Joint Assessment Research Articles

Estimating the impact of metabolic syndrome on low back pain and the joint effects of metabolic syndrome and depressive symptoms on low back pain: insights from the China Health and Retirement Longitudinal Study

BackgroundAlthough metabolic syndrome (MetS) and depressive symptoms (DS) are predictors of low back pain (LBP), their combined effects and relative contributions to LBP have not been well studied. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), this study conducted cross-sectional and longitudinal analyses to investigate the impact of MetS on LBP, and the joint effects of MetS and DS on LBP.MethodsThis study included a cross-sectional analysis of 8957 participants aged at least 45 years from the CHARLS 2011 dataset and a longitudinal follow-up of 3468 participants without LBP from the CHARLS 2011, tracked over 9.25 years (from June 2011 to September 2020) with 4 times LBP assessment in CHARLS 2013, 2015, 2018, and 2020. To explore the association between MetS on LBP and the joint effects of MetS and DS on LBP, multivariable-adjusted multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable-adjusted COX proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs. All statistical analyses were conducted using STATA (version SE16).ResultsIn the cross-sectional analysis, MetS was associated with a lower risk of LBP (adjusted OR = 0.85, 95% CI = 0.74–0.97), while there was no significance for this association in the longitudinal analysis. In the joint association of MetS and DS with LBP, participants with NoMetS + DS (adjusted OR = 2.31, 95% CI = 1.94–2.75), and MetS + DS (adjusted OR = 2.16, 95% CI = 1.81–2.59) were risk factors for LBP events, while those with MetS + NoDS (adjusted OR = 0.75, 95% CI = 0.62–0.90) was a protective factor for LBP events than those with NoMetS + NoDS. During the 9.25 years of follow-up, 1708 cases (49.25%) experienced incident LBP events. In the longitudinal analysis, a significantly negative association was not found in MetS + NoDS for LBP events. Three sensitivity analyses identified the robustness of the associations. Moreover, the nature of cross-sectional associations differed by age (45–64 and 65 + years).ConclusionsOur study found that MetS was linked to a lower incidence of LBP, but this effect does not persist over time. Importantly, the combination of MetS and DS significantly increased LBP risk, a joint effect not extensively studied before. These findings underscore the novel contribution of our research, advocating for the joint assessment of MetS and DS to enhance LBP risk stratification and inform prevention strategies.

Advances on the Global Human Settlement Layer by joint assessment of Earth Observation and population survey data

ABSTRACT The Global Human Settlement Layer (GHSL) project fosters an enhanced, public understanding of the human presence on Earth. A decade after its inception in the Digital Earth 2020 vision, GHSL is an established project of the European Commission’s Joint Research Centre and an integral part of the Copernicus Emergency Management Service. The 2023 GHSL edition, a result of rigorous research on Earth Observation data and population censuses, contributes significantly to understanding worldwide human settlements. It introduces new elements like 10-m-resolution, sub-pixel estimation of built-up surfaces, global building height and volume estimates, and a classification of residential and non-residential areas, improving population density grids. This paper evaluates the key components of the GHSL, including the Symbolic Machine Learning approach, using novel reference data. These data enable a comparative assessment of GHSL model predictions on the evolution of built-up surface, building heights, and resident population. Empirical evidence suggests that GHSL estimates are the most accurate in the public domain today, e.g. achieving an IoU of 0.98 for the water class, 0.92 for the built-up class, and 0.8 for the non-residential class at 10 m resolution. At 100 m resolution, we find that the MAE of built-up surface estimates corresponds to 6% of the grid cell area, the MAE for the building height estimates is 2.27 m, and we find a total allocation accuracy of 83% for resident population. This paper consolidates the theoretical foundation of the GHSL and highlights its innovative features for transparent Artificial Intelligence, facilitating international decision-making processes.

Development of a theory-monitoring integrated structure joints assessment method of prefabricated underground stations

Prefabricated assembly structures have been extensively applied for the construction of low carbon and cost effective underground subway stations in China. Engineers faced significant challenges in dealing with the assessment of mechanical performance of structures joints within prefabricated underground station (PUS) structures during construction process. Manual assembly of large-scale prefabricated structures may lead to significant disturbance of structures joints, resulting in structures joints failure in construction process or even water leakage in maintenance of underground stations. To address these issues, this study proposed an integrated theory-monitoring method for joint performance assessment. The initial step involved the establishment of a fiber optical sensors (FOS) monitoring system for PUS joints. A joint performance assessment module was then developed utilizing the Joint Interfaces Contact Model (JICM) and was subsequently integrated into monitoring system, forming a joint performance assessment method, namely FOS-JICM (FOJI). A case study was finally conducted on a Shenzhen pipe jacking PUS to evaluate the effectiveness of FOJI. Main research findings of this study include (a) FOS monitoring system demonstrated excellent adaptability, accuracy, and real-time performance in practical applications; (b) FOS monitoring system effectively captured joint deformation and stress evolution throughout the entire construction process, providing insights into the impact of complex geological conditions and box culverts on joint behavior; (c) FOJI, with its integration of the JICM module, enabled safety assessment of joint performance during pipe jacking process; (d) FOJI successfully identified joint damage, offering valuable guidance for engineering restoration and protective measures. It facilitated prompt updates and adjustments based on the actual construction conditions, establishing a cycle mechanism for safety protection. These achievements not only establish a theoretical foundation for ensuring the construction safety of PUS joints but also present substantial practical application value.

