Joint Deformity Research Articles

Tailoring Strength Training Prescriptions for People with Rheumatoid Arthritis: A Scoping Review.

Introduction: Prescribing strength training (ST) for people with rheumatoid arthritis (RA) is complicated by factors (barriers and facilitators) that affect participation. It is unclear whether guidelines include recommendations beyond prescription parameters (frequency, intensity, time, type, volume, and progression) and adequately incorporate participation factors tailored to people with RA. Objective: To summarize available recommendations to aid in the tailoring of ST prescriptions for people with RA. Methods: Medline, Embase, and CINAHL databases and gray literature were searched for guidelines, recommendations, and review articles containing ST prescription recommendations for RA. Article screening and data extraction were performed in duplicate by two reviewers. Results: Twenty-seven articles met the inclusion criteria. The recommendations address RA-specific ST participation factors including: knowledge gaps (of equipment, ST benefits, disease), memory problems, the management of joint deformity, comorbidity, the fluctuating nature of the disease and symptoms (pain, stiffness, flares), fear avoidance, motivation, need for referral to other professionals, and provision of RA-specific resources. Conclusion: This review summarizes recommendations for tailoring ST prescriptions for people with RA. Future research is required to understand how pain, symptom assessment, and unaddressed ST participation factors like sleep and medication side effects can be addressed to support ST participation amongst people with RA.

Topographic design in wearable MXene sensors with in-sensor machine learning for full-body avatar reconstruction

Wearable strain sensors that detect joint/muscle strain changes become prevalent at human–machine interfaces for full-body motion monitoring. However, most wearable devices cannot offer customizable opportunities to match the sensor characteristics with specific deformation ranges of joints/muscles, resulting in suboptimal performance. Adequate wearable strain sensor design is highly required to achieve user-designated working windows without sacrificing high sensitivity, accompanied with real-time data processing. Herein, wearable Ti3C2Tx MXene sensor modules are fabricated with in-sensor machine learning (ML) models, either functioning via wireless streaming or edge computing, for full-body motion classifications and avatar reconstruction. Through topographic design on piezoresistive nanolayers, the wearable strain sensor modules exhibited ultrahigh sensitivities within the working windows that meet all joint deformation ranges. By integrating the wearable sensors with a ML chip, an edge sensor module is fabricated, enabling in-sensor reconstruction of high-precision avatar animations that mimic continuous full-body motions with an average avatar determination error of 3.5 cm, without additional computing devices.

Research on Dynamic Characteristics of Joint of RC Frame Structure with NES

The NES (nonlinear energy sink) is a new type of nonlinear tuned mass damper that is connected to the shock-absorbing main structure through strong nonlinear stiffness and viscous damping. The vibrational energy in the main structure is transferred to the NES oscillator by means of target energy transfer. A shaking table test of a 1:4 scaled RC (Reinforced Concrete) frame structure model with a new type of NES shock absorber was conducted to study the damping effect of the NES shock absorber, especially for the influence of joint strength and deformation. The NES used in this experiment has a relatively large nonlinear stiffness and a wide vibration absorption frequency band. The variation of reinforcement strains, node failure mode, and structural natural frequency of 1 story and two-layer joints of the model frame structure with NES were studied. The test results showed that NES could effectively reduce the strains of longitudinal reinforcement and stirrup in beams and columns and delay the plastic hinge development at the bottom and the top of the column. The frame model with NES installed has failures at the beam ends and shear failures at the nodes, realizing the seismic mechanism of solid columns and weak beams. Compared with ordinary seismic structures, the NES can effectively reduce the shear stress of concrete at the joints and alleviate the shear failure of joints. The final failure of the NES shock absorbing structure was the yielding of the steel bars at the bottom of the column and the crushing of the concrete at the foot of the column, and the connection between the column foot and the backplane became loose simultaneously. The decreasing rate of the vibration frequency declined due to the NES with varied broadband absorbing capability. It can be seen that the NES shock absorber not only has a good effect on reducing the seismic response of the structure, but more importantly, the damage of the structural nodes is greatly reduced, and therefore, the seismic capacity of the structure improved.

