Joint Changes Research Articles

A case series of post-tuberculous Baker's cyst

IntroductionThe gastrocnemius-semimembranous bursa of the knee, which connects to the posterior region of the joint capsule, becomes distended in a Baker's (popliteal) cyst. In adults, it is nearly always secondary to pathological changes in the knee joint that cause an effusion. Baker cysts are mostly asymptomatic, but they may have presentations ranging from mild swelling, a picture similar to infective arthritis, to massive swelling leading to rupture and causing lower limb ischemia. We have presented these cases of post-tubercular baker cysts and evaluated their post-treatment outcomes. Material and methodsBetween September 2018 and September 2021, 12 patients with post-tuberculous baker cysts who presented to the outpatient department or emergency department of our institute were treated with conservative or open excision and followed up for 12 months at regular intervals. The functional assessment was done by VAS pain scoring and Lysholm knee scoring at the start of treatment, 1, 6 and 12 months after the surgery or conservative treatment. Results8 patients with post-tubercular Baker cysts were managed conservatively with aspirations and medications. Four patients with large multiloculated post-tubercular baker cysts were managed operatively. The mean age of patients with complicated post-tuberculosis Baker cyst was 44.92 ± 5.07 years. VAS The scoring of all the patients improved with each visit and 1-year follow-up. The Lysholm Knee score of patients also improved with each visit. All patients had excellent scores, with 3 patients having a score of 100 at 1-year follow-up. ConclusionComplicated Baker's cysts with multiloculated post-tubercular cysts need surgical management in most cases. Excellent to good functional outcomes can be achieved in these unusual cases with prompt intervention, detailed work-up, and medications.

Combined articular and ligament reconstructions in neglected fracture-dislocation of the knee

BackgroundThe management of neglected traumatic knee dislocations is challenging and is commonly associated with suboptimal outcomes. In this article we present two cases of neglected knee dislocations in two young trauma victims who presented late due to restrictions during the COVID-19 pandemic. MethodsTwo young patients presented at our center with neglected knee fracture-dislocations after eight weeks and six months of trauma. Comprehensive evaluation was performed using radiographs, computed tomography scans, and magnetic resonance imaging. Surgical intervention included open reduction and internal fixation of the mal-aligned intra-articular fracture fragments. Additionally, articular congruency was restored and repair or reconstruction of the posterior cruciate ligament, anterior cruciate ligament, and meniscus was conducted using suitable tendinous autografts and implants. Following surgery, the knees were immobilized for six weeks, followed by aggressive physical therapy. ResultsAfter three months of surgical intervention, fracture union and joint stability were achieved. At the >36-month follow-up appointments, both patients were pain-free at rest with a stable knee joint, achieving ≥90 degrees of knee flexion and without extensor deficits. Concurrent with radiographic evidence of osteoarthritic changes in the knee joint, there was mild pain (VAS 2) after prolonged knee movement activities and walking for long distances (>1 km). ConclusionOpen reduction and internal fixation, along with simultaneous menisco-ligamentous reconstructions in neglected fracture-dislocations of the knee result in satisfactory clinical outcomes. This approach proves to be an effective joint preservation procedure in young patients, even in delayed and neglected conditions.

Silicone Arthroplasty as an Alternative to Arthrodesis in the Metatarsophalangeal Degenerative Disease of Hallux Valgus-A 5-Year Observational Study.

Background: Arthroplasty is gaining more and more popularity in the treatment of osteoarthritis (OA) of the metatarsophalangeal I joint (MTP1). The aim of our study was to evaluate the early and long-term objective clinical and radiographic results, as well as the subjective results, of MTP1 arthroplasty in comparison to MTP1 arthrodesis among patients with OA and a valgus deformity of their MTP 1 joint. Methods: Patients with OA MTP1 were examined before surgery and in the 5-year period after surgery. The inclusion criteria for the study were OA of the MTP1 joint and a non-axial position of the toe in valgus between 20 and 40 degrees. Prostheses were created for the patients with higher demands for mobility of their MTP 1 joint and arthrodesis was carried out for those with lower expectations. The treatment outcomes were assessed by clinical examination, radiography, the AOFAS scale, the SEFAS scale, and using patient-related outcome measures (PROM). Results: A total of 39 people, 37 women and 2 men, aged 55 to 67 years old (average, 61 years old) participated in the study. During the follow-up period, there were no complications in the form of infection or a loosening of the implant after both arthroplasty and arthrodesis. The follow-up examination 60 months after the surgery showed an improvement in scores (>20 points) on both the AOFAS and SEFAS scales. All patients, after surgery, reported reduced pain. Conclusions: The use of a silicone prosthesis in the surgical treatment of degenerative changes in the MTPI joint, with appropriate indications and excluding cases with large hallux valgus, gives better results than arthrodesis.

