Joint Deformity Research Articles

Characteristics of deformation and defect of shield tunnel in coastal structured soil in China

Shield tunnel is a type of linear underground structure assembled by lining segments, characterized with long joint, weak stiffness, and strict deformation control requirement. The situation of the long-term deformation and defect of the shield tunnel in soft ground in coastal area of China is severe, mainly attributed to the tunneling-induced ground consolidation, frozen cross passage, groundwater pumping, cyclic train load, and nearby construction. Shield tunnel is buried in ground, and the above factors could result in underlying ground settlement, overlying ground loading/unloading, and at-side ground unloading. As a result, the tunnel could suffer from different types of structural deformation and defect. Based upon the aforementioned different reasons, this study investigates the characteristics of the tunnel deformation and defect corresponding to the different types of ground stress change and deformation. It is found that tunneling-induced ground consolidation, frozen cross passage, groundwater pumping, and cyclic train load mainly contribute to the longitudinal differential settlement but negligible transverse convergence, associated with water leakages at circumferential joints. In comparison, surface surcharge and at-side unloading not only cause significant longitudinal differential deformation but also increase transverse lining internal forces, resulting in water leakages at circumferential joints, longitudinal lining concrete cracks and water leakages. Finally, nearby construction could strongly disturb the ground and cause the generation of excess pore-water pressure, making the shield tunnel deformation develops continuously after the nearby construction is completed.

Experimental studies of the influence of deformations in nodal joints on the stress-strain state in a full-scale support made of MIC-C

Experimental studies of the influence of deformations in nodal joints on the stress-strain state in a full-scale support made of MIC-C

History and formation of “Limb lengthening and reconstruction surgery — LLRS” as a subspecialty of orthopedic surgery

In 1998, the first meeting of members of the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was held in the USA to introduce and popularize the methods developed in Kurgan by Professor G. Ilizarov and his staff. During 2005-2016, other communities worked in parallel with ASAMI, which went beyond the use of only the Ilizarov apparatus. Since 2017, the joint meetings have been called “Combined congress of the ASAMI-BR and ILLRS societies”. This actually became the basis for the definition of “Limb Lengthening and Reconstruction Surgery (LLRS)” as a subspecialty of orthopedic surgery that treats patients with nonunions, congenital and acquired long bone, large joints deformities of the upper and lower extremities. LLRS is based on the Ilizarov method and discovery (“Ilizarov effect”) with the rational use of external and internal fixation, osteotomy and soft tissue procedures. It takes at least three years for an orthopedic surgeon to become a specialist in the field of LLRS, and the education must be staged. A significant role in this is played by the ASAMI-BR ILLRS congresses, ExFix LLRS courses held in many countries, ExFix modules integrated into courses provided as part of the education of AO Trauma, as well as extensive world literature.

Experimental study on the residual strength of butt adhesive joints subjected to systematic creep damage

AbstractUsing adhesively bonded joints is an effective strategy for achieving lightweight designs. However, understanding the long‐term performance of these bonded joints remains a critical concern. Creep is a time‐dependent phenomenon induced by sustained mechanical loads, which can lead to viscous strain in adhesive materials. This strain has the potential to cause cracking in bonded structures over time. This study aims to investigate the creep and post‐creep behaviors of adhesively bonded aluminum joints, focusing on two crucial parameters: creep load level and creep duration. Butt adhesive joint (BAJ) specimens were fabricated and exposed to varying creep loads and times. Subsequently, quasi‐static tensile tests were conducted to assess the residual mechanical properties. The results indicated that higher creep loads resulted in increased creep deformations at constant creep durations. Furthermore, a downward trend was observed in the residual tensile mechanical properties of BAJ specimens following creep. Specifically, higher creep load levels and longer times led to more pronounced reductions in joint strength, strain, and stiffness. These reductions in joint mechanical properties were corroborated through joint fracture surface analysis. Additionally, mathematical models were developed using response surface methodology (RSM) to predict the experimental joint residual mechanical properties under different creep loads and times.Highlights Investigation of creep and post‐creep behaviors in adhesive joints. Higher creep load levels result in greater joint permanent deformations. Impact of higher creep load levels and durations on joint failure strength. Decreasing in the joint deformability and stiffness after creep.

