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The oxidative-stress-elicited deterioration of chondrocyte function is the initial stage of changes leading to the disruption of cartilage homeostasis. These changes entail a series of catabolic damages mediated by proinflammatory cytokines, MMPs, and aggrecanases, which increase ROS generation. Such uncontrolled ROS production, inadequately balanced by the cellular antioxidant capacity, eventually contributes to the development and progression of chondropathies. Several pieces of evidence show that different growth factors, single or combined, as well as anti-inflammatory cytokines and chemokines, can stimulate chondrogenesis and improve cartilage repair and regeneration. In this view, hypothesizing a potential growth-factor-associated action, we investigate the possible protective effect of post-operation knee fluid from patients undergoing prosthesis replacement surgery against ROS-induced damage on normal human knee articular chondrocytes (HKACs). To this end, HKACs were pre-treated with post-operation knee fluid and then exposed to H2O2 to mimic oxidative stress. Intracellular ROS levels were measured by using the molecular probe H2DCFDA; cytosolic and mitochondrial oxidative status were assessed by using HKACs infected with lentiviral particles harboring the redox-sensing green fluorescent protein (roGFP); and cell proliferation was determined by measuring the rate of DNA synthesis with BrdU incorporation. Moreover, superoxide dismutase (SOD), catalase, and glutathione levels from the cell lysates of treated cells were also measured. Postoperative peripheral blood sera from the same patients were used as controls. Our study shows that post-operation knee fluid can counteract H2O2-elicited oxidative stress by decreasing the intracellular ROS levels, preserving the cytosolic and mitochondrial redox status, maintaining the proliferation of oxidatively stressed HKACs, and upregulating chondrocyte antioxidant defense. Overall, our results support and propose an important effect of post-operation knee fluid substances in maintaining HKAC function by mediating cell antioxidative system upregulation and protecting cells from oxidative stress.

Trends in the coupled stratosphere‐troposphere system during the 1979–2022 period are investigated in the Northern Hemisphere using reanalysis datasets. More upward planetary wave propagation in December is shown to precede the deceleration of the stratospheric polar vortex in January. This deceleration prevents the waves from continuing to propagate upward in February and favors an acceleration of the stratospheric polar vortex in March. This is associated with an increased Northern Hemisphere annular mode in March in the stratosphere and the troposphere. Trends show a moderate significance level because of strong interannual variability. Recent seasons whose anomalies project onto the trends are those for which wave‐1 anomaly constructively interferes with wave‐1 climatology in December, which occurs when there is warming in an area extending from Eastern Canada to Greenland and slight cooling over Eurasia. It shows the potential for predicting the springtime stratospheric polar vortex from wintertime wave‐1 anomalies. Plain Language Summary: In winter the stratosphere hosts strong westerly winds forming the stratospheric polar vortex. Variations in the vortex strength can affect weather patterns in the underlying troposphere. Vice‐versa, the stratospheric vortex can also be disrupted by tropospheric waves that propagate upwards into the stratosphere. Sea‐ice loss from Arctic warming is amongst the forcings that have been proposed to produce tropospheric waves leading to a weakening of the polar vortex. However, there is a strong dependence of the stratospheric signal on the region of sea ice loss. In the present study, we show that mid‐winter to early spring stratospheric trends during the 1979–2022 period are linked to large‐scale surface temperature trends in December. Specifically, strong warming from Eastern Canada to Greenland and relative cooling over Eurasia in December are associated with enhanced upward wave propagation and a deceleration of the stratospheric polar vortex in January. In mid‐winter a weaker than usual vortex inhibits wave propagation to the stratosphere, allowing for a recovery in vortex strength by March. In conclusion, our work shows how the opposite mid‐winter and early spring trends in the stratosphere can be connected with stronger wave propagation from the surface in December and with its time‐evolving effects on troposphere–stratosphere coupling. Key Points: January and March exhibit opposite trends in the stratospheric Northern Annular Mode (NAM) during 1979–2022The negative (positive) trend in the NAM in January (March) is explained by more (less) upward wave propagation in December (February)More upward wave propagation in December is linked to warming over Eastern Canada and cooling over Siberia [ABSTRACT FROM AUTHOR]

Abstract Purpose The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA). Methods A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis‐Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options. Results Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub‐analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects. Conclusions This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.