Diagnosis Ability Evaluation of TMJ Condylar Disorders of Panoramic Radiographs in Senior Dental Students

Introduction: The temporomandibular joint is a unique and complex joint in the human body due to anatomical and functional reasons. The present study was conducted with the aim of investigating the knowledge of the senior dentistry students of Yazd Dental School about temporomandibular joint radiographic changes in panoramic images in 2022-2023. Methods: A cross-sectional descriptive analytical study was conducted with the participation of 59 senior dentistry students. After obtaining the consent of the students and collecting their background information, a questionnaire containing 14 questions was presented to the students with the aim of examining the students' ability to distinguish between normal, dislocation, hypoplasia, hyperplasia, osteophyte and condylar erosion appearance. Finally, the descriptive data were presented in the form of numbers and percentages in the form of a table. Data analysis was done with SPSS version16 and T-test. The significance level of the tests was considered less than 0.05. Results: The results showed that there was no significant difference in students' ability score according to their gender and type of entry (national-international) (P>0.05). The grade of students according to general point average (GPA) showed a significant difference (P<0.05). Conclusion: Based on the results of the study, and considering the importance and high prevalence of TMJ disorders, senior dentistry students in Yazd City did not have acceptable knowledge about radiographic changes in the TMJ joint.

The Use of 18F-Fluoride Positron Emission Tomography/Computed Tomography Scanning to Identify Sources of Pain after Posterior Lumbar Interbody Fusion-An Analysis in Patients with and without Symptoms.

Identifying the cause of recurrent or persisting pain after posterior lumbar interbody fusion (PLIF) is essential for establishing optimal treatment. In this study, we evaluate patients after PLIF surgery by 18F-fluoride PET/CT scans and patient-reported outcome measures (PROMs). A total of 36 PLIF patients were included. Sixty minutes after intravenous injection of 18F-fluoride, PET/CT scanning was performed. Bone graft ingrowth, subsidence, screw loosening and damage of facet joints were scored by quantifying the level of bone metabolism of the vertebral endplates in the disc spaces, around screws and around the facet joints on the PET scans. In contrast to asymptomatic patients, symptomatic patients showed abnormal PET values around pedicle screws and/or facet joints and at the lower endplates of the disc spaces, identifying a possible source of pain. On CT, no significant differences between these two groups were found. The PET/CT findings appeared to correlate better with symptoms on PROMs compared to CT findings alone. When interpreting 18F-fluoride PET/CT findings after PLIF surgery, one should realize bone metabolism in the disc spaces of the operated segments and around pedicle screws or facet joint changes during follow-up, reflecting natural recovery.

ARE TOTAL ANKLE ARTHROPLASTIES MORE PROTECTIVE OF THE HINDFOOT JOINTS THAN ANKLE ARTHRODESIS? A 13-YEAR AVERAGE RETROSPECTIVE REVIEW OF 516 CASES

One assumed function of Total Ankle Replacement (TAR) is that by maintaining ankle joint motion we can protect the other hind foot joints from further degredation1. However, there is no work to our knowledge that compares hindfoot outcomes between TAR and arthrodesis. Sokolowski et al. found that 68% of TAR patients had no radiological progression of subtalar arthritis after TAR, and 4% went on to fusion2. However, no evaluation of the other hindfoot joints was made and no comparison made to other treatment. We performed a retrospective review of all patients at our centre who had had a TAR or ankle arthrodesis since 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patients were excluded who had no documentation, were followed up at other hospitals, had prior hindfoot fusion, or were having staged surgeries at the time of index treatment. Chi squared analysis was used to compare the cohorts. 214 arthrodesis cases and 302 TAR were eligible. The average age was 57. Average time to follow up was 13 years (4–21). At the time of abstract submission 107 sets of notes had been reviewed fully. Full analysis will be performed by conference. 14% of TAR patients went on to have further procedures to the hindfoot joints while 35% of arthrodesis patients had further procedures (p=0.014). There was also a significant difference in the number of patients progressing to fusion of a further hindfoot joint between groups (TAR- 4%, arthrodesis- 20%, p=0.01). These data suggest that TAR are protective of symptomatic change of hindfoot joints. Patients with TAR had fewer hindfoot fusions than those with arthrodesis and also fewer procedures of any form, including injections.