Two-step cluster analysis based on three-dimensional CT measurements of craniofacial structures in severe craniofacial microsomia

BackgroundThe Pruzansky-Kaban and OMENS classifications do not provide additional details on temporomandibular joint deformities. The aim of this study was to classify and quantitatively delineate severe forms of craniofacial microsomia based on three-dimensional maxillofacial measurements, focusing on deformities in the zygomatic, temporal, and mandibular bones. MethodsMaxillofacial computed tomography(CT) scans of children with severe types of CFM from 2010 to 2020 were collected. Three-dimensional measurements of zygomatic arch length, height of mandibular ramus, height of maxilla, and occlusal cant were performed. Two-step cluster analysis was conducted based on zygomatic arch continuity, occlusal cant, the ratio of affected side to unaffected side(A/U ratio) for zygomatic arch length, mandibular ramus height, and maxillary height. ResultsFifty patients (32 male, 18 female) were included in the study. They were classified into 2 clusters through cluster analysis. Cluster 1 comprised subjects (44% of patients) with continuous zygomatic arches. Cluster 2 comprised subjects (39%) with discontinuous zygomatic arches. The zygomatic arch A/U ratio in Cluster 1 was greater than that in Cluster 2, with statistical significance observed. Additionally, the maxilla height A/U ratio in Cluster 1 was lower than in Cluster 2, also with statistical significance. There was no statistically significant difference observed in the ramus height A/U ratio and occlusal cant between Cluster 1 and Cluster 2. ConclusionsBased on craniofacial measurements, severe CFM can be categorized into two types: continuous zygomatic arch and discontinuous zygomatic arch. This cluster analysis complemented the OMENS classification and could assist in the selection and design of prosthetic joints for patients with CFM.

Acupuncture at the Zusanli acupoint can reduce the inflammatory response in AIA mice by regulating the arachidonic acid and pentose phosphate pathways

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by synovitis, which can lead to joint deformity. Acupuncture treatment stimulates specific acupoints to adjust qi and blood function, relieving joint inflammation and pain. MethodsUltra-high performance liquid chromatography-mass spectrometry (UPLC-QTOF-MS) was utilized for non-targeted metabolomics analysis of plasma samples from the blank group, Adjuvant-Induced Arthritis (AIA) model mice model mice group, and acupuncture group. Metabolite hierarchical clustering analysis, multivariate statistical analysis, standardized processing, principal component analysis (PCA), partial least squares-discriminant analysis (PLS-DA), and other methods were employed to identify targeted metabolites affected by acupuncture treatment in AIA mice. The related metabolic pathways were analyzed using KEGG pathway. ResultsHistopathological results demonstrated that acupuncture at Zusanli point (ST 36) significantly improved the inflammatory response in AIA mice. The PCA score plot indicated relatively close sample clustering within each group with significant differences observed between the four groups, confirming successful establishment of the AIA animal model with metabolic disorders occurring. Acupuncture treatment effectively corrected these metabolic disorders. Plasma metabolomics identified a total of 10 differential metabolites primarily associated with arachidonic acid and pentose phosphate metabolic pathways. ConclusionsAcupuncture at ST36 can significantly improve the inflammatory response in AIA mice through modulation of arachidonic acid and pentose phosphate metabolic pathways.

Radial neck fracture in children-"Abenign fracture?"

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of8 and 12 years old are more frequently affected, whereby acubitus valgus variant can be apredisposing factor. The main trauma mechanism is afall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while asurgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using aelastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires acomprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

Different surgical interventions for unstable intertrochanteric fracture of the femur: Network meta-analysis.