Abstract Purpose The aim of this work was to retrospectively analyze the clinical, subjective, and radiological results of medial closing-wedge distal femur osteotomy (MCW-DFO) for the treatment of osteoarthritis (OA) in valgus knee at medium- to long-term follow-up. Materials and methods A total of 57 patients (62 knees) treated with MCW-DFO between 1984 and 2018 were included in the study. Patient age at the time of the surgery ranged between 28 and 61 years (average: 48 years). All patients with a minimum follow-up of 4 years were contacted to request for them to undergo clinical, subjective, and radiological evaluation. Preoperative hip–knee–ankle (HKA) angle (i.e., preoperative valgus malalignment) was 8.6° ± 2°. Patients were evaluated using the following scales: the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), the Visual Analog Scale (VAS), and the Numeric Rating Scale 11 (NRS-11). Results Mean follow-up was 11.6 ± 4.9 years, and a total of 17 patients (20 knees) were available for the last examination. At maximum follow-up, 4 patients underwent conversion to a total knee replacement (20%); their survival rate was 100% at 10 years and 66.7% at 15 years, as estimated using the Kaplan–Meier curve. The subjective Knee Society Score improved on average from 37.7 ± 10 to 63.9 ± 15.4. The objective Knee Society Score improved on average from 42.2 ± 11.7 to 75 ± 22.5. The pain detected through the VAS and NRS-11 scales improved from 56.7 ± 12.9 to 42 ± 17.1 and from 5.8 ± 1.1 to 4.4 ± 1.7, respectively. Thirteen patients (70%) required hardware removal at an average time of 19 ± 4 months due to a local nuisance. Conclusions MCW-DFO can improve symptoms in patients with osteoarthritis in a valgus knee at medium- to long-term follow-up, reducing the progression of osteoarthritis in properly selected patients.

The Mediterranean region is experiencing pronounced aridification and in certain areas higher occurrence of intense precipitation. In this work, we analyze the evolution of the precipitation probability distribution in terms of precipitating days (or "wet‐days") and all‐days quantile trends, in Europe and the Mediterranean, using the ERA5 reanalysis. Looking at the form of wet‐days quantile trends curves, we identify four regimes. Two are predominant: in most of northern Europe the precipitation quantiles all intensify, while in the Mediterranean the low‐medium quantiles are mostly decreasing as extremes intensify or decrease. The wet‐days distribution is then modeled by a Weibull law with two parameters, whose changes capture the four regimes. Assessing the significance of the parameters' changes over 1950–2020 shows that a signal on wet‐days distribution has already emerged in northern Europe (where the distribution shifts to more intense precipitation), but not yet in the Mediterranean, where the natural variability is stronger. We extend the results by describing the all‐days distribution change as the wet‐days' change plus a contribution from the dry‐days frequency change, and study their relative contribution. In northern Europe, the wet‐days distribution change is the dominant driver, and the contribution of dry‐days frequency change can be neglected for wet‐days percentiles above about 50%. In the Mediterranean, however, the change of precipitation distribution comes from the significant increase of dry‐days frequency instead of an intensity change during wet‐days. Therefore, in the Mediterranean the increase of dry‐days frequency is crucial for all‐days trends, even for heavy precipitation. Plain Language Summary: The Mediterranean region is facing increased dryness alongside more intense rainfall in certain areas. We delved into the change of precipitation frequency and intensity across Europe and the Mediterranean using ERA5 reanalysis data from 1950 to 2020. Our analysis revealed four distinct patterns in how rainfall is evolving. In much of northern Europe, heavy rainfall events are becoming more frequent, while in the Mediterranean, lighter precipitation is decreasing while heavy rain is either increasing or decreasing. To understand these changes better, we used a mathematical model with two parameters. This model helped us track the types of changes in precipitation patterns. We found that in northern Europe, the increase in rainfall intensity is the primary driver of change, while in the Mediterranean, it's more about the increase of the dry‐days frequency. These findings underscore the importance of considering both the frequency and intensity of precipitation when studying climate change impacts. By understanding these shifts, we can better prepare for future weather extremes in these regions and adapt to the changing climate. Key Points: Four regimes of change for daily precipitation distribution are identified, and are captured by a two parameters analytical modelIn northern Europe, a signal of increasing mean and extreme precipitation has emergedIn the Mediterranean, the changes of precipitation appears dominated by changes in dry‐days frequency [ABSTRACT FROM AUTHOR]