Deep Learning-Enhanced Accelerated 2D TSE and 3D Superresolution Dixon TSE for Rapid Comprehensive Knee Joint Assessment.

The aim of this study was to evaluate the use of a multicontrast deep learning (DL)-reconstructed 4-fold accelerated 2-dimensional (2D) turbo spin echo (TSE) protocol and the feasibility of 3-dimensional (3D) superresolution reconstruction (SRR) of DL-enhanced 6-fold accelerated 2D Dixon TSE magnetic resonance imaging (MRI) for comprehensive knee joint assessment, by comparing image quality and diagnostic performance with a conventional 2-fold accelerated 2D TSE knee MRI protocol. This prospective, ethics-approved study included 19 symptomatic adult subjects who underwent knee MRI on a clinical 3 T scanner. Every subject was scanned with 3 DL-enhanced acquisition protocols in a single session: a clinical standard 2-fold in-plane parallel imaging (PI) accelerated 2D TSE-based protocol (5 sequences, 11 minutes 23 seconds) that served as a reference, a DL-reconstructed 4-fold accelerated 2D TSE protocol combining 2-fold PI and 2-fold simultaneous multislice acceleration (5 sequences, 6 minutes 24 seconds), and a 3D SRR protocol based on DL-enhanced 6-fold accelerated (ie, 3-fold PI and 2-fold simultaneous multislice) 2D Dixon TSE MRI (6 anisotropic 2D Dixon TSE acquisitions rotated around the phase-encoding axis, 6 minutes 24 seconds). This resulted in a total of 228 knee MRI scans comprising 21,204 images. Three readers evaluated all pseudonymized and randomized images in terms of image quality using a 5-point Likert scale. Two of the readers (musculoskeletal radiologists) additionally evaluated anatomical visibility and diagnostic confidence to assess normal and pathological knee structures with a 5-point Likert scale. They recorded the presence and location of internal knee derangements, including cartilage defects, meniscal tears, tears of ligaments, tendons and muscles, and bone injuries. The statistical analysis included nonparametric Friedman tests, and interreader and intrareader agreement assessment using the weighted Fleiss-Cohen kappa (κ) statistic. P values of less than 0.05 were considered statistically significant. The evaluated DL-enhanced 4-fold accelerated 2D TSE protocol provided very similar image quality and anatomical visibility to the standard 2D TSE protocol, whereas the 3D SRR Dixon TSE protocol scored less in terms of overall image quality due to reduced edge sharpness and the presence of artifacts (P < 0.001). Subjective signal-to-noise ratio, contrast resolution, fluid brightness, and fat suppression were good to excellent for all protocols. For 1 reader, the Dixon method of the 3D SRR protocol provided significantly better fat suppression than the spectral fat saturation applied in the standard 2D TSE protocol (P < 0.05). The visualization of knee structures with 3D SRR Dixon TSE was very similar to the standard protocol, except for cartilage, tendons, and bone, which were affected by the presence of reconstruction and aliasing artifacts (P < 0.001). The diagnostic confidence of both readers was high for all protocols and all knee structures, except for cartilage and tendons. The standard 2D TSE protocol showed a significantly higher diagnostic confidence for assessing tendons than 3D SRR Dixon TSE MRI (P < 0.01). The interreader and intrareader agreement for the assessment of internal knee derangements using any of the 3 protocols was substantial to almost perfect (κ = 0.67-1.00). For cartilage, the interreader agreement was substantial for DL-enhanced accelerated 2D TSE (κ = 0.79) and almost perfect for standard 2D TSE (κ = 0.98) and 3D SRR Dixon TSE (κ = 0.87). For menisci, the interreader agreement was substantial for 3D SRR Dixon TSE (κ = 0.70-0.80) and substantial to almost perfect for standard 2D TSE (κ = 0.80-0.99) and DL-enhanced 2D TSE (κ = 0.87-1.00). Moreover, the total acquisition time was reduced by 44% when using the DL-enhanced accelerated 2D TSE or 3D SRR Dixon TSE protocol instead of the conventional 2D TSE protocol. The presented DL-enhanced 4-fold accelerated 2D TSE protocol provides image quality and diagnostic performance similar to the standard 2D protocol. Moreover, the 3D SRR of DL-enhanced 6-fold accelerated 2D Dixon TSE MRI is feasible for multicontrast 3D knee MRI as its diagnostic performance is comparable to standard 2-fold accelerated 2D knee MRI. However, reconstruction and aliasing artifacts need to be further addressed to guarantee a more reliable visualization and assessment of cartilage, tendons, and bone. Both the 2D and 3D SRR DL-enhanced protocols enable a 44% faster examination compared with conventional 2-fold accelerated routine 2D TSE knee MRI and thus open new paths for more efficient clinical 2D and 3D knee MRI.

