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Funder: Alma Mater Studiorum - Università di Bologna, The Late Bronze Age (1700–900 BC) represents an extremely dynamic period for Mediterranean Europe. Here, we provide a comparative survey of the archaeological record of over half a millennium within the entire northern littoral of the Mediterranean, from Greece to Iberia, incorporating archaeological, archaeometric, and bioarchaeological evidence. The picture that emerges, while certainly fragmented and not displaying a unique trajectory, reveals a number of broad trends in aspects as different as social organization, trade, transcultural phenomena, and human mobility. The contribution of such trends to the processes that caused the end of the Bronze Age is also examined. Taken together, they illustrate how networks of interaction, ranging from the short to the long range, became a defining aspect of the “Middle Sea” during this time, influencing the lives of the communities that inhabited its northern shore. They also highlight the importance of research that crosses modern boundaries for gaining a better understanding of broad comparable dynamics.

This study evaluated tubule penetration of GuttaFlow Bioseal with cold single cone or carrier-based technique, under confocal laser scanning microscopy (CLSM). Twenty straight single-rooted teeth were instrumented with Hyflex CM and divided in two groups (n = 10) according to the obturation method: single cold gutta-percha cones; experimental carrier-based obturators. GuttaFlow Bioseal, labelled with Rhodamine B dye, was used as sealer in both groups. Teeth transversally sectioned were observed under CLSM. Percentage of sealer penetration and integrity of sealer layer perimeter were measured. Surface and microstructural characteristics of obturators and gutta-percha cones were compared by FEG-SEM and EDX analysis. No significant differences were found between groups for each examined parameter. Significant differences (P < 0.05) were reported mainly within groups. Integrity was similar among and within groups. FEG-SEM/EDX analysis of obturators revealed the presence of Ba and Zn. Carrier-based obturation technique associated with GuttaFlow Bioseal does not seem to affect sealer penetration into dentinal tubules.

Treatment options for anterior cruciate ligament (ACL) injuries have greatly developed over the past decades. Although reconstruction surgery is a concrete reality, stimulation of ACL healing through biological techniques could represent a revolutionary conservative approach. The use of biologic products, such as platelet-rich plasma (PRP) or mesenchymal stem cells (MSCs), to treat partial ruptures or to enhance ligamentization after reconstruction, could thoroughly improve clinical outcomes. The aim of the present paper is to systematically review the available literature on this topic, to (i) describe the current state of the art in available biologic techniques; (ii) clarify the outcomes of their application; (iii) identify areas needing further investigation and possible future development. A systematic review of the literature on the use of biologically active agents (PRP and MSCs) to enhance outcomes of ACL surgery was performed: 31 studies were included. Based on the ACL injury pattern, 6 papers investigated biologic agents in ACL partial tears whereas 25 papers in ACL reconstruction. Sixteen of twenty-five studies dealing with ACL reconstruction were randomized controlled trials, whereas only case series are available for partial ACL tears. Current evidence is still lacking sound data to support the use of biological agents: no clinical superiority has been described when using PRP in ACL reconstruction. Concerning ACL healing in partial tears, the application of PRP has led to encouraging outcomes, but these findings should be confirmed by appropriately designed RCTs.

In the described proof-of-principle experiments, we introduced a novel testing device to investigate how different concurrent torsional loads influence the cyclic fatigue (CF) resistance of a nickel–titanium (NiTi) instrument. The device was designed to test CF resistance of NiTi files with a standardized load on the apical 5mm; a movable cylinder controlled by a lever provided a uniform real-time load. Thirty-three NiTi instruments 25.04 (F360, Komet, Lemgo, Germany) were rotated until fracture at 30° curvature under three different torsional loads (n=11 each); Group A: 2.5Ncm; Group B: 5Ncm; Group C: 10Ncm. anova, multiple comparisons Tamhane tests, regression and Kaplan–Meyer analysis were performed to contrast means. Resistance to cyclic fatigue differed significantly among groups (P=0.0001). Increased torsional loads led to a decrease in time to failure. An inverse correlation (r=−0.721, P=0.001) was observed between time and torsional load, with higher torsional loads correlated to shorter times to fracture.