Although a large body of evidence has reported on surgical approaches for the treatment of unstable intertrochanteric femoral fractures, studies that comprehensively evaluate treatment outcomes are limited. The purpose of this study was to compare the effectiveness of extramedullary fixation (i.e., dynamic hip screw [DHS]), intramedullary fixation (i.e., the proximal femoral nailing [PFN]), and hemiarthroplasty (HA) for the treatment of unstable intertrochanteric femoral fractures using network meta-analysis. This study meets the preferred reporting items for systematic reviews and meta-analyses criteria. The Patient, Intervention, Comparison and Outcome search protocol framework was used to search the Google Scholar, PubMed, Embase, and Cochrane Library databases were searched from inception until June 2023. A total of 15 randomized controlled trials, including 1282 patients were analyzed. The Harris hip score (HHS) after DHS fixation was the lowest compared with that of PFN fixation and HA. DHS fixation had a significantly longer operation time than that of PFN fixation. Compared with HA, a lower incidence of superficial wound infection was observed with PFN and DHS fixations. PFN was significantly more likely to be implant cut out compared with HA. Compared with DHS, PFN and HA showed a lower incidence of fracture healing malunion. HA and PFN have good efficacy in improving the HHS and preventing joint deformities. However, HA showed a higher incidence of superficial infection than that observed with PFN, whereas a higher risk of screw cutout is observed with PFN than with HA.

Evaluation of the Curative Effects of Surgical Intervention in Cases of Congenital Malformation of the Ossicular Chain in Children.

Purpose: Congenital malformation of the ossicular chain results in challenges with hearing and language development in children. We aimed to analyze the clinical characteristics, prognosis, and surgical treatments of different types of congenital ossicular chain malformations in children. Methods: Eight cases (10 ears) treated between October 2019 and February 2022 were analyzed retrospectively. Patients were divided according to the location of the ossicular chain malformation and whether it was complicated by external ear malformation. Imaging, audiological examination, intraoperative exploration of the middle ear, and postoperative outcomes were recorded. Results: Group 1 incudostapedial joint deformity): 6 ears/60%; Group 2 (simple incus deformity): 2 ears/20%; Group 3 (simple malleus deformity): 2 ears/20%; Group A (with external ear malformations): 4 ears/40%; Group B (without external ear malformations): 6 ears/60%. The average hearing threshold before and after the operation was 51.25 ± 12.88 and 31.94 ± 12.96 dB, respectively. There were differences in the intervention effects of different malformed sites (Group 1: t = 5.139, P = .004; Group 2: t = 13.500, P = .047; Group 3: t = 15.000, P = .042). The effect of the intervention in cases of malformation with mobile stapes footplates was better than that with immobile stapes footplates (t = 4.082, P = .027). The effect of the intervention without external ear malformations was better than that with external ear malformations (t = 7.706, P = .001). Conclusions: The intervention yielded superior results in cases of malformation with mobile stapes footplates compared to those with immobile stapes footplates. Different intervention strategies should be determined through precise deformity assessments, with the degree of stapes mobility serving as a crucial factor in improving the prognosis.

Hip joint degeneration - not only an issue of the elderly

Introduction: Legg-Calve-Perthes Disease (LCPD) is a condition characterized by ischemia of the proximal femoral epiphysis, leading to pain, limping, and potential hip joint deformities in children. Its etiology remains unclear, with theories implicating repetitive microtrauma, skeletal retardation, and vascular insufficiency. Diagnosis involves radiological assessment and classification systems to monitor disease progression, influencing treatment decisions and long-term outcomes. Material and methods: This study summarizes existing literature and clinical data on LCPD, focusing on etiological theories, diagnostic methods, treatment strategies, risk factors, and prognostic indicators. Information was gathered from medical databases, peer-reviewed journals, and case studies to compile a comprehensive overview of the disease. Aim of study: The aim was to gather current knowledge on LCPD, emphasizing diagnostic approaches, treatment modalities, and factors influencing clinical outcomes. Special attention was given to discussing the efficacy of various treatment options and identifying prognostic factors that impact the disease trajectory. Conclusion: Effective management of LCPD hinges on early diagnosis, appropriate treatment selection, and careful monitoring of disease progression. Prognosis is influenced by factors such as age at diagnosis, extent of femoral head involvement, and maintenance of hip joint congruence. Further research is needed to refine treatment protocols and improve long-term outcomes for affected children.