In this essay I put forward the hypothesis that Pareto's theory of action should be understood as an unintentional, pioneering study on the complexity of humanity rather than as an attempt to explain and correct non-logical behaviours. Through a critical reading of Pareto's vocabulary and unspoken convictions, it will be shown that he went well beyond his own intentions highlighting a fundamental - though unacknowledged and stigmatized - dynamics of human interaction and organization. Building on Pareto's evidence of the importance of non-logical action, it is possible to free humanity from the normative obligation to be rational and begin to understand the actual complexity of interaction and culture creation, taking into account heuristic spheres that rationalization has banned from awareness, but are still crucial, unbeknownst to us: corporeity, emotions, symbolic-imaginal thinking. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) is a key factor of lifestyle behavior enhancing general health and fitness, especially in people after total hip or knee replacement (THR and TKR). Orthopaedic surgeons can play a primary role in advocating the benefits of an active lifestyle. Aim of the study was 1) to assess the attitude of orthopaedic surgeons towards PA for people after THR/TKR and 2) to compare the attitude between a Northern European (the Netherlands) and a Southern European (Italy) country and analyze which factors influence the attitude towards PA. Methods: A cross-cultural study. An (online) survey was distributed among orthopaedic surgeons in Italy and the Netherlands. Chi-square and Mann–Whitney tests were used to compare surgeons' and clinics' characteristics, and questionnaires' scores, respectively. A linear regression analysis was conducted to assess which surgeon characteristics influence attitude towards PA. Results: A cohort of 159 surgeons (103 Italians and 56 Dutch) was analyzed. The median score of overall orthopaedic surgeons' attitude towards PA was positive (57 out of 72). Dutch surgeons showed a more positive attitude compared to Italian surgeons (p < 0.01). Main difference was found in the "Physical activity concern" factor, where Italian surgeons showed more concern about the negative effects of PA on the survival of the prosthesis. The regression analyses showed that "Country" and "Type of clinic" were associated with the surgeons' attitude. Conclusions: Overall, the orthopaedic surgeons' attitude towards PA for people with THR and TKR was positive. However, Dutch surgeons seem to be more positive compared to the Italian. The country of residence was the item that most influenced attitude. Further investigations are needed to untangle specific factors, such as cultural, socioeconomic, or contextual differences within the variable "country" that may influence orthopaedic surgeons' attitudes towards PA. [ABSTRACT FROM AUTHOR]

Literature presents several examples of surgical techniques for the treatment of carpometacarpal osteoarthritis. In our study we used a modified Ceruso’s suspended arthroplasty technique. In this study, 53 patients from 2011 to 2017 underwent arthroplasty with trapezius excision and suture suspension between abductor pollicis longus and flexor carpi radialis. The average age at surgery was 69, the participants were 43 women and 10 men. The average total operation time was 59 minutes. The modified CMC suspension arthroplasty technique provides excellent results compared with those in the literature.

Management of intra-articular heel fractures is controversial. The main goals of surgical treatment are restoring subtalar articular congruence and width, height, form and alignment of the heel. The gold standard is considered Open Reduction and Internal Fixation (ORIF), a complex technique with a high rate of complications. External Fixation (EF) could be a good alternative. In this study were identified 37 fractures in 35 patients (24 patients underwent ORIF and EF was performed in 13 cases) and the outcomes of the two techniques were compared. The mean surgical time for ORIF was 107.8 minutes, while for EF was 88.61 minutes and the ORIF group presented a higher rate of complications, despite of similar results in the mean postoperative AOFAS Ankle and Hindfoot Scale scores (73.31/100 points in the ORIF group and 75.40/100 points in the EF group). Fast learning curve, short surgery time and low complications rate make EF an alternative to ORIF in treating intraarticular heel fractures.

Mid‐tropospheric deep depressions in summer over the North Atlantic are shown to have strongly increased in the eastern and strongly decreased in the western North Atlantic region. This evolution is linked to a change in baroclinicity in the west of the North Atlantic ocean and over the North American coast, likely due to the increased surface temperature there. Deep depressions in the Eastern North Atlantic are linked to a temperature pattern typical of extreme heat events in the region. The same analysis is applied to a sample of CMIP6 model outputs, and no such trends are found. This study suggests a link between the observed increase of summer extreme heat events in the region and the increase of the number of Atlantic depressions. The failure of CMIP6 models to reproduce these events can consequently also reside in an incorrect reproduction of this specific feature of midlatitude atmospheric dynamics. Plain Language Summary: Extreme temperatures events in Western Europe have been rising fast, and current global climate models are not able to reproduce this excess. There are different hypotheses to explain this discrepancy. One is that the large‐scale atmospheric dynamics, responsible for the local weather, is not correctly represented by the models: indeed, the frequency and amplitude of some specific weather phenomena have been shown to be insufficiently reproduced, especially in summer. Here, we study one such phenomenon, namely the transient deep depressions, or extratropical cyclones, that travel across the Atlantic basin. A significant large increase of the number of these events is found in summer in the region of the North Atlantic off the western European coast. Depressions in that region are accompanied by high temperatures in continental western Europe. An ensemble of state of the art climate models are also analyzed and none of them is able to correctly reproduce the frequency of deep depressions nor their large trend, which suggests a common origin with the insufficient prediction of western European extreme heat events. Great caution should be used when analyzing climate change predictions in the region, and even more so when studying changes in complex dynamical phenomena. Key Points: Deep depression occurrences have significantly increased over the eastern side, and decreased over the western side of the North AtlanticDeep depressions are linked to high surface temperature patterns in western continental Europe but have little impact on the mean warmingGlobal Climate Models fail to reproduce the observed trends in deep depressions correctly [ABSTRACT FROM AUTHOR]