Morphometric Assessment of the Hip Joint in a Functional Dysplastic Rabbit Model.

The present study investigates the morphometric changes in the hip joint in a surgically induced rabbit model of hip dysplasia through the sectioning of the ligamentum capitis femoris and pelvic limb immobilization. A total of seventeen rabbits were evaluated using radiographic and computed tomographic imaging to measure the following parameters: the femoral angles of anteversion and inclination, length and width indexes of the neck of the femur, and acetabular depth and ventroversion. Significant differences in femoral anteversion angle and acetabular depth were observed, particularly in the group of hip instability surgery with pelvic limb immobilization. The results have shown the influence of hip joint instability in the promotion of femoral anteversion and acetabular shallowing. These findings provide a foundation for future research on naturally occurring or experimentally induced hip dysplasia in rabbits and underscore the model's potential for studying the biomechanical and developmental aspects of hip joint disorders.

Integrating adult occurrence and reproduction data to identify conservation measures for amphibians.

Monitoring programs are pivotal to establishing sound management. Due to economic, logistic, and time limitations, monitoring programs often overlook differences among life-history stages. However, species occurrence does not necessarily mean population viability, and it is unclear to what extent monitoring programs that do not consider separately adult presence and reproduction provide effective management indications. Unfortunately, collecting data on certain life stages requires high sampling effort, leading to a trade-off between model reliability and resources needed for monitoring. We collected data on presence and reproduction of amphibians by monitoring 207 waterbodies in Lombardy (northern Italy) in 2017-2022. We then used multistate occupancy models to test whether certain environmental features, namely, pond area, hydroperiod, forest cover, shade, aquatic vegetation, and predators' presence, differentially affected adult occurrence and breeding probabilities of multiple amphibian species. To assess optimal sampling efforts, we modeled the detection probabilities of adults and reproduction across multiple species. Finally, we identified the optimal monitoring strategy under different scenarios of resource availability, comparing adult-only monitoring versus joint assessment of the occurrence of adults and reproduction. In many cases, the main drivers of adult occurrence and reproduction did not coincide because most investigated ecological variables affected one life stage or the other. Forest area, for instance, increased occurrence probabilities of adults of the endemic Rana latastei but showed no effect on their reproduction probabilities. Quantitative estimates of the sampling effort showed that occurrence of adults was easier to spot in 4 out of 7 species. Multicriteria decision analyses showed that when resources were scarce, monitoring adults was the optimal strategy for those 4 species. Conversely, with more resources, monitoring both adults and reproduction emerged as the best strategy for all the considered species. Integrated monitoring of adults and reproduction is essential to comprehensively identify effective conservation measures for amphibians.

Association between Clinical Manifestations in Temporomandibular Joint Disorders and Corresponding Radiographic Findings.

Background: Temporomandibular disorders are common conditions characterized by discomfort within the temporomandibular joints, acoustic changes, and restricted mandibular movement. Accurate diagnosis and subsequent treatment rely heavily on clinical examination, but it is often necessary to add radiological examinations to the diagnostics. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the disc, while cone-beam computed tomography (CBCT) is primarily used for evaluating condylar morphology. Ultrasound (US) serves as a real-time imaging modality for soft tissues. The objective of the present study was to explore the association between clinical manifestations observed in patients with temporomandibular joint disorders and corresponding radiographic findings. Methods: A total of 63 adult patients (51 female and 12 male) with temporomandibular joint disorders were included in this cross-sectional study. Each patient underwent a clinical examination, followed by appropriate radiological examinations (MRI, CBCT, or US). The level of statistical significance was set at an alpha of 0.05. The Shapiro-Wilk test assessed the normality of numerical variables. The Wilcoxon rank sum test compared two independent groups with non-normally distributed data. Relationships between categorical variables were evaluated using the Pearson chi-square test or Fisher's exact test. The Kendall tau (τ) method analyzed the correlation between two binary variables. Results: The analysis included 63 patients with TMD, predominantly females (80.95%). Ages ranged from 18 to 74 years with a median of 39 years. In the CBCT study, we observed rarefied changes in the left bone structures in patients with bruxism (p = 0.010). MRI and ultrasound imaging revealed changes in patients with limited jaw opening: erosions in the right mandibular head on ultrasound (p = 0.008) and abnormal right bone structures on MRI (p = 0.009). In CBCT, asymmetry in the left joint space was correlated with a high incidence of right side muscle tension (p = 0.004). Additionally, both CBCT and ultrasound showed a correlation between muscle tension and erosion (p = 0.040 in ultrasound, p = 0.020 in CBCT). Acoustic changes, when compared with radiological imaging, were evident in all three studies, like temporomandibular joint pain or palpation. Conclusions: Our study compared three radiographic imaging methods with clinical examinations to assess their correlation with clinical symptoms. Each imaging technique provided unique insights depending on the specific symptoms presented. The observed correlations varied, highlighting the unique contributions of each modality to the diagnostic process. This underscores the importance of employing multiple diagnostic approaches for a thorough assessment of the temporomandibular joint. However, a limitation of our study is the small sample size and the uneven distribution of participants among the groups. Additionally, not all patients underwent every imaging modality.