Nonlinear numerical modeling approach and seismic mechanism analysis on new modular precast composite shear wall structure

An innovative modular precast composite shear wall structure with the advantages of modular precast construction and demountable ability was proposed, and its seismic performance was validated by shaking table tests. This study aims to develop a nonlinear numerical modeling approach for the innovative modular precast structure to promote its engineering application. An equivalent energy method for the overall backbone of the concrete constitutive relationship was derived to consider the concrete stiffness reduction in the numerical model. Based on sectional analysis and plane section assumption, an explicit equivalent joint model was developed to simulate the nonlinear behavior and failure process of the vertical joints. Comparisons between the numerical and test results validated the ability of the numerical model to capture both the global and local responses. More detailed results that were hardly obtained by tests, such as displacement components, joint mechanical state and gap opening behavior, were extracted from the numerical analysis to reveal the seismic mechanism of the modular precast structure. The dynamic analysis results showed that the vertical joint deformation induced 10% to 14% of the total inter-story displacement at the first floor within the maximum considered earthquake intensity. The equivalent joint model could simulate the failure process of individual screws which exhibited larger strains than those in shear walls. The gap opening behavior induced additional energy dissipation mechanism for the modular precast structure.

Optimal Design for Vibration Mitigation of a Planar Parallel Mechanism for a Fast Automatic Machine

This work studies a planar parallel mechanism installed on a fast-operating automatic machine. In particular, the mechanism design is optimized to mitigate experimentally-observed vibrations. The latter are a frequent issue in mechanisms operating at high speeds, since they may lead to low-quality products and, ultimately, to permanent damage to the goods that are processed. In order to identify the vibration cause, several possible factors are explored, such as resonance phenomena, elastic deformations of the components, and joint deformations under operation loads. Then, two design optimization are performed, which result in a significant improvement in the vibrational behaviour, with oscillations being strongly reduced in comparison to the initial design.

Design and Development of a Repetitive Bending Tester for Bending Deformation in Textile Fabrics and Bonded Joints

Abstract It is critical to investigate the technical performance of non-stitch joining methods that have become prevalent recently. While examining the bonding strength and the factors that affect the strength of adhesive bonding in textiles, a bending test device was designed and produced to investigate the repetitive bending deformation. The novel test device provides bending deformation and tensile stress to the fabrics at different angles with its oscillating motion. The effects of repetitive bending deformation on fabric strength and adhesive bonding strength were investigated. The experimental analysis showed that repetitive bending deformation did not have a significant effect on the tensile strength of cotton/polyester blend and cotton fabrics. However, strength loss was observed in polyester fabric and cotton/elastane blended fabric samples. Moreover, significant reductions in bonded textile joint strength were observed even in the case of much less repetitive bending exposure.

Multilayer Structures under Non-Stationary Loading: Prediction of Damages and Further Operation Possibility

Mathematical model of the complex interaction of composite structures elements is developed. A half-strip composed of two various materials is considered as a case of the composite structure. For each layer the dynamic equations of the theory of elasticity are used. An impact-impulse load is applied at the end of the structure. During the complex interaction, the conjugation of layers is carried out by conditions that ensure joint deformation, slipping (with friction) or absence of contact. The area and the contact type are determined during the solving process. This approach requires the construction of the special numerical algorithm which allows to change the boundary conditions during the calculation depending on the fulfilment of the strength criterion. The problem is solved numerically using method of characteristics. The propagation of elastic waves in the two-layer half-strip is studied. The wave field characteristics are determined in the calculated point of the layer at a given time. The calculation results are analysed in order to identify areas of the contact surface that are most prone to damage. The geometric and mechanical parameters influence on the behaviour of the structure is studied.