The purpose of this paper is to systematically review the available literature to understand the effectiveness, the survivorship, the clinical outcomes and the complications of lateral UKA. A review of the current literature available about lateral UKA was performed in March 2020, according to the PRISMA guidelines. Selection was based on the following inclusion criteria: (1) clinical reports of any level of evidence, (2) written in English language, (3) published from 1996 to 2020, (4) dealing with clinical data on lateral UKA. A total of 47 articles, published between 1996 and 2020, were included in the review. Quality of every article was assessed using the Modified Coleman Methodology Score. A total of 47 studies were included. Mean mCMS was 45.27 (range 30–62). Mean age at surgery was 64.5 years (range 34.1–88.0 years). In 1741 patients (65.5%) a metal back implant was used and in 421 patients (15.8%) an all poly design was used. Several scores were used to evaluate clinical results (OKS, AKSS, IKS, KOOS, WOMAC, VAS). Range of motion improved with an overall mean value of 120.3° (range: 105.9°–143.3°). The mean follow-up was 60.7 months (range, 7–204 months), mean survivorship (absence of a revision) with a minimum 60 months of follow-up was 88.6% (range 74.5–100) and mean satisfaction of patients was 78.5% (range 41.0–97.9). Lateral UKA seems to be an effective solution to manage lateral osteoarthritis (OA), based on preliminary results, with survivorship and satisfaction rate comparable to medial UKA and total knee arthroplasty (TKA). Nonetheless, this review highlights that the quality of studies available in current literature is low. Systematic review of level IV studies.

Purpose To review the available literature on the application of oxygen–ozone therapy (OOT) in the treatment of knee osteoarthritis (KOA) to understand its therapeutic potential and to compare it with other conservative treatment options. Methods A systematic review of the literature was performed on the PubMed, Cochrane, Embase, ResearchGate, and PedRo Databases, with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in English, (3) published on indexed journals in the last 20 years (1998-2018), (4) dealing with the use of ozone intra-articular injection for the treatment of KOA. The risk of bias was assessed by the Cochrane Risk of Bias tool for RCTs. Results Eleven studies involving 858 patients in total (629 female and 229 male) were included. Patients in the control groups received different treatments: placebo in 1 trial; hyaluronic acid in 2 studies; hyaluronic acid and PRP in 1 trial; corticosteroids in 4; and hypertonic dextrose, radiofrequency, or celecoxib + glucosamine in the remaining 3 trials. In looking at the quality of the available literature, we found that none of the studies included reached “good quality” standard, 2 were ranked as “fair,” and the rest were considered “poor.” No major complications or serious adverse events were reported following intra-articular OOT, which provided encouraging pain relief at short term. On the basis of the available data, no clear indication emerged from the comparison of OOT with other established treatments for KOA. Conclusions The analysis of the available RCTs on OOT for KOA revealed poor methodologic quality, with most studies flawed by relevant bias, thus severely limiting the possibility of drawing conclusions on the efficacy of OOT compared with other treatments. On the basis of the data available, OOT has, however, proven to be a safe approach with encouraging effects in pain control and functional recovery in the short-middle term. Level of Evidence Systematic review of Level I and III studies.

It has long been held that at the transition between the Middle and Late Helladic, considerable social, political, economic and cultural changes occurred within mainland Greek societies (Dickinson 1977; Voutsaki – Wiersma 2017), changes ultimately leading to the formation of early Mycenaean polities and later palatial states (Voutsaki 2010, 99). Houses are increasingly being considered a fruitful domain of enquiry in order to explore such changes, as they can directly express the values, images, perceptions and ways of life of a human group (Rapoport 1969, 12; Wiersma 2017, 91). The present paper investigates whether social change happening in the Peloponnese at the transition between MH and LH affected the formal and functional solutions adopted in the domestic architecture. To that end, we will analyse a sample of 149 domestic buildings, seeking to identify main trends visible through time and whether these are geographically inflected and/or connected to the unfolding of the trajectory of the Mycenaean palaces.