Time-Dependent Effects of Altered Prebedtime Light Exposure in Enclosed Spaces on Sleep Performance Associated with Human States.

Exposure to artificial light influences human performance, which is essential for maintaining healthy work and sleep. However, existing research has not explored the intrinsic links between sleep performance and human states over time under prebedtime light exposure interventions (LEIs). To investigate the time-dependent effects of altered prebedtime light exposure, four LEI groupings (#L1 - #L4) and a Time factor (D8, D9, and D10) were chosen for sleep experiments in enclosed spaces. Forty-eight young adults recruited were available for data analysis. Subjective alertness (SA), negative affect (NA), subjective sleep, and objective sleep were measured via the Karolinska Sleepiness Scale, Positive and Negative Affect Schedule, Next-day Self-assessment Sleep Quality, and joint assessment of wrist actigraphy and sleep diaries, respectively. Statistical analysis was used for the effects of light exposure on the human states (corresponding to the SA and NA) and sleep performance, while the process model helped construct the associations between the two. The statistical effects revealed that the Time had a significant main effect on subjective sleep and changes in prebedtime alertness; the LEI had a significant main effect only on sleep onset latency (SOL). After undergoing altered prebedtime light exposure, the mean SA increased at prebedtime of D9 (p = 0.022) and D10 (p = 0.044); No significant effect on the NA was observed; Mean subjective sleep had a significant increase from D8 to D10. Moreover, five actigraphy-estimated sleep parameters were interrelated. In light of this, a chained pathway relationship was identified. The SOL played a mediating predictor between prebedtime state and objective sleep, which was linked to the awakening state through subjective sleep. Our study suggests that time-dependent effects of altered prebedtime light exposure on sleep performance are associated with human states at prebedtime and awakening, with implications for its prediction of sleep health.

Clinician Stakeholder Experience With Telemedicine Consults to Assess Neonatal Encephalopathy in a Rural State

BackgroundSerial neonatal encephalopathy (NE) examinations are difficult to perform in rural community hospitals as on-site experts are not readily available. We implemented a synchronous, acute care model of teleconsultation—the Maine Neonatal Encephalopathy Teleconsultation program (Maine NET)—to provide remote, joint assessment of NE by pediatric neurology and neonatology at nine community hospitals and one tertiary care center. We performed a qualitative study to interview clinicians about their experience of this program. MethodsFrom April 2018 to October 2022, we employed a semistructured interview format with 16 clinicians representing all participating hospitals. We utilized deductive analysis to assign a set of predefined codes to the transcribed interviews. ResultsThematic analysis supported the anticipated benefits of Maine NET, demonstrating that clinicians felt resource utilization, collaborative decision making, communication, and continuity of care were improved. Clinicians overwhelmingly supported the program: “This program has truly saved babies' lives and future function. I have not met any parents through this journey, who aren't incredibly grateful for the care that is provided” and emphasized the benefit of collaboration between all care team members. Teleconsultation was felt to be “more than adequate to [assess] NE.” Connectivity issues were cited as a limitation. ConclusionsMaine NET has positively impacted care delivery for newborns with clinical concerns for NE. Additionally, the program has improved resource allocation, collaborative decision making, communication, and equity of care. Addressing technological challenges will be vital to the success and sustainability of the planned Maine NET expansion.

Comparative evaluation of knee osteoarthritis: radiography vs. ultrasonography in Nepalese population: a cross-sectional study.