Review of Industrial Robot Stiffness Identification and Modelling

Due to their high flexibility, large workspace, and high repeatability, industrial robots are widely used in roughing and semifinishing fields. However, their low machining accuracy and low stability limit further development of industrial robots in the machining field, with low stiffness being the most significant factor. The stiffness of industrial robots is affected by the joint deformation, transmission mechanism, friction, environment, and coupling of these factors. Moreover, the stiffness of a robot has a nonlinear distribution throughout the workspace, and external forces during processing cause irregular deviations of the robot, thereby affecting the machining accuracy and surface quality of the workpiece. Many scholars have researched identifying the stiffness of industrial robots and have proposed methods for improving the performance of industrial robots, mainly by optimizing the body structure of the robot and compensating for deformation errors with stiffness models. This paper reviews recent research on the stiffness modelling of industrial robots, which can be broadly classified as finite element analysis (FEA), matrix structure analysis (MSA), and virtual joint modelling (VJM) methods. Each method is studied from three aspects: algorithms, implementation, and limitations. In addition, common measurement techniques have been introduced for measuring deformation. Further research directions are also discussed.

Основні методи фізичної реабілітації хворих на ревматоїдний артрит

Rheumatoid arthritis is a common disease characterized by a high level of disability and disability due to dysfunction of the musculoskeletal system. It is important to combine the basic therapy of rheumatoid arthritis and non-drug methods of recovery and physical rehabilitation of patients. The purpose of the study was to show the main methods of physical rehabilitation of patients with rheumatoid arthritis. Materials and method. Analysis and generalization of scientific literature were used in the study. Results and discussion. The formation of functional insufficiency of the joints in patients requires improving the functioning of the musculoskeletal system and the quality of life of patients through the use of physical rehabilitation methods. The main element of the rehabilitation complex for patients with rheumatoid arthritis is therapeutic physical culture, aimed at increasing the range of motion of the limbs, muscle strength, reducing pain and improving the general physical condition. One of the important methods of rehabilitation of patients with rheumatoid arthritis is orthosis, since the progression of the disease is inevitably associated with the development of joint deformations, especially in the feet. The goals of orthoses prescription are to protect and relieve joint stress, reduce pain and inflammation by creating controlled rest, correct anatomical axes, prevent or slow down the development of contractures, deviations and deformations. Physiotherapy methods in different periods of the disease provide anti-inflammatory and analgesic effects. Restorative treatment and physical rehabilitation of patients with rheumatoid arthritis involves a combination of various methods, among which the most effective are exercise therapy, orthotics, and physical therapy. Conclusion. Rheumatoid arthritis is characterized by a significant limitation of the functions of the musculoskeletal system due to damage to the articular cartilage and bone, which requires, in addition to drug therapy, the use of methods to restore an adequate level of physical activity and physical rehabilitation. The most effective methods of complex rehabilitation of patients with rheumatoid arthritis are physical exercises of therapeutic physical culture, orthotics and physiotherapy methods that reduce the activity of the inflammatory process, progression of deformities, maintain the volume of daily household activities, the ability to self-service, professional work and improvement of quality of life

Clinical and Radiographic Features of the Atlantoaxial Dislocation Associated With Kashin-Beck Disease

Keshin-Beck disease (KBD) is a particular type of osteoarthritis that affects many joints. However, the deformity of atlantoaxial joint has been rarely reported in KBD, and therefore its clinical and radiograph features have not been identified. We reviewed data in 14 patients who were diagnosed with atlantoaxial dislocation (AAD) in KBD at our institution. The demographic data, clinical history, imaging data, operative data, and Japanese Orthopaedic Association score were collected for evaluation. The mean age at presentation was 50 ± 1.7 years old. The most common features of AAD in KBD were the osteoarthritis, characterized by hypertrophic dens and anterior arch of the atlas. The average inner anteroposterior diameter (IAPD) of C1 was 28 ± 3.5 mm and the average spinal canal diameter was 14 ± 3.3 mm, which were respectively lower than the control level. Five patients had severe C1 stenosis (IAPD < 26mm). Separated odontoid process, like os odontoideum, was seen 9 patients. The tip of dens fused to C1 was observed in 4 patients; 12 patients had high-riding vertebral artery; and 5 patients had severe C1 stenosis, and they underwent C1 laminectomy with C1-C2 interarticular fusion or occipital-cervical fusion. All the patients displayed neurologic improvement after surgery. The atlantoaxial level could be affected by KBD, which may lead to typical abnormalities and cause AAD. A C1 laminectomy with an C1-C2 interarticular fusion or occipital-cervical fusion is recommended for the patient with severe stenosis.