In the last two decades or so, gradually but steadily, the concept of network has acquired a considerable importance, mainly as a metaphor through which to filter our understanding of society. Cultural theorists and specialists in media studies have been at the forefront of this development, often borrowing keywords from the work of social physics and transforming them into loose metaphors (i.e. Barabási, 2002; Castells, 1996; Prey, 2012). The affirmation of such a trend, though, has not occurred without criticism. Boltanski and Chiapello (2005), for instance, have stigmatised the tendency to apply the logic of networks to the analysis of contemporary social phenomena. In their view this is a very recent development that flattens dynamics of exploitation in a dualistic dichotomy of inclusion vs. exclusion and that projects a negative ‘halo’ on those who are excluded. Without endorsing the efficacy and versatility of the inclusion/exclusion paradigm tout-court, it is certain that, although deficient, this paradigm is not limited to capitalism and the modern Internet society. Indeed, as recognised long ago by anthropologists (e.g. Barth, 1969), the inclusion/exclusion dynamics is critical to many premodern contexts e.g. in various forms of membership, identity formation, and ethnicity. However, the problem runs deeper and underlies the basic question of whether focusing on inclusion/exclusion is enough; that is, if the network metaphor has completely cancelled the need for more traditional theoretical tools in order to make sense of society and its multiple facets. Have networks superseded “class”?

The last few decades have marked a considerable increase in our level of knowledge of the southern Adriatic/ Ionian area during the Bronze Age. However, observing these developments from the vantage point of the main- land masses lying at the north-western boundary of the Ionian, namely Salento in southeastern Italy, the picture we have remains primarily based on the record of a very limited number of well explored sites, with very few data on landscape occupation. Yet, as we know from these limited snapshots, during the 2nd millennium BC Salento is a privileged hub of long-range mobility and interaction, involving actors with origins as different as the Aegean world (broadly understood, but with intense connections with the Ionian area and western Greece), as well as northern Italy and selected areas of the Balkans. How is this landscape of mobility manifested in the archaeological record? What are the traces left on the ground? This paper tries to answer such questions using data from a survey project recently undertaken in the territory around the site of Roca, one of the main loci of Bronze Age connectivity in the area.

The objective of this study is to evaluate the retreatment time and weight of apically extruded debris yielded by two different kinematics during the removal of different root canal filling materials. Forty straight single-rooted extracted teeth were instrumented with HyFlex CM files and obturated with two different techniques: 25.04 HyFlex experimental carrier-based obturators (Coltène/Whaledent, Altstätten, Switzerland) (group 1) or 25.04 single gutta-percha cones (Roeko Coltène/Whaledent, Altstätten, Switzerland) (group 2) and Guttaflow Bioseal as the sealer. Samples were divided into four subgroups (n = 10) according to the used kinematics for the removal of root canal filling materials: continuous rotation (A) or retreatment motion (B) with a Remover and HyFlex EDM Nickel-Titanium instruments activated with a CanalPro Jeni micromotor (Coltène/Whaledent, Altstätten, Switzerland). Time for retreatment was digitally recorded, and debris extruded from the apex was collected in Eppendorf tubes and weighted with an analytical balance. Data on retreatment time and apical extrusion were statistically analyzed with the Kruskal–Wallis test ( p < 0.05 ). Working length was achieved in all the retreated samples. The removal of root filling material resulted significantly faster with the Jeni mode ( p < 0.001 ), and the difference was significant for the removal of both filling materials ( p < 0.05 ). No significant differences on debris extrusion between single cone and experimental obturators groups were noted ( p > 0.05 ), and no significant differences between kinematics (continuous rotation vs. Jeni motion) were observed ( p > 0.05 ). All the tested retreatment strategies lead to an extrusion of material from the apex, and the weight of apically extruded debris was similar. The use of the innovative CanalPro Jeni kinematics accelerates the time for the removal of root filling materials.