Osteoarthritis (OA) is a degenerative and long-term debilitating disease with rising prevalence, predominantly involving larger joints including the knee joint. While radiography has traditionally been the primary modality for joint evaluation, there is a growing trend towards using ultrasonography (USG) for musculoskeletal disorders, including joint assessment. This study aimed to find the role of USG in the evaluation of OA of knee joints with comparison to the radiographs. This was a cross-sectional study done on patients with signs and symptoms of OA of the knee who visited the radiology department for knee radiographs. Kellgren and Lawrence system was used for grading OA in radiographs. USG of knee joints was done with high-frequency probes and searched for joint space width, articular cartilage thickness, marginal osteophytes, meniscal extrusion, and other articular/ extra-articular abnormalities. The USG findings were correlated with findings in anteroposterior and lateral radiographs. The mean number of osteophytes was higher in USG compared to the radiographs (P<0.001). Mean joint spaces were comparable in both modalities. Meniscal extrusion was seen with USG, which significantly correlated with joint space width and cartilage thickness (P<0.005). USG also detected synovial changes, effusion, and Baker's cyst. Although radiography is the standard first-line radiological investigation for the diagnosis of OA of the knee joint, USG can be an adjunct as it well correlates with the radiograph findings and can provide more useful information.

Development of an Ultrasound Imaging Atlas for Grading Osteoarthritis in the First Metatarsophalangeal Joint.

Ultrasound (US) imaging may play a fundamental role in the earlier detection and assessment of first metatarsophalangeal joint (MTPJ) osteoarthritis (OA) because of its ability to depict tissue-specific morphologic changes before the point of irreversible structural damage. However, the role of US in supporting the diagnosis of OA in foot joints has not been clearly defined. The aims of this study were to develop a semiquantitative US atlas (the AUT ultrasound imaging [AUTUSI] atlas) to grade the degree of osteoarthritic change in the first MTPJ and to evaluate the intraexaminer and interexaminer reproducibility of using the atlas. US images were obtained from 57 participants (30 participants with radiographically confirmed first MTPJ OA). The AUTUSI atlas supports the examination of grading joint effusion, synovial hypertrophy, synovitis, osteophytes, joint space narrowing, and cartilage thickness. Six examiners used the atlas to independently grade 24 US images across 2 sessions. Intraexaminer and interexaminer reproducibility were determined using percentage agreement and Gwet's AC2. Observations using the AUTUSI atlas demonstrated almost perfect-to-perfect interexaminer agreement (percentage agreement ranged from 96% to 100%, and Gwet's AC2 values ranged from 0.81 to 1.00) and moderate-to-perfect intraexaminer agreement (percentage agreement ranged from 67% to 100%, and Gwet's AC2 values ranged from 0.54 to 1.00). The AUTUSI atlas demonstrated excellent intraexaminer and interexaminer reproducibility for evaluating first MTPJ joint effusion, synovial hypertrophy, synovitis, joint space narrowing, osteophytes, and cartilage thickness. The AUTUSI atlas affords an opportunity to detect prognostic markers of OA earlier in the disease cascade and has the potential to advance understanding of the pathologic process of first MTPJ OA.

Carbon capture and utilisation (CCU) solutions: Assessing environmental, economic, and social impacts using a new integrated methodology

Carbon Capture and Utilisation (CCU) technologies play a significant role in climate change mitigation, as these platforms aim to capture and convert CO2 that would be otherwise emitted into the atmosphere. Effective and economically sustainable technologies are crucial to support the transition to renewable and low-carbon energy sources by 2030 and beyond.Currently, studies exploring the financial viability of CCU technologies besides the joint analyses of life-cycle costs and environmental and social impacts are still limited.In this context, the study developed and validated an innovative and integrated methodology, called Life Cycle Cost and Sustainability Assessment (LCC-SA) which allows the joint assessment of (i) project life-cycle costs, (ii) socio-cultural and environmental externalities. This tool was validated with an application to an algal photobioreactors (PBRs) and allowed to assess the economic and environmental sustainability besides identifying the main critical issues to be addressed during the transition from pilot-scale plant to industrial application.The methodology's implementation estimated benefits in two main areas: (i) environmental, including CO2 removal and avoidance through biodiesel production instead of fossil-derived diesel; (ii) socio-cultural, encompassing new patents, knowledge spillovers, human capital formation, and knowledge outputs. The analysis returned as main result that the present value of the social externalities amounts to around EUR 550,000 and the present value of the costs to approximately EUR 60,000. The Economic Net Present Value (ENPV) is EUR 487,394, which shows the significance of the extra-financial effects generated by the research project. At full-scale application, environmental benefits include capturing 187 to 1867 tons of CO2 per year and avoiding 1.7 to 16.7 tons of CO2 annually through biodiesel production instead of fossil-derived diesel.