Pain Sensitization and Neuropathic Pain-like Symptoms Associated with Effectiveness of Exercise Therapy in Patients with Hip and Knee Osteoarthritis.

Pain sensitization and neuropathic pain-like symptoms are some of the common pain symptoms in patients with lower limbs, including hip and knee, osteoarthritis (HOA/KOA). Exercise therapy has been the first-line treatment; however, the effects differ for each patient. This prospective cohort study investigated the relationship between the effectiveness of exercise therapy and pretreatment characteristics (radiologic severity, pain sensitization, and neuropathic pain-like symptoms) of patients with HOA/KOA. We assessed the pain intensity using a numerical rating scale (NRS) before and after 12 weeks of exercise therapy in patients with HOA/KOA (n = 101). Before treatment, the Kellgren–Lawrence (K-L) grade; minimum joint space width (mJSW); pressure pain threshold (PPT) and temporal summation of pain (TSP) at the affected joint, tibia, and forearm; Central Sensitization Inventory-9; and painDETECT questionnaire (PDQ) were assessed. Cluster analysis was based on the pretreatment NRS and change in NRS with exercise therapy to identify the subgroups of pain reduction. The pretreatment characteristics of each cluster were compared. According to the results of the cluster analyses, patients in cluster 1 had severe pain that did not improve after exercise therapy, patients in cluster 2 had severe pain that improved, and those in cluster 3 had mild pain that improved. The patients in cluster 1 exhibited lower PPT at all measurement sites, higher TSP at the affected joint, and higher PDQ scores than those in other clusters. There was no difference in the K-L grade and mJSW among the clusters. The subgroup with severe pain and pain sensitization or neuropathic pain-like symptoms at pretreatment, even with mild joint deformity, may have difficulty in achieving improvement in pain after 12 weeks of exercise therapy. These findings could be useful for prognosis prediction and for planning exercise therapy and combining with other treatment.

Postural limb abnormality: an unusual presentation of retroperitoneal Schwannoma

Schwannoma is a tumor of soft tissue originating from Schwann cells that rarely appears in the retroperitoneum. Presentation depends on the site of disease leading to mostly pressure symptoms, sometimes with distal manifestations. Because of its complex location, it has varied presentations and is always a diagnostic dilemma. We reported a rare case of retroperitoneal schwannoma having mild difficulty in walking due to flexion deformity of left hip joint as the only initial presenting symptoms. Following imaging studies, a retroperitoneal mass was found. Partial excision of the tumor was performed, with the histology finding consistent with the retroperitoneal schwannoma. Patient was followed up for the last 2 years and had no evidence of recurrence.

Charcot Arthropathy of the Spine.

Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis. Although radiological features can assist with diagnosis, the need for recognition and associated treatment is vital to limit the lifelong disability with the disease. The goals of treatment are to limit symptoms and provide spinal stabilization. Surgical treatment of these patients can be demanding, and alternative techniques of instrumentation are often required.

Systems biology approach delineates critical pathways associated with disease progression in rheumatoid arthritis

Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease leading to inflammation, cartilage cell death, synoviocyte proliferation, and increased and impaired differentiation of osteoclasts and osteoblasts leading to joint erosions and deformities. Transcriptomics, proteomics, and metabolomics datasets were analyzed to identify the critical pathways that drive the RA pathophysiology. Single nucleotide polymorphisms (SNPs) associated with RA were analyzed for the functional implications, clinical outcomes, and blood parameters later validated by literature. SNPs associated with RA were grouped into pathways that drive the immune response and cytokine production. Further gene set enrichment analysis (GSEA) was performed on gene expression omnibus (GEO) data sets of peripheral blood mononuclear cells (PBMCs), synovial macrophages, and synovial biopsies from RA patients showed enrichment of Th1, Th2, Th17 differentiation, viral and bacterial infections, metabolic signalling and immunological pathways with potential implications for RA. The proteomics data analysis presented pathways with genes involved in immunological signaling and metabolic pathways, including vitamin B12 and folate metabolism. Metabolomics datasets analysis showed significant pathways like amino-acyl tRNA biosynthesis, metabolism of amino acids (arginine, alanine aspartate, glutamate, glutamine, phenylalanine, and tryptophan), and nucleotide metabolism. Furthermore, our commonality analysis of multi-omics datasets identified common pathways with potential implications for joint remodeling in RA. Disease-modifying anti-rheumatic drugs (DMARDs) and biologics treatments were found to modulate many of the pathways that were deregulated in RA. Overall, our analysis identified molecular signatures associated with the observed symptoms, joint erosions, potential biomarkers, and therapeutic targets in RA. Communicated by Ramaswamy H. Sarma