Improvement of the temporomandibular joint symptoms due to the condylar position change following modified L-shaped intraoral vertico-sagittal ramus osteotomy: a single-center, retrospective study.

Intraoral vertico-sagittal ramus osteotomy (IVSRO) was first reported by Choung in 1992 as a surgical procedure to decrease postoperative condylar dislocation. In 2017, Iwanaga et al. developed modified L-shaped IVSRO (mIVSRO) to reduce postoperative nerve dysfunction and achieved favorable outcomes. This study aimed to clarify the effect of mIVSRO on changes in temporomandibular joint (TMJ) symptoms and three-dimensional condylar position. We conducted a retrospective study of thirty sides in fifteen Japanese adults diagnosed with jaw deformities who underwent mIVSRO and sagittal split ramus osteotomy (SSRO). TMJ symptoms were assessed chronologically, and the condylar long axis and the condylar position were analyzed two- and three-dimensionally using axial cephalograms and cone-beam computed tomography. Postoperative TMJ symptoms improved by 90% (9/10 sides) in the mIVSRO group and by 50% (7/14 sides) in the SSRO group. The mIVSRO group exhibited outward rotation of the condylar long axis, while the SSRO group exhibited inward rotation. Moreover, mIVSRO induced residual anteromedial-inferior deviation of the condyle. The inclination angle of the condylar process was not significantly different between the two procedures pre- and postoperatively. These results clearly demonstrated the effect of mIVSRO on symptomatic TMJ. Residual changes in the position of the condyle following mIVSRO may not affect jaw function.

Mid-term effectiveness of LU-tarjet procedure for recurrent anterior shoulder dislocation

To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet) procedure in treatment of recurrent anterior shoulder dislocation. Between March 2017 and February 2019, 56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure. There were 44 males and 12 females with an average age of 26.3 years (range, 18-41 years). Shoulder joint dislocation occurred 2-16 times, with an average of 7.5 times. The time from the initial dislocation to operation ranged from 6 months to 13 years, with a median of 4.6 years. Preoperative shoulder joint fear test and re-reduction test were positive in all patients. The Beighton score of joint relaxation ranged from 1 to 7, with an average of 4.1. The shoulder Instability Severity Index Score (ISIS) ranged from 5 to 10, with an average of 7.8. The size of glenoid defects on the affected side ranged from 15% to 32% (mean, 22.4%). All patients had Hill-Sachs injuries of varying degrees. Six patients had re-dislocation after Bankart surgery. The operation time, incision healing, and postoperative complications were recorded. The range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation) of shoulder joint were compared between pre- and post-operation. The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score. X-ray films and three-dimensional CT were used to analyze the location, healing, and remolding of bone graft, the repair of glenoid defect, and degenerative changes of the shoulder joint. All operations were successfully completed. The operation time ranged from 42 to 98 minutes, with an average of 63 minutes. All incisions healed by first intention. All patients were followed up 5-7 years (mean, 6.3 years). During follow-up, 2 patients experienced shoulder subluxation within 1 year after operation and 1 patient experienced recurrent shoulder joint pain. The remaining patients had no related complications. At last follow-up, there was no significant difference between the two groups ( P>0.05) in range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation). The ASES score, Rowe score, and Walch-Duplay score of shoulder significantly improved when compared with those before operation ( P<0.05). Postoperative CT showed that 53 cases (94.64%) of coracoid bone masses were centered placed vertically, 2 cases (3.57%) were superior, and 1 case (1.79%) was inferior; 49 cases (87.50%) of the coracoid bone grafts were flush with the glenoid, 2 cases (3.57%) and 5 cases (8.93%) were medially and laterally positioned. The volume of coracoid bone graft decreased first and then increased, and the shape of the bone graft was continuously remodeling and gradually matched with the track of the humerus head (the optimal circle of the glenoid), all coracoid bone grafts healed. At last follow-up, the coverage rate of optimal glenoid circle was 89.6%-100%, with an average of 97.4%. The area of glenoid defect was 2.6%±1.3%, which significantly decreased when compared with preoperative (22.4%±5.4%) ( P<0.05). At last follow-up, no obvious degenerative changes of shoulder joint was observed. LU-tarjet procedure for recurrent anterior shoulder dislocation has good mid-term effectiveness with short operation time and few complications.