Hybridized deep learning goniometry for improved precision in Ehlers-Danlos Syndrome (EDS) evaluation

BackgroundGeneralized Joint Hyper-mobility (GJH) can aid in the diagnosis of Ehlers-Danlos Syndrome (EDS), a complex genetic connective tissue disorder with clinical features that can mimic other disease processes. Our study focuses on developing a unique image-based goniometry system, the HybridPoseNet, which utilizes a hybrid deep learning model.ObjectiveThe proposed model is designed to provide the most accurate joint angle measurements in EDS appraisals. Using a hybrid of CNNs and HyperLSTMs in the pose estimation module of HybridPoseNet offers superior generalization and time consistency properties, setting it apart from existing complex libraries.MethodologyHybridPoseNet integrates the spatial pattern recognition prowess of MobileNet-V2 with the sequential data processing capability of HyperLSTM units. The system captures the dynamic nature of joint motion by creating a model that learns from individual frames and the sequence of movements. The CNN module of HybridPoseNet was trained on a large and diverse data set before the fine-tuning of video data involving 50 individuals visiting the EDS clinic, focusing on joints that can hyperextend. HyperLSTMs have been incorporated in video frames to avoid any time breakage in joint angle estimation in consecutive frames. The model performance was evaluated using Spearman’s coefficient correlation versus manual goniometry measurements, as well as by the human labeling of joint position, the second validation step.OutcomePreliminary findings demonstrate HybridPoseNet achieving a remarkable correlation with manual Goniometric measurements: thumb (rho = 0.847), elbows (rho = 0.822), knees (rho = 0.839), and fifth fingers (rho = 0.896), indicating that the newest model is considerably better. The model manifested a consistent performance in all joint assessments, hence not requiring selecting a variety of pose-measuring libraries for every joint. The presentation of HybridPoseNet contributes to achieving a combined and normalized approach to reviewing the mobility of joints, which has an overall enhancement of approximately 20% in accuracy compared to the regular pose estimation libraries. This innovation is very valuable to the field of medical diagnostics of connective tissue diseases and a vast improvement to its understanding.

Application of Autologous Bone Graft versus Non Grafting in Medial Opening Wedge High Tibial Osteotomy Less than 14 mm: A Systematic Review and Meta-Analysis

Abstract Background Unicompartmental Knee osteoarthritis KOA due to varus malalignment is increased in young active patients which occurs predominantly in the medial compartment. Aim of the Work The objective of this study to compare MOWHTOs with autologous bone graft and without bone graft (wedge space mean less than 14 mm) in treatment of unicompartmental KOA and varus malalignment of the knee to determine which is better in decision-making according to outcomes. Patients and Methods Studies that matched the inclusion criteria were included in this meta-analysis. participants with medial compartmental knee osteoarthritis and varus malalignment were shown in the investigation. The age of the participants was unrestricted. Plate as a fixation method was the only option regardless of plate type. During 2000 and 2021, a research study of internet databases (Egyptian Universities Research, Medline, PubMed, Cochran library, medical journals) was conducted. Following that, the references from the user research were examined, and specialists were approached for assistance in locating other papers. Two independent reviewers extracted data separately and cross-checked it. Results The Knee Society Knee score (KSKS) and Knee Society Function score (KSFS) are most commonly used for the assessment of the knee joint reveled that there is no statically significant difference between bone graft vs non graft. Regarding this systematic review the radiological outcomes, the clinical bone union and the full weight bearing movement, are rendering any statistical analysis meaningless. Regarding complications presented, there was a similar tendency for complication rate when compared according to grafting or non- grafting. The use of autograft accelerates radiographic healing of the osteotomy gap after OWHTO while shorten the union time but confers no advantages in terms of functional or patient elated out comes at 3 or 12 months postoperatively. Conclusion MOWHTO can be performed without a graft with less operative time and avoiding graft harvest comorbidity with similar clinical and radiological results regarding bone union and posterior tibial slope alteration and knee scores.