Knowledge and Attitudes of General Population's Toward Rheumatoid Arthritis in Hail, Saudi Arabia

Background: A chronic inflammatory autoimmune illness, rheumatoid arthritis (RA) mainly affects small, symmetrical joints, especially those in the hand, wrist, and foot. However, it can also affect other joints and systems. Joint deformity, persistent pain, and a reduced quality of life are brought on by recurrent assaults. Aim: The objective of the research is to evaluate the general public's awareness and insights regarding rheumatoid arthritis in Hail, Saudi Arabia. Method: The cross-sectional research took place on people in Hail who were at least 18 years old and over. A self-administered questionnaire was distributed among Hail population using online platforms primarily social media. The questionnaire includes basic demographic characteristics, types of RA, the causes of RA, the symptoms, the risk factors, complications, treatment of RA and whether they know what RA is or not. Results: 532 people in responded to the questionnaire; of them, 42.5% were female and 50.9% were male. 8.3% had received a diagnosis of RA, and 60.0% correctly associated it with joint pain and morning stiffness. 67.3% believed that RA is not a contagious disease. A significant majority (56.6%) correctly identified that women are more likely to develop RA. Regarding risk factors, 28.0% acknowledged smoking as a significant factor. A notable finding is that 63.7% were uncertain about RA's impact on pregnancy. Knowledge about specific joint involvement varied, with 60.0% correctly associating RA with inflammation in small joints. Conclusion: The results indicate that while some participants demonstrated a correct comprehension of the disease, there were misconceptions, particularly regarding the joint pain characteristic, types of joint involvement and extra-articular manifestations. These results emphasize how crucial it is to set educational initiatives in place to clear up these misunderstandings and raise community understanding about rheumatoid arthritis.

Relationship Between Ankle Ligamentous Injuries and Osteochondral Lesions in a Saudi Arabian Population: A Retrospective Cohort Study.

Objectives This study aimed to investigate the relationship between ankle ligamentous injuries and osteochondral defects (OCDs) and to determine the incidence of these conditions within the Saudi Arabian population. Methods This retrospective cohort study included 215 patients (110 males and 105 females) who sought medical advice for an ankle injury at our institute from January 2017 to August 2022. The patients were divided according to age, sex, presence and type of ligamentous injury, and status of OCDs. Patients' ages were categorized into three groups: younger than 30 years (48 patients), 30-60 years (145 patients), and older than 60 years (22 patients). The patients were assessed for ligamentous ankle sprains, tears, and OCDs by reviewing their magnetic resonance imaging reports from radiology records. The exclusion criteria included ankle fracture, ankle surgery, osteoarthritis of the ankle joint, inflammatory arthritis, and congenital deformity of the ankle. The data were collected using a simple questionnaire created via Google Forms. Results Of the 24 patients with OCD, 23 had OCD of the talus. Anterior talofibular ligament (ATFL) injury was the most common injury (75 patients), whereas posterior talofibular ligament (PTFL) injury was the least common. The only significant relationship between ligamentous injury and OCD was observed between PTFL injury and OCD of the talus (P = 0.041). Conclusions In patients with an ankle injury, the most common OCDs occur at the talus, whereas the most injured ligament is the ATFL. Nevertheless, a significant relationship was observed between PTFL injury and OCD of the talus. The findings underscore the importance of considering specific ligament injuries when diagnosing and managing OCDs, especially in patients with chronic ankle pain.

Multicentric Osteolysis Nodulosis and Arthropathy (MONA): A Case Series and Review of the Literature.

Multicentric Osteolysis Nodulosis and Arthropathy (MONA) is a rare skeletal disorder driven by mutations in the MMP2 gene, leading to bone and joint degradation. This case series presents three unique MONA cases, highlighting clinical, radiological, and genetic aspects. These insights shed light on the complexities of MONA, aiding early diagnosis and multidisciplinary management. Case 1 is a 13-year-old male, born to consanguineous parents, presented with a 5-year history of progressive joint deformities, pain, and difficulty walking. Initially diagnosed as juvenile idiopathic arthritis (JIA), despite treatment, his symptoms persisted. Examination revealed multiple clinical findings, including joint contractures and nodules. Genetic analysis identified a pathogenic variant in the MMP2 gene, confirming MONA. Case 2 and Case 3 were two siblings, aged 12 and 17 years respectively, who presented progressive joint contractures in their hands and feet since early childhood. Clinical examinations revealed contractures and subcutaneous nodules. Genetic analysis confirmed MONA with a shared homozygous pathogenic MMP2 variant, emphasising the genetic basis of this rare disorder.

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.