Purple textiles were highly valued in the ancient Mediterranean as a symbol of prestige, social status and power. Despite the numerous publications focused on the production and spread of purple dye technologies, the discussion regarding this particular dye has often been compartmentalised regionally (eastern or western Mediterranean) and chronologically (second or first millennium bc). The aim of this paper is threefold: (1) to propose a full chaîne opératoire for the production of shellfish-purple-dyed textiles; (2) to synthesise the archaeological evidence on production and consumption of such textiles in the entire Mediterranean before the Romans; and (3) to discuss the social implications of the production and consumption of these textiles, to gain a better understanding of their economic and social significance. Open access: Attribution—Non Commercial—NoDerivs / CC BY-NC-ND

This article analyzes the current literature on the use of adipose-derived stem cells (ASCs) to evaluate the available evidence regarding their therapeutic potential in the treatment of cartilage pathology. Seventeen articles were included and analyzed, showing that there is overall a lack of high quality evidence concerning the use of ASCs. Most trials are case series with short-term evaluation. The most adopted approach consists of an intra-articular injection of the stromal vascular fraction (SVF) rather than the expanded cells. Based on the available data, no specific preparation method or formulation could be considered as the preferred choice in clinical practice.

Joint line (JL) restoration is one of the major challenges in revision total knee arthroplasty (rTKA). There is debate regarding the most reliable methodology for the assessment of JL level during revision surgery. Among the strategies, the use of adductor tubercle (AT) as an anatomical landmark has been proposed. The purpose of this paper is to systematically review the available literature to understand the reliability of AT ratio to identify the JL, and the advantages and drawbacks of its application. A research was performed on the PubMed, Embase, Cochrane and Google Scholar databases based on the following inclusion criteria for articles' selection: (I) clinical reports of any level of evidence, (II) written in the English language, (III) published from 2010 to 2020, (IV) dealing with the use of the adductor tubercle as a landmark to restore JL in revision TKA. All relevant data were extracted by two independent investigators, and discrepancies were resolved by discussion and consensus. A total of 13 studies were included: nine were radiographic evaluations, 3 clinical reports and 1 was an ex-vivo study. Radiographic studies highlighted that AT is a landmark easy to identify, with high intra and inter-observer agreement, irrespective of gender, age and size of the patient. The comparison with other bony landmarks revealed superior reliability in favor of AT. Also during surgical procedures, AT can be safely located and some clinical studies confirmed that AT ratio helps surgeon in re-establishing a correct JL and achieve ligament balancing even in complex revision cases. AT is a reliable and easily detectable landmark, and AT ratio is a valid tool to determine the JL level and help surgeons to restore the JL and simultaneously achieve knee ligament balancing in r-TKA.

Objective: To define surface, mechanical, microstructural and metallurgical features of conventional OneShape (OShape) and heat-treated OneCurve (OCurve) nickel-titanium instruments. Methods: Instruments were analysed by scanning electron microscopy (SEM) on new instruments and after simulated clinical use (SCU). Cyclic fatigue testing was performed and the number of cycles to fracture (NCF) and the length of the fractured instruments were measured (Mann-Whitney test). Fractured instruments during cyclic fatigue testing were then inspected by SEM fractographic analysis. Field emission gun scanning scanning electron microscopy (FEG-SEM), energy-dispersive X-ray spectroscopy (EDX) and micro-Raman spectroscopy were used to assess alloy surface chemistry. Focused ion beam (FIB) was performed to analyse the oxide layer on the surface of OCurve before and after SCU. X-Ray diffraction (XRD), metallographic evaluation and differential scanning calorimetry (DSC) were used to determine martensitic/austenitic phase transformation temperatures. Results: SEM observations on new instruments revealed a smooth regular surface with flattened milling grooves. No wear features were detected after SCU. OCurve exhibited a higher cyclic fatigue resistance (P