Registration of jaw centric relation with different deprogramming devices

BACKGROUND: There are several methods to register jaw centric relation for diagnosis and therapy of dysfunctional disorders of the temporomandibular joint. However, there is insufficient information in the literature regarding the choice of the optimal way to determine this indicator. AIM: To compare different methods for recording jaw centric relation according to the data of the computed tomography of temporomandibular joint. MATERIALS AND METHODS: The study includes participants with increased abrasion of hard tooth tissues and symptoms of musculoskeletal dysfunction of the temporomandibular joint. The main group (80 people) has been recorded jaw centric relation using deprogramming devices (Lucia jig — 1stsubgroup, Kois deprogrammer — 2ndsubgroup, sheet calibrator — 3rd subgroup, deprogrammer in combination with M. Rocаbado kinesiotherapy elements — 4th subgroup). The control group included 20 participants, who had not had deprogramming before registration of jaw centric relation. The results were monitored using computed tomography of temporomandibular joint and subsequent assessment of the sizes of the TMG articular gap in the coronary and sagittal sections at 3 stages of the study: diagnostic, after registration of jaws central relation and prosthetic treatment and 6 months after prosthetic rehabilitation. Since there were no more than 50 observations in each group, the Shapiro–Wilk W-test was used to verify compliance with the norm. RESULTS: According to the data obtained, the parameters of the temporomandibular joint gap have changed in the main group of the 1th subgroup, where indicators are approaching the physiological norm (98% of cases). In the 2ndsubgroup, 90% of the participants show a tendency to conform to the physiological norm. The exception is 10% of the participants with no tendency of improvement. The smaller part (75%) of the participants of the 3rd subgroup observed compliance of the parameters of the articular gap with the criteria of the norm. The dimensions of the anterior part of the articular gap of the temporomandibular joint exceed the dimensions of the distal part, which indicates the anterior position of the temporomandibular joint. Some patients in this group (25%) showed no positive results of computed tomography measurements after jaws centric relation registration. In the 4th subgroup, the patients returned to normal values (100% of the cases). The positive effect of prosthetic treatment and restoration of the position of the articular heads of the temporomandibular joint were obtained in 45 % of the participants in the control group. However, in 55% of the participants the location of the articular gap of the temporomandibular joint did not improve. CONCLUSIONS: Lucia jig in combination with the M. Rokabado’s complex of cranial-postural kinesiotherapy is the most effective method to register jaw centric relation within this study. The remaining methods are also applied among prosthetic dentists and gnathologists. However, in each clinical situation, it is necessary to consider temporomandibular joint pathology indications, type and degree of severity as well as the technical and financial capacity of both doctor and patient.

Ultrasound-guided pericapsular nerve group block and anterior quadratus lumborum block for analgesia in hip arthroplasty: a prospective randomized comparative study

Background and objective The ideal regional analgesic block following hip arthroplasty is not yet defined. This trial aimed to compare the efficacy of anterior quadratus lumborum block (QLB) and pericapsular nerve group (PENG) block analgesia in patients subjected to hip arthroplasty under spinal anesthesia. Patients and methods Following ethical approval, 70 participants scheduled for hip arthroplasty under subarachnoid block were included in the current prospective randomized double-blinded comparative study. They were randomly assigned into two equal groups (n=35 each): anterior QLB group and PENG group. The primary outcome was the time to the first postoperative request for analgesia. The secondary outcomes were assessment of pain during the positioning for giving spinal anesthesia, visual analog scale (VAS) pain scores during movement and at rest, the total opioid consumption during the first postoperative 24 h, motor power assessment of the hip joint, and block and opioid-related complications. Results There were no statistically significant differences between the two studied groups regarding the time to first analgesic request, pain VAS scores at rest and on movement, total morphine consumption, positing pain, hip motor recovery, and block and opioid-related adverse effects. Conclusion The anterior QLB and the PENG block provided comparable posthip arthroplasty analgesia for patients subjected to surgeries under spinal anesthesia as evidenced by the comparable pain VAS scores, duration of analgesia, and total 24 h’ morphine consumption with comparable block and opioid safety profiles.

Integrating fraud hexagon into fraud control system: a study of Indonesia

The fraud control system is an assessment of the risk of irregularities which is a proactive process that aims to identify and overcome organizational vulnerabilities due to conditions carried out by internal and external parties to the organization. The purpose of this research is to determine the effectiveness of the newly formed Fraud Control System regulations with the integration of Fraud Hexagon to formulate effective fraud prevention and detection procedures. This study is based on empirical literature collected and interpreted from the Fraud Control System and Fraud Hexagon to formulate effective fraud prevention and detection procedures at BPKP and KemenPAN RB. The result is that BPKP and KemenPAN RB must start a joint assessment rather than working separately, because the two anti-fraud frameworks complement each other, so they must be assessed coherently to allow for a check and balance mechanism. BPKP and KemenPAN RB must also design a fraud prevention and detection framework at the national level so that the assessment also includes top level leadership. It is hoped that the implications of the research can help Indonesia to perfect a more holistic fraud control mechanism so that the effectiveness of the Fraud Control System is even better.