The role of resveratrol on rheumatoid arthritis: From bench to bedside.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by symmetrical polyarthritis as its main clinical manifestation. Uncontrolled RA eventually leads to joint deformities and loss of function. Currently, the pathogenesis of RA remains under discussion, and RA treatment is still at the bottleneck stage. Resveratrol has long been regarded as a potential antioxidant drug for RA treatment. Currently, resveratrol is considered to exert therapeutic effects on RA by activating silent information regulator 1 (SIRT1) and its downstream pathways. There is notable crosstalk between the SIRT1 and NF-κB pathways, and these pathways, which play an essential role in the development of RA, are unexpectedly linked to the influence of resveratrol. Based on recent studies of almost all the pathways that resveratrol can affect, this review summarizes a regulatory chain of core components that cover multiple tracks. We also list the effects of resveratrol on immune cells and other subtle controls, which can help clinicians understand the known mechanism of resveratrol and better treat patients with RA.

Nail ridging in rheumatoid arthritis patients and relation to disease activity: An integrated rheumatology-dermatology multi-centre study

Aim of the workTo evaluate the frequency of nail ridging (NR) in patients with rheumatoid arthritis (RA) and to study its relation to disease activity. Patients and methods230 RA patients and 97 matched controls from Helwan, Ain Shams and Mansoura university hospitals were studied. Disease activity score (DAS28) was assessed. NR has been searched for in all patients. The number of affected fingers was recorded. NR was determined by a magnifying lens, seen by naked eye or seen and felt. Dermoscopic photography of the NR using Dermalite DL4 3Gen dermatoscope has been recorded. ResultsThe median age of patients was 49 years (42–58 years); they were 221 females and 19 males (F:M 11.1:1) with a disease duration 9 years (5–11 years). Their DAS28 was 3.6 (2.9–4.6). NR was significantly increased in RA cases vs. control; 73% vs 20%; p < 0.001. In patients, NR was detected by a magnifying lens in 32.6%, seen in 27% and seen and felt in 13.5%. Joint deformities were significantly higher in those with NR. DAS28 was a significant independent predictor of NR; for every one-point increase in DAS28, there was a 153 times higher odds to exhibit NR at a sensitivity of 93.5%, specificity 80.3% and at a diagnostic accuracy of 90%. ConclusionNR is a frequent finding in RA. An integrated rheumatological- dermatological clinical evaluation may be helpful and further studies are required to prove the importance of this sign for follow up of RA patients.

324 Total Knee Arthroplasty in Haemophilia Patients: A Systematic Review and Meta-Analysis of Long-Term Survivorship, Functional Outcomes and Complications

Abstract Aim End-stage arthropathy is a well-known complication of haemophilia, with recurrent haemarthroses leading to joint destruction, deformity, pain, and stiffness. In the knee, this is often treated with total knee arthroplasty (TKA), which can be more challenging in patients with haemophilia (PwH) and associated with poorer outcomes. We conducted a systematic literature review and meta-analysis to determine implant survivorship, functional outcomes, and complication rates. Method A systematic review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting TKA outcomes with Kaplan-Meier survivorship in PwH (PROSPERO registered). Meta-analysis was performed for survivorship and outcomes, and the results were compared to outcomes from the National Joint Registry (NJR). Results 19 studies, totalling 1187 TKAs (average age 39 years) were reviewed. In PwH, implant survivorship at 5, 10, and 15 years was 94%, 86%, and 76% respectively, whereas NJR reported survivorship for males &amp;lt;55 years was 94%, 90%, and 86%. Survivorship generally improved over the time period studied (1973–2017) but was inversely correlated with HIV infection (common in PwH). Range of motion improved by 10–20° post-operatively, and there were large improvements in Patient Reported Outcome Measures (PROMS). The prosthetic joint infection rate (PJI) was 6% compared to 0.5–1% in non-PwH, but the reporting of other complications, especially haematological, was inconsistent. Conclusions TKA in PwH has similar 5-year survivorship to non-PwH, but a six-fold higher infection rate. There were marked improvements in range of motion and PROMS, but complications were poorly reported. There remains a need for larger, long-term studies with standardised reporting.