РАЗВИТИЕ ХРОНИЧЕСКОГО МУЛЬТИОЧАГОВОГО НЕБАКТЕРИАЛЬНОГО ОСТЕОМИЕЛИТА У ПАЦИЕНТА С ИСХОДНО ДИАГНОСТИРОВАННЫМ СИСТЕМНЫМ ЮВЕНИЛЬНЫМ АРТРИТОМ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Systemic juvenile arthritis (sJA) is a special variant of chronic arthritis in children belonging to the spectrum of polygenic autoinflammatory diseases whose main features are persistent febrile fever, skin rashes, other systemic manifestations (serositis, lymphadenopathy, hepatosplenomegaly) as well as the presence of joint damage with the frequent development of destructive polyarthritis and osteonecrosis, high laboratory indicators of systemic inflammation either at the disease onset or delayed. The list of differentiated conditions includes many diseases such as infections, cancer, primary immunodeficiencies, monogenic autoinflammatory diseases etc. Authors represent a clinical case of a patient with sJA manifestations who was diagnosed with chronic multifocal nonbacterial osteomyelitis (CMNO), that demonstrates the great difficulties in diagnosis and the variability of the course of rheumatic diseases in childhood, which in its turn causes a delay in the timely prescription of effective therapy. Thus, patients with manifestations of a systemic inflammatory process, joint changes, especially those with an atypical course of the disease, pain in the bones and joints of a nocturnal nature, as well as an insufficient response to the therapy even long-term, are in need of conducting of a differential diagnostic search with the inclusion of CMNO, the ‘whole body’ mode magnetic-resonance tomography prescribed by a rheumatologist practitioner.

Investigating the utility of HR-pQCT for the assessment of joint space and bone mineral density in hand osteoarthritis

ObjectiveOsteoarthritis affects joints of the hand and is radiographically characterized by joint space narrowing and changes in volumetric bone mineral density (vBMD). High-resolution peripheral computed tomography (HR-pQCT) allows for three-dimensional analysis of joint space width (JSW) changes but has yet to be applied to hand OA (HOA). The purpose of this study was to assess the utility of HR-pQCT in quantifying JSW and vBMD changes in HOA. DesignThe 2nd and 3rd distal interphalangeal (DIP2, DIP3) and trapeziometacarpal (TMC) joints of 20 women (10 controls, 10 HOA) were scanned using HR-pQCT. The Diseases of the Arm, Shoulder, and Hand (DASH) questionnaire and the Jebsen Hand Function Test (JHFT) were obtained. Radiographs were scored using the Eaton-Littler classification. We assessed between-group differences in HR-pQCT outcomes, and relationships between HR-pQCT outcomes and patient and radiographic characteristics. ResultsJSW maximum (JSW.Max) was higher in OA patients in the DIP2 (OA median [interquartile rage]: 2.07 mm [1.90–2.18], controls: 1.88 mm [1.84–1.89]) and DIP3 joints (OA: 2.01 mm [1.89–2.24], controls: 1.86 mm [1.82–1.95]). DIP3 JS volume was higher in OA (30.36 mm3, 19.35–34.57 mm3, controls: 17.05 mm3, 15.53–18.52 mm3). DASH scores were positively associated with DIP2 JSW asymmetry (JSW.AS), and JHFT times were positively associated with DIP3 JSW.Max, JSW.AS, and proximal DIP2 vBMD. Worsening radiographic TMC OA was associated with first metacarpal vBMD, JSW minimum, JSW.Max, and JSW.AS. ConclusionsThese preliminary findings suggest that HR-pQCT may be useful in investigating JS changes in HOA and warrants further investigation.