Objective To systematically review the available clinical evidence regarding the safety and efficacy of knee intraosseous injections for the treatment of bone marrow lesions in patients affected by knee osteoarthritis. Design A literature search was carried out on PubMed, Embase, and Google Scholar databases in January 2020. The following inclusion criteria were adopted: (1) studies of any level of evidence, dealing with subchondral injection of bone substitute materials and/or biologic agents; (2) studies with minimum 5 patients treated; and (3) studies with at least 6 months’ follow-up evaluation. All relevant data concerning clinical outcomes, adverse events, and rate of conversion to arthroplasty were extracted. Results A total of 12 studies were identified: 7 dealt with calcium phosphate administration, 3 with platelet-rich plasma, and 2 with bone marrow concentrate injection. Only 2 studies were randomized controlled trials, whereas 6 studies were prospective and the remaining 4 were retrospective. Studies included a total of 459 patients treated with intraosseous injections. Overall, only a few patients experienced adverse events and clinical improvement was documented in the majority of trial. The lack of any comparative evaluation versus subchondral drilling alone is the main limitation of the available evidence. Conclusions Knee intraosseous injections are a minimally invasive and safe procedure to address subchondral bone damage in osteoarthritic patients. They are able to provide beneficial effects at short-term evaluation. More high-quality evidence is needed to confirm their potential and to identify the best product to adopt in clinical practice.

Correct component alignment in total knee arthroplasty (TKA) is crucial for implant functionality and longevity. Several devices have been developed to help surgeons to achieve optimal component positioning. The purpose of our study was to evaluate the accuracy and reliability of a novel inertial-based cutting guide used to perform tibial resection in TKA taking into account users with different levels of experience.Seven operators (raters) with different levels of experience participated in the study. To evaluate the accuracy, the varus/valgus (VV) and slope (SL) angles obtained with this novel device were compared with the reference angles obtained with the navigation system. To calculate intra-(rater) reliability repeated measurements of VV and SL angles by the same operator were used. To calculate inter-(rater) reliability repeated measurements of VV and SL by different operators were used.A total of 140 acquisitions were performed. In this study both for the VV and for the SL the maximum mean absolute error (MAE) that the inertial system registered was1°. Intra-inter reliability was evaluated by calculating the Fleiss' Kappa coefficient, which recorded values close to 0.75 (75%) with regard to the VV and the SL for intra-reliability, while values were recorded around 0.9 (90%) for the inter subject reliability.The Perseus system is accurate, reliable and surgeon-friendly and could be very useful in improving results in low-volume centers.

Purpose This work presents a kinematic evaluation of a cruciate retaining highly congruent mobile bearing total knee arthroplasty design using dynamic Roentgen sterephotogrammetric analysis. The aim was to understand the effect of this implant design on the kinematics of prosthetic knees during dynamic activities. Methods A cohort of 15 patients was evaluated at nine month follow-up after surgery. The mean age was 74.8 (range 66–85) years. The kinematics was evaluated using the Grood and Suntay decomposition and the Low-Point (LP) methods. Results ?tlsb=-0.15pt?>From sitting to standing up position, the femoral component internally rotated (from − 11.3 ± 0.2° to − 7.0 ± 0.2°). Varus–valgus rotations were very close to 0° during the whole motor task. LP of medial condyle moved from an anterior position of 12.0 ± 0.2 mm to a posterior position of − 12.4 ± 0.2 mm; LP of the lateral condyle moved from an anterior position of 8.1 ± 0.2 mm to a posterior position of − 12.4 ± 0.2 mm, showing a bi-condylar rollback where both condyles moved parallel backward. Moreover, the femoral component showed anterior translation with respect to the tibia from 80° to 20° (from − 4.9 ± 0.2 mm to 3.3 ± 0.2 mm), then a posterior translation from 20° to full extension was identified (from 3.3 ± 0.2 mm to 0.5 ± 0.2 mm). Conclusions Paradoxical anterior femoral translation and absence of medial-pivoting motion were recorded, highlighting the role of the symmetric deep dishes insert as main driver of the kinematic of this TKA design.

Survivorship of unicondylar knee arthroplasty (UKA) remains a drawback, especially compared with the outcome of total knee arthroplasty. This could be improved by identifying and correcting failure mechanisms. To this purpose, this study aimed at exploring failure modalities of UKA, with particular focus on the role of joint line (JL) position and alignment as variable to be optimized for a successful outcome. This study explored modes of failure in 266 medial UKAs. Radiological comparison was performed between 24 failures and 24 matched controls, to determine the importance of UKA positioning in terms of femorotibial angle (FTA), tibial plateau angle, and posterior tibial slope (PTS). Radiographic comparative analysis showed statistically significant differences in the failure group compared with the control group in terms of variation in FTA (p = 0.0222), PTS (p = 0.0025), and JL height (p = 0.0022). Variations not only in FTA but also PTS and JL height were correlated with failures observed in this series. Thus, based on the results of this study, it emerges that JL position should be carefully controlled in all planes while implanting a UKA. This is a Level III, case–control study.

Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years). Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI) was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2), healing (without any symptoms and PAI = 3) or diseased (with symptoms or PAI ≥ 4 and not functional) on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p

Objectives: Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF). Materials and methods: Patients treated by postgraduate students in an Endodontics Master’s Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as “healthy” (PAI ≤ 2 in absence of signs/symptoms), “endodontically diseased” (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or “non-endodontically diseased” (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05). Results: At 10years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered “endodontically diseased”). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as “healthy.” Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively. Conclusions: After 10years, teeth filled with Thermafil in a specialist master’s program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques. Clinical relevance: Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.

Marxist archaeologies have represented one of the most important theoretical developments of archaeology. The approaches that go under this label can be extremely diverse, but often maintain the use of and/or the engagement with some basic ideas derived from the thought of Marx, Engels, and subsequent thinkers of the Marxist tradition. These concepts can be identified, for instance, in the notions of means, relations, and mode of production as well as in that of class. Contrarily to many other strands of archaeological theory, however, Marxism is not only a philosophy but has had an active role in recent global history, being related to both emancipatory struggles and dictatorial regimes worldwide. Because of this, the development of Marxist archaeologies (variously declined) will be discussed also in their historical development through the twentieth century and beyond, until the present day.

More than a quarter of a century after the fall of the eastern bloc (broadly intended), former commu­nist countries have dramatically changed. Yet the memory of the recent past is sometimes perceived as being accompanied by a considerable sense of unease. This process is mirrored clearly in the way some countries have dealt with the physical remains of the regime. This paper will focus on a case study from contemporary Albania and represents one of the first attempts at addressing the social significance of the remnants of the recent communist past in this country. It is undertaken not only through a theo­retical and historical investigation, but also via a direct survey of the public (in this case a sample of citizens of the capital city Tirana). Our results suggest that, contrary to our initial assumptions, there is a considerable widely shared interest in the material remnants of the regime and that its cultural heritage its cultural heritage still needs to be explained.

The author names in the original version of this article were inadvertently interchange. Correct presentation of author names is reflected here.

Osteoarthritis (OA) is one of the most common causes of chronic disability in adults due to pain and altered joint function. Although most patients report pain and functional limitation, symptoms, age of onset and disease progression are extremely variable. While inflammation could play a central role in the OA pathogenesis and progression, many underpinning mechanisms are still unclear. A number of proinflammatory mediators have been found in OA joints and could play a role, such as IL-1, IL-6, IL-7, IL-8, IL-15, IL-17, IL-18, TNF-alpha, macrophage chemotactic protein (MCP)-1, interferon-induced protein (IP)-10, monokine induced by interferon (MIG), oncostatin M (OSM), growth-related oncogene (GRO)-alpha, chemokine (C-C-motif) ligand 19 (CCL19), macrophage inflammatory protein (MIP)-1beta, and TGF-alpha. Biological approaches have recently got increasing interest due to their anti-inflammatory and immunomodulatory properties, regenerative potential, and high tolerability. The primary aim of this paper is to report the current concepts on regenerative medicine for knee OA with a particular focus on Autologous Protein solution (APS). APS is a blood derived product obtained by using a proprietary device, made of APS Separator, which isolates WBCs and platelets in a small volume of plasma, and APS Concentrator, which further concentrates platelets, WBCs and plasma proteins. The result is a peculiar formulation differing from other biologic products as it contains high levels of growth factors (EGF, IGF-1, PDGF-AB, PDGF-BB, VEGF, TGF-β1) along with high concentrations of anti-inflammatory mediators (IL-1ra, sIL-1RII, sTNF-RI, sTNF-RII) and low levels of pro-inflammatory cytokines (Il-1β and TNF-α). While emerging evidence supports the use of APS, as confirmed by in vitro studies and preliminary clinical results, the real clinical potential of APS and its benefits are still under investigation.