Study unsteady flow of synovial fluid in the elastic porosity of layers using double ZZ transformation

The elastic deformation of the human synovial joint in the standing and swing phases is presented in this paper, as well as the relationship between elastic muscle fibers and layer porosity using a mathematical model and analyzing the results with the appropriate boundary condition for the types of lubrication. During the gait cycle, elastic muscle fibers have a large impact on the magnetic field and the film (thinning of the thickness) of layers. The impact of elastic muscle fibers is to increase the hydrodynamic pressure and carry the load. We employed the double ZZ transformation as a strong tool to acquire a solution to the hydrodynamic pressure and bearing loads directly without finding the general solution of a differential equation.

STUDENT VOLUNTEERISM IN THE REHABILITATION OF A CHILD WITH FRACTURA OLECRANI: PRESENTATION OF CLINICAL CASE

Aim: To monitor the rehabilitation progress of a child with fracturaolecrani with the participation of a student volunteer in the multidisciplinary team. Methods: K.J. is an 11-year-old child admitted for rehabilitation in the Clinic of Orthopaedics and Traumatology at University Hospital "St. Marina"- Varna. In 2011 K.J. suffered a fracture in the area of the right elbow joint and underwent surgery with the placement of three Kirschner needles. Four years later, the patient suffered the same fracture and underwent surgery with the placement of two Kirschner needles. Oedema, joint deformation, severely limited range of motion, contractures, muscle hypotrophy and psychotrauma, were found after examination by an orthopaedist and a kinesitherapist. The individual kinesitherapeutic approach is focused on reducing oedema; improving activity; preventing complications; stimulating the patient's participation in social activities. Results: With the help of functional examinations (centimetre measurements, anglemetry and MMT), we established significant restoration of the upper extremity's function and reduction of the oedema. The minimal differences result from the rough operative cicatrix and slight joint deformation. The range of motion is restored to a large extent, as the deficit of 5-10 degrees is not essential in daily activities and could be further restored. Conclusions: the application of an individual approach in the multidisciplinary team's work, with the participation of a student volunteer, helps build a trustworthy relationship with the child patient. The inclusion of a student volunteer in the multidisciplinary team improves communication with vulnerable population groups and contributes to a faster physical and mental recovery.

Cubital tunnel syndrome due to old lateral humeral condyle fractures with gouty stone: A case report

IntroductionCubital tunnel syndrome is a peripheral nerve compression disease, which is caused by the reduction of cubital tunnel space and the compression of ulnar nerve in the cubital tunnel. The main clinical symptoms were numbness and hypoesthesia in the distribution area of ulnar nerve.Case presentationWe report a case of complex cubital tunnel syndrome caused by an old lateral humeral condyle fracture combined with gouty stone compression. Before surgery, the patient's left hypothenar, ring finger and little finger were numb, decreased grip strength, positive paper clamp test. And finger numbness and finger weakness were significantly improved after ulnar nerve release combined with Gout stone resection.Clinical DiscussionIn this case report, the elbow joint deformity caused by old lateral humeral condyle fracture was not treated surgically. Only ulnar nerve release combined with Gout stone resection was performed, and the patient's symptoms were significantly relieved.ConclusionIn this case report, for the treatment of cubital tunnel syndrome caused by multiple causes, we only need to find out the main causes of clinical symptoms and targeted treatment, which can not only reduce surgical trauma, but also achieve good treatment results. Its treatment method and treatment result, hoping to provide reference experience forthe diagnosis and treatment of similar diseases.