ORTHODOX-INNOVATIVE EXPOSITION OF FINANCIAL MECHANISMS OF THE POST-WAR RECONSTRUCTION OF THE ECONOMY OF UKRAINE

The article is devoted to the study of modern financial mechanisms, which in the medium term can be effectively applied to rebuild the economy of Ukraine after the end of the war. The authors emphasize that the orthodox-innovative exposition of financial mechanisms represents a flexible and adaptive approach capable of effectively responding to current challenges, threats and needs of the country in the process of its reconstruction.The main focus of the article is on the study of such aspects as: outlines of the main challenges faced by the Ukrainian economy in the conditions of the war period, including the destruction of infrastructure, loss of production capacity and a decrease in the standard of living of the population; disclosure of traditional financial approaches, such as international loans and grants, that can be applied to the reconstruction of the economy; identification of modern innovative financial instruments, including “green” bonds, blockchain, crowdfunding and other financial instruments in order to provide additional sources of financing and increase trust on the part of international partners and donors; determining the role of international financial organizations, institutions and donors in the process of reconstruction of our state. An analysis of the assessment of the damage caused in Ukraine by the russian federation was carried out, which is based on the reports of the project “russia will pay” KSE Institute with the support of international partners and organizations and the report on the updated joint assessment of damages and needs that arose as a result of the invasion of the russian federation in Ukraine (Rapid Damage and Needs Assessment, RDNA3, developed by the Government together with the World Bank Group, the UN and the European Commission. The authors carried out a SWOT analysis, which made it possible to assess the strengths and weaknesses, opportunities and threats (risks) associated with the integration of orthodox and innovative financial mechanisms in the recovery process economy of Ukraine after the war. The article focuses on the Matrix of reforms – a huge plan of changes that systematizes and integrates reforms, includes officially approved recommendations and conditions under macro-financial support programs, in particular: “structural beacons” of the IMF, Plan of Ukraine under the Ukraine Facility program, documents of the European Commission, conditions of the World Bank (Development Policy Loan, DPL). Also, within the framework of the study, an analysis of the consensus forecast of the Ministry of Economy of Ukraine “Ukraine: Scenarios of Restorative Growth” was carried out to provide and assess risks for 2024–2027.

Chronic Pain and Joint Hypermobility: A Brief Diagnostic Review for Clinicians and the Potential Application of Infrared Thermography in Screening Hypermobile Inflamed Joints.

Joint hypermobility syndromes, particularly chronic pain associated with this condition, including Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD), present diagnostic challenges due to their multifactorial origins and remain poorly understood from biomechanical and genomic-molecular perspectives. Recent diagnostic guidelines have differentiated hEDS, HSD, and benign joint hypermobility, providing a more objective diagnostic framework. However, incorrect diagnoses and underdiagnoses persist, leading to prolonged journeys for affected individuals. Musculoskeletal manifestations, chronic pain, dysautonomia, and gastrointestinal symptoms illustrate the multifactorial impact of these conditions, affecting both the physical and emotional well-being of affected individuals. Infrared thermography (IRT) emerges as a promising tool for joint assessment, especially in detecting inflammatory processes. Thermal distribution patterns offer valuable insights into joint dysfunctions, although the direct correlation between pain and inflammation remains challenging. The prevalence of neuropathies among hypermobile individuals accentuates the discordance between pain perception and thermographic findings, further complicating diagnosis and management. Despite its potential, the clinical integration of IRT faces challenges, with conflicting evidence hindering its adoption. However, studies demonstrate objective temperature disparities between healthy and diseased joints, especially under dynamic thermography, suggesting its potential utility in clinical practice. Future research focused on refining diagnostic criteria and elucidating the underlying mechanisms of hypermobility syndromes will be essential to improve diagnostic accuracy and enhance patient care in this complex and multidimensional context.

Myocardial viability under various ischemic burdens in chronic total occlusions: A stress-cardiac magnetic resonance study

ObjectivesThis study aimed to analyze each myocardial segment's ischemic burden, scarring, function, and viability by late gadolinium enhancement (LGE) imaging and stress-MRI using adenosine. Materials and methodsSemi-quantitative and qualitative parameters of myocardial segments were obtained by stress-MRI. Moreover, segments without perfusion defect were defined as the no ischemic group, segments with a perfusion defect of ≤50% were defined as a low ischemic burden group, and segments with a perfusion defect of >50% were defined as a high ischemic burden group. “Segmental wall thickening (SWT)” was defined as the absolute difference between the end-diastolic and end-systolic wall thickness. Finally, viability was defined by dysfunctional myocardium (<3 ​mm segmental wall thickening [SWT]) and ≤50% late gadolinium enhancement (LGE). ResultsA total of 445 segments in the CTO territory were analyzed, scar tissue was found in the CTO territory, with LGE evident in 18.2% of CTO segments totaling >50%. Among the different ischemic burden groups, there were significant differences in LGE volume (p ​< ​0.01), and the trend of SWT was consistent with the degree of myocardial ischemia. The incidence of ≤50% LGE and viable myocardium was higher in segments of the no ischemia and low ischemic burden groups. However, there was no significant difference in the incidence of dysfunctional myocardial segments among the three groups (P ​> ​0.05). ConclusionsStress MRI parameters can accurately and detailly assess myocardial viability and function, so multi-parameter joint assessment of CTO patients by stress MRI may help in treatment decisions.