Background. The use of laboratory-expanded mesenchymal stem cells (MSCs) is subject to several restrictions, resulting in “minimal manipulation” methods becoming the current most popular strategy to increase the use of MSCs in an orthopaedic practice. The aim of the present systematic review is to assess the clinical applications of “minimally” manipulated MSCs, either as bone marrow aspirate concentrate (BMAC) or as stromal vascular fraction (SVF), in the treatment of knee osteoarthritis (OA). Methods. A systematic review of three databases (PubMed, ScienceDirect, and Google Scholar) was performed using the following keywords: “Knee Osteoarthritis” with “(Bone marrow aspirate) OR (bone marrow concentrate)” or with “(adipose-derived mesenchymal stem cells) OR (adipose derived stromal cells) OR (stromal vascular fraction) OR (SVF)” as either keywords or MeSH terms. The reference lists of all retrieved articles were further reviewed for identification of potentially relevant studies. Results. Twenty-three papers were included in the final analysis (10 on BMAC and 13 on SVF). Of these, only 4 were randomized controlled trials (RCTs). Bias risk evaluation, performed using a modified Coleman score, revealed an overall poor quality of the studies. In terms of clinical application, despite the apparent safety of minimally manipulated MSCs and the short-term positive clinical outcomes associated with their use, clinicians reported different preparation and administration methods, ranging from single intra-articular injections to intraosseous applications to administration in combination with other surgical procedures. Conclusions. The available literature is undermined by both the lack of high-quality studies and the varied clinical settings and different protocols reported in the few RCTs presently published. This prevents any recommendation on the use of either product in a clinical practice. Nevertheless, the use of minimally manipulated MSCs (in the form of BMAC or SVF) has been shown to be safe and have some short-term beneficial effects.

In occidental societies, a great number of people practice sport regularly at all ages. In this context, cartilage injury incidences have become higher and higher. They are frequently diagnosed during knee arthroscopy even in asymptomatic patients. However, patients commonly present with pain, recurrent effusion, and loss of function. Concomitantly with the increasing incidence, the expectations of patients about function restore have risen as well. Since articular cartilage is characterized by a poor intrinsic regenerative capacity, treatment of these lesions is particularly challenging.

Purpose: To assess, using model-based dynamic radiostereometric analysis (RSA), the biomechanical behaviour of a new design posterior-stabilized (PS) fixed-bearing (FB) total knee arthroplasty (TKA) in vivo while patients performing two common motor tasks. The hypothesis was that model-based dynamic RSA is able to detect different behaviour of the implant under weight-bearing and non-weight-bearing conditions. Methods: A cohort of 15 non-consecutive patients was evaluated by dynamic RSA 9months after TKA implantation. The mean age of patients was 73.4 (65–72) years. The kinematic evaluations were performed using an RSA device (BI-STAND DRX 2) developed in our Institute. The patients were asked to perform two active motor tasks: sit-to-stand in weight-bearing condition; range of motion (ROM) while sitting on the chair. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods. Results: The dynamic RSA evaluation showed a significant difference (p < 0.05) between the biomechanical behaviour of the prosthesis during the two motor tasks. When subjected to the patient weight (in the sit-to-stand) the low point of the medial compartment had a shorter motion (5.7 ± 0.2mm) than the lateral (11.0 ± 0.2mm). This realizes a medial pivot motion as in the normal knee. In the ROM task, where the patient had no weight on the prosthesis, this difference was not present: the medial compartment had a displacement of 12.7 ± 0.2mm, while the lateral had 17.3 ± 0.2mm. Conclusions: Model-based RSA proved to be an effective tool for the evaluation of TKA biomechanics. In particular, it was able to determine that the fixed-bearing posterior-stabilized TKA design evaluated in this study showed a medial pivoting movement under weight-bearing conditions that was not present when load was not applied. Under loading conditions what drives the pattern of movement is the prosthetic design itself. By the systematic use of this study protocol future comparisons among different implants could be performed, thus contributing significantly to the improvement of TKA design. Level of evidence: IV.