Effect of different ulnar osteotomies on loading of the distal radioulnar joint: a finite element analysis

BackgroundUlnar impingement syndrome is a prevalent source of ulnar carpal pain; however, there is ongoing debate regarding the specific location of shortening, the method of osteotomy, the extent of shortening, and the resulting biomechanical alterations.MethodTo investigate the biomechanical changes in the distal radioulnar joint (DRUJ) resulting from different osteotomy methods, a cadaveric specimen was dissected, and the presence of a stable DRUJ structure was confirmed. Subsequently, three-dimensional data of the specimen were obtained using a CT scan, and finite element analysis was conducted after additional processing.ResultsThe DRUJ stress did not change significantly at the metaphyseal osteotomy of 2–3 mm but increased significantly when the osteotomy length reached 5 mm. When the osteotomy was performed at the diaphysis, the DRUJ stress increased with the osteotomy length, and the increase was greater than that of metaphyseal osteotomy. Stress on the DRUJ significantly increases when the position is changed to pronation dorsi-extension. Similarly, the increase in stress in diaphyseal osteotomy was greater than that in metaphyseal osteotomy. When the model was subjected to a longitudinal load of 100 N, neither osteotomy showed a significant change in DRUJ stress at the neutral position. However, the 100 N load significantly increased stress on the DRUJ when the position was changed to pronation dorsi-extension, and the diaphyseal osteotomy significantly increased stress on the DRUJ.ConclusionsFor patients with distal oblique bundle, metaphyseal osteotomy result in a lower increase in intra-articular pressure in the DRUJ compared to diaphyseal osteotomy. However, it is crucial to note that regardless of the specific type of osteotomy employed, it is advisable to avoid a shortening length exceeding 5 mm.

Aging and Autophagy: Roles in Musculoskeletal System Injury.

Aging is a multifactorial process that ultimately leads to a decline in physiological function and a consequent reduction in the health span, and quality of life in elderly population. In musculoskeletal diseases, aging is often associated with a gradual loss of skeletal muscle mass and strength, resulting in reduced functional capacity and an increased risk of chronic metabolic diseases, leading to impaired function and increased mortality. Autophagy is a highly conserved physiological process by which cells, under the regulation of autophagy-related genes, degrade their own organelles and large molecules by lysosomal degradation. This process is unique to eukaryotic cells and is a strict regulator of homeostasis, the maintenance of energy and substance balance. Autophagy plays an important role in a wide range of physiological and pathological processes such as cell homeostasis, aging, immunity, tumorigenesis and neurodegenerative diseases. On the one hand, under mild stress conditions, autophagy mediates the restoration of homeostasis and proliferation, reduction of the rate of aging and delay of the aging process. On the other hand, under more intense stress conditions, an inadequate suppression of autophagy can lead to cellular aging. Conversely, autophagy activity decreases during aging. Due to the interrelationship between aging and autophagy, limited literature exists on this topic. Therefore, the objective of this review is to summarize the current concepts on aging and autophagy in the musculoskeletal system. The aim is to better understand the mechanisms of age-related changes in bone, joint and muscle, as well as the interaction relationship between autophagy and aging. Its goal is to provide a comprehensive perspective for the improvement of diseases of the musculoskeletal system.

Effect of umbilical cord blood-mononuclear cells on knee osteoarthritis in rabbits

BackgroundTo investigate the effect and underlying mechanism of umbilical cord blood-mononuclear cells (UCB-MNCs) in treating knee osteoarthritis (KOA) in rabbits.MethodsA rabbit KOA model was prepared by anterior cruciate ligament transection (ACLT). Fifty New Zealand white rabbits were randomly divided into the control group, model group, sodium hyaluronate (SH) group, platelet-rich plasma (PRP) group and UCB-MNC group. Knee injections were performed once a week for five consecutive weeks. The gross view of the knee joint, morphology of knee cartilage and structural changes in the knee joint were observed on CT scans, and graded by the Lequesne MG behavioral score and the Mankin score. TNF-α and IL-1β levels in the synovial fluid of the knee were measured by the enzyme-linked immunosorbent assay (ELISA). Expression levels of MMP-13 and COL-II in the knee cartilage were detected by Western blotting and qRT-PCR.ResultsThe Lequesne MG behavioral score and the Mankin score were significantly higher in the model group than those in the control group (P < 0.05). Rabbits in the SH, PRP and UCB-MNC groups had sequentially lower scores than those in the model group. Imaging features of KOA were more pronounced in the model group than in the remaining groups. CB-MNC significantly relieved KOA, compared to SH and PRP. Significantly higher levels of TNF-α and IL-1β in the synovial fluid of the knee, and up-regulated MMP-13 and down-regulated COL-II in the knee cartilage were detected in the model group than in the control group. These changes were significantly reversed by the treatment with SH, PRP and UCB-MNCs, especially UCB-MNCs.ConclusionInjections of UCB-MNCs into knees protect the articular cartilage and hinder the progression of KOA in rabbits by improving the local microenvironment at knee joints.

Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study

Backgroundthe pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS. Objectivesto compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals. Designcross-sectional study. MethodThirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level. ResultsPatients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups. ConclusionA clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.

Business model platformization drives social value—A configuration research based on the technology‐organization‐environment framework

AbstractData connectivity is driving a shift in corporate business models toward social responsibility and stakeholder orientation, but existing research has focused on the significant increase in business value from business model platformization and has failed to answer the question of “what kind of business model platformization creates high social value in what contexts.” Business model platformization features are decomposed into three‐dimensional components of technology, architecture, and capability, and the external environment in which the business model creates value is segmented in terms of demand evolution and peer competition. This paper develops a technology–organization–environment (TOE) configurational framework, adopts fuzzy‐set qualitative comparative analysis (fsQCA), collects data from 42 enterprises with business model platformization, and analyzes what combinations of digital intelligence technology, platform architecture, dynamic capability, demand evolution, and peer competition constitute a high social value configuration. The study suggests that four configurations of the three main types, resource‐driven, demand‐driven, and total factor‐driven, constitute equivalent paths to high social value. With the help of the TOE framework to identify the configurations of business model platformization to create high social value, this paper provides theoretical support for enterprises aiming to create high social value in the face of peer competition and joint changes in the demand environment to choose the appropriate path of business model platformization from their own point of view.

Displasia do desenvolvimento do quadril: série de casos no Rio Grande do Norte

Developmental dysplasia of the hip (DDH) represents a spectrum of anatomical abnormalities of the hip. The objective of this manuscript is to report the atypical presentation pattern of developmental dysplasia of the hip present in a family group in Rio Grande do Norte and to emphasize the importance of early diagnosis performed through the Ortolani and Barlow maneuvers. Both orthopedic clinical tests are essential in screening for changes in the hip joint in the newborn and should preferably be performed from birth to approximately three months of age. In addition, requesting complementary ultrasound of the hip could be indicated. Pediatric patients with developmental hip dysplasia treated at the Children’s Rehabilitation Center were atypical clinical cases because they had male predominance in a family group in Rio Grande do Norte/RN, Brazil. It is concluded that this report emphasizes the need for early and adequate clinical evaluation by the physician for all newborns, regardless of gender, as well as the creation of a protocol which meets the suspicion parameters for requesting an ultrasound of the hip joint in newborns in order to diagnose and treat this condition early, thus reducing the need for surgical treatment and its complications.

Cumulative loading increases and loading asymmetries persist during walking for people with a transfemoral bone-anchored limb

BackgroundA bone-anchored limb (BAL) is an alternative to a traditional socket-type prosthesis for people with transfemoral amputation. Early laboratory-based evidence suggests improvement in joint and limb loading mechanics during walking with a BAL compared to socket prosthesis use. However, changes in cumulative joint and limb loading measures, which may be predictive of degenerative joint disease progression, remain unknown. Research questionDo cumulative total limb and hip joint loading during walking change using a BAL for people with unilateral transfemoral amputation, compared to prior socket prosthesis use? MethodsA case-series cohort of eight participants with prior unilateral transfemoral amputation who underwent BAL hardware implantation surgery were retrospectively analyzed (4 M/4 F; BMI: 27.7 ± 3.1 kg/m2; age: 50.4 ± 10.2 years). Daily step count and whole-body motion capture data were collected before (using socket prosthesis) and one-year after BAL hardware implantation. Cumulative total limb and hip joint loading and between-limb loading symmetry metrics were calculated during overground walking at both time points and compared using Cohen’s d effect sizes. ResultsOne year after BAL hardware implantation, participants demonstrated bilateral increases in cumulative total limb loading (amputated: d = -0.65; intact: d = -0.72) and frontal-plane hip moment (amputated: d = -1.29; intact: d = -1.68). Total limb loading and hip joint loading in all planes remained asymmetric over time, with relative overloading of the intact limb in all variables of interest at the one-year point. SignificanceDespite increases in cumulative total limb and hip joint loading, between-limb loading asymmetries persist. Habitual loading asymmetry has been implicated in contributing to negative long-term joint health and onset or progression of degenerative joint diseases. Improved understanding of methods to address habitual loading asymmetries is needed to optimize rehabilitation and long-term joint health as people with transfemoral amputation increase physical activity when using a BAL.

