the rarity of this tumor. We report the clinical case of a 56-year-old man with a swelling on the distal third of the left thigh. The mass had grown in the course of 1 year and was surgically excised, obtaining complete resolution. Immuno-histological examination demonstrated the lesion to be a LGFMS, defined as a benign tumor but with a high incidence of local and distant recurrence (5-10%). At 2-year follow-up the patient was disease-free, confirming the efficacy of the surgical excision. In literature, the frequency of incomplete excision of LGFMS due to inappropriate diagnosis is stressed. It is this element that contributes most to the high rate of recurrence. We recommend that the eventuality of observing this rare tumor be borne in mind, and that care be taken to perform a complete, ample excision. [ABSTRACT FROM AUTHOR]

Hydatidosis is a zoonosis caused by the ingestion of Echinococcus granulosus eggs, released though the feces, from infected dogs to humans. Primary localization is mostly hepatic and/or pulmonary, whereas muscular involvement is very rare, even more so in muscular striated tissue. This is the report of a case of a primary intramuscular hydatid cyst in a 79-year-old woman who presented with a 3-year history of a painful lump in her proximal medial left thigh. The authors document the exceptional giant dimensions of the cyst, which have not previously been reported in a case of striated muscular hydatid disease. [ABSTRACT FROM AUTHOR]

We present a case report of a 14-year-old Caucasian sport woman affected by bilateral and symmetrical knee osteochondritis dissecans (OCD) addressed to surgery, in which extracorporeal shock wave therapy determined complete healing. Shock wave is a longitudinal acoustic wave traveling with the speed of ultrasound through the water of the body tissue. Recently, this therapy has been used in the treatment of a number of musculoskeletal pathologies on the basis of the effects produced by the induction of angiogenesis, recruitment of progenitor cells and downregulation of cartilage damage. This therapy is useful, because it is non-invasive, safe, without complications or adverse effects and repeatable. Thus, it could be suggested as a useful strategy for the treatment of OCD prior starting surgery. [ABSTRACT FROM AUTHOR]

Primary myelofibrosis (PMF) is a chronic myeloproliferative neoplasm characterized by progressive anemia, massive splenomegaly, leukoerythroblastosis, extramedullary hematopoiesis and in about 50% of cases the presence of JAK2V617F mutation. Curative therapy in PMF is currently possible only with allogeneic haematopoietic stem cell transplantation which is, unfortunately, associated with relatively high risks of mortality and morbidity which undermine its broad applications. Non-transplant treatment modalities are used for palliative purposes. Recently, anti-angiogenic drugs such as thalidomide have been used to treat these patients on the basis of the prominent bone marrow angiogenesis. Here, we report the case of a patient suffering from JAK2V617F-positive PMF with marked bone marrow neo-angiogenesis. The patient was treated with thalidomide but after 20 days developed life-threatening toxic epidermal necrolysis (TEN). To the best of our knowledge this is the first case of TEN in a patient with PMF under thalidomide therapy. [ABSTRACT FROM AUTHOR]

In this article we report a case of bizarre paraosteal osteochondromatous proliferation (BPOP), also known as Nora’s lesion, arising on the distal phalanx of the fifth finger of the hand in a young-adult subject. In this paper, we discuss the possible therapeutic programme related to the grade of severity of the clinical features and underline the rarity of this lesion and the difficulty of diagnosis, which is exclusively histological. [ABSTRACT FROM AUTHOR]

Bilateral rupture of the patellar tendon is a very rare injury. It occurs in association with chronic systemic diseases or corticosteroid medications. We report a case of a 13-year-old child with Ehlers-Danlos syndrome presenting a bilateral patellar tendon disruption of proximal insertion that occurred with a trivial trauma. Surgical management consisting in tendon repair with a suture anchor technique protected temporarily with a cerclage wiring gives a good outcome [ABSTRACT FROM AUTHOR]