Objectives: To evaluate the impact of a modified motion on the fatigue life of four brands of nickel–titanium (NiTi) reciprocating instruments. Materials and methods: Cyclic fatigue (CF) resistance of 160 instruments was evaluated in an artificial stainless-steel canal (90° angle, 5-mm radius of curvature). WaveOne and WaveOne Gold (Denstply Maillefer, Baillagues, Switzerland) and Reciproc and Reciproc Blue (VDW, Munich, Germany) were tested with two different motions: (1) X-Smart Plus (Denstply Maillefer) endodontic motor and (2) a 4:1 contra-angle with an experimental motion (EVO) with different rotation angles and based on a sinusoidal acceleration. Motions with X-Smart Plus and EVO were recorded and analyzed at a reduced speed with VLC Media Player software for a more accurate analysis. Mean half-life, beta, and eta Weibull parameters were determined and compared. Results: Reciproc Blue resulted the most resistant instruments either with EVO or X-Smart. WaveOne Gold lasted significantly longer than WaveOne with EVO (probability of 91%) while no significant differences were found with X-Smart. Considering NCF, Reciproc, WaveOne Gold, and Reciproc Blue lasted significantly longer with EVO (probabilities of 66%, 80%, and 89% respectively). WaveOne Gold showed the highest beta parameter. Conclusions: The experimental motion was found to have a positive impact on fatigue lifetime of reciprocating instruments. Clinical relevance: Current findings provide insight for future improvements in the clinical use of reciprocating files. Experimental motions may be considered when searching for additional strategies in order to increase the safer use of NiTi files during endodontic procedures.

Through the last few decades, the study of the relations between the Aegean world and Central Mediterranean societies during the Late Bronze Age (as investigated primarily through the analysis of Aegean type pottery) has highlighted an evident overarching pattern: a limited number of sites played an overwhelmingly important role, while other centres produced only limited amounts of material evidence. In other words, much of the LBA Aegean interaction to the west seems to have been extremely nodal in nature. How are we to interpret this asymmetry? What characterises the ‘exceptional’ as opposed to the ‘normal’ pattern? Many explanations can be (and have been) adopted to make sense of this situation, ranging from attributing the difference to exploration bias, to the placing of emphasis on geographic position to the use of explanatory models like colonies (declined in a variety of ways) and gateway communities. And yet, although capturing part of the processes at work, these elements are not enough to provide a well-rounded assessment of the rationale beyond these macroscopic differences. In this paper I will try to explore these issues trying to glimpse some broad similarities recognisable in the material record. A diachronic contextual analysis of some of the main interaction nodes identifiable in the Central Mediterranean, will be contrasted to the regional ‘norm’ identifiable. A specific attention will be dedicated to the Adriatic area and the site that represents probably the most significant ‘exception’ to the general pattern of interaction in the overall central and western portion of the middle sea, i.e. the site of Roca that produced about half of the overall material recovered west of the Adriatic.

Roca e il mondo egeo tra il XVi e l’Xi sec. a.c.: una messa a punto - il contributo contiene tre brevi note degli autori su temi attinenti ai rapporti con l’egeo e oggetto di ricerche in corso. nella prima si propone un aggior- namento e una breve sintesi sulla documentazione riguardante le fasi più antiche di occupazione. nella seconda è esposto uno studio quantitativo dei materiali di tipo egeo dal sas X per ricostruire le dinamiche diacroniche dei rapporti. nella terza viene presentata un’analisi delle innovazioni architettoniche registrabili nella fase subappenninica delle mura di for- tificazione.

The Bronze Age societies of southern Italy and the Aegean have been characterized as having a continuous and intense relationship for much of the second millennium bc. This is suggested by the import and copying of artefacts (primarily pottery, known under the umbrella name of ‘Aegean type pottery’); the way in which those artefacts, and their contents, were used; as well as the diffusion and transformation of social practices connected to all these materials. The coastal settlement of Roca located a few kilometres north of Otranto in Apulia represents the ideal vantage point to explore these dynamics because: (a) its occupation covers much of this chronological spectrum; (b) it has produced the largest amount of Aegean type pottery west of Greece.