Myricetin reduces neutrophil extracellular trap release in a rat model of rheumatoid arthritis, which is associated with a decrease in disease severity.

Rheumatoid arthritis (RA) is a chronic disease characterized by joint inflammation and severe disability. However, there is a lack of safe and effective drugs for treating RA. In our previous study, we discovered that myricetin (MC) and celecoxib have a synergistic effect in the treatment of RA. We conducted in vitro and in vivo experiments to further investigate the effects and mechanisms of action of MC. Our findings demonstrated that MC treatment effectively reduced the release of neutrophil extracellular traps (NETs) and alleviated the inflammatory response in RA. Mechanistic studies showed that MC prevents the entry of PADI4 and MPO into the cell nucleus, thereby protecting DNA from decondensation. In a rat arthritis model, MC improved histological changes in ankle joints and suppressed NET-related signaling factors. In conclusion, MC protects the ankle joints against arthritis by inhibiting MPO and PADI4, thereby reducing NET release. The pharmacological mechanism of MC in RA involves the inhibition of NET release.

Micromechanical and microstructure evolution of leaded (SnPb) and lead-free (SAC305 and SnCu) mixed solder joints during isothermal aging

This paper studies how isothermal aging affects the micromechanical and structural properties of mixed solder joints made of 60Sn-40Pb (SnPb) with Sn-3.0Ag-0.5Cu (SAC305) and SnPb with Sn-0.7Cu (SnCu). The nanoindentation test was done to measure the micromechanical properties of SnPb/SAC305 and SnPb/SnCu mixed solder joints. These properties are hardness, reduced modulus, and stress exponent. Scanning electron microscopy (SEM) was used to look at the microstructure of a cross-section of mixed solder joints. The micrographs that were taken were then examined with open-source image processing software called ImageJ. It was found that the rate and distribution of intermetallic compound (IMC) formation and the reduction of Sn-rich phase grain size affect how the hardness and stress exponent values of mixed solder joints change after 1000 h of high temperature storage (HTS). ImageJ analysis shows that the Pb-rich phase particle count and distribution can be used to figure out how mixed solder joints respond to indentation creep and how that relates to isothermal aging. Using ImageJ, it’s clear that the indentation creep behavior of the GBS mechanism of an as soldered SnPb/SnCu mixed solder joint is caused by the highest number and size of Pb-rich phase particles that are not well distributed across the dendritic area of Sn-rich phase grain boundaries.

Biodegradable flexible triboelectric nanogenerator for winter sports monitoring

With the energy crisis and environmental pollution becoming a growing concern worldwide, the development of clean and renewable energy from the environment has become an imperative for human survival and development. However, the equipment used to harvest clean renewable energy is large, subject to environmental impacts and regional differences (such as wind, solar and tidal energy). In this study, a biodegradable eggshell membrane triboelectric nanogenerator (EM-TENG) is introduced for the purpose of harvesting low-frequency mechanical energy. A Wireless Intelligent Motion Monitoring System (WIMMS) has been created using EM-TENG. It includes a Bluetooth sensor terminal and an intelligent processing terminal for digital signal reception on a host computer. The EM-TENG can be attached to knee and ankle joints to monitor posture. Therefore, for real-time monitoring of joint and kinetic chain changes during land training of ice dance athletes, the intelligent ice dance land training aid system is important. As a wearable motion monitoring sensor, EM-TENGs application in intelligent motion monitoring, intelligent wearable devices and big data analytics is being promoted.