Test on progressive collapse of steel moment-resisting frame with upper-and-lower flange angle steel connection

Both of test and numerical simulation methods are employed to study the vertical progressive collapse and collapse assessment methods of steel frame under accidental loads. Firstly, a steel frame collapse test model with a geometric similarity ratio of 1:1.5 is designed and manufactured. The ends of column of test model is fixed. The upper and lower flange angle steel connection is used. The far end of the beam is constrained by a controllable sliding hinge support. The various stages of vertical progressive collapse of structures are simulated by a large displacement loads applied at the far end of the beam. The main focus of the testing is to examine the stress and deformation of beam and joint at various stages, particularly the development of stress and deformation in the angle steel attached to the beam-column connection. The development law of collapse load-displacement curve, joint rotation, beam strain, and angle steel strain are analyzed. The structural resistance mechanism and the transformation relationship between resistance mechanisms during collapse are studied. Subsequently, the relationship between the structural dynamic increase factor curve and the structural collapse process is analyzed using finite element method. The results show that the strain of angle steels can better reflect the destruction and deformation process of substructure during the collapse, the collapse resistance mechanism of structure, and the transition between resistance mechanisms.With the help of the characteristic points on the structural dynamic increase factor curve, the collapse limit state of structure can be reliably determined.

Management of Dorsal Bunion in Nonambulatory Adolescents with Cerebral Palsy: A Retrospective Cohort Study.

A dorsal bunion may occur in nonambulatory adolescents with cerebral palsy (CP) and a Gross Motor Function Classification System (GMFCS) level of IV or V. The deformity can cause pain, skin breakdown, and difficulty wearing shoes and braces. A consensus on the biomechanics and surgical management of dorsal bunions in persons with severe CP has not been established. This retrospective cohort study included 23 nonambulatory adolescents with CP, GMFCS level IV or V, and symptomatic dorsal bunions requiring surgery. The median age at surgery was 17 years, and the median follow-up was 56 months. Reconstructive surgery included the excision of a 2 to 3-cm segment of the tibialis anterior tendon to correct the elevation of the first metatarsal. The fixed deformity of the first metatarsophalangeal joint was managed with use of corrective arthrodesis and dorsal plate fixation. Clinical and radiographic outcomes were assessed preoperatively and postoperatively at the transition to adult services. There were significant improvements in the clinical and radiographic outcome measures (p < 0.001). Pain was relieved, and there were no further episodes of skin breakdown. The elevation of the first metatarsal was corrected from a mean of 3° of dorsiflexion to a mean of 19° of plantar flexion. The deformity of the first metatarsophalangeal joint was corrected from a mean of 55° of plantar flexion to a mean of 21° of dorsiflexion. Six patients had complications, all of which were grade I or II according to the modified Clavien-Dindo system. The surgical reconstruction of a dorsal bunion via soft-tissue rebalancing of the first ray and corrective arthrodesis of the first metatarsophalangeal joint resulted in favorable medium-term clinical and radiographic outcomes in nonambulatory adolescents with CP. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Transverse seismic analysis method of underground interchange prefabricated utility tunnel

The rapid development of underground utility tunnels has led to the formation of a large number of interchange utility tunnels. Due to significant differences in the lateral resisting stiffness in orthogonal directions, coupled with the close relationship between soil deformation and the depth of the utility tunnel, the seismic response mechanism of the interchange utility tunnel is complex. This paper proposes a method for transverse seismic analysis of the underground interchange utility tunnel based on the response displacement method. A load-structure analysis model of a certain underground cross-type interchange utility tunnel is first established. Then, the different conditions corresponding to maximum relative deformation between layers of the interchange node are discussed, and the proposed method is validated via the time-history analysis method. Based on the proposed analysis method in this paper, seismic response analysis is performed on the interchange utility tunnel considering the condition of vertical incidence of three different input seismic waves. Discussions are conducted in terms of internal forces, inter-story displacement angles, and damage responses under seismic excitations in different principal axis directions. The results show that under major earthquakes, the maximum inter-story displacement angle of the interchange node exceeds the standard limit by up to approximately 184 %, while the tensile damage can reach up to 0.985, significantly surpassing the tensile damage limit. Accordingly, the interchange node is the weakest part of the interchange utility tunnel. There exists deformation inconsistency between the interchange node and standard segments due to significant stiffness differences, with the influence range of the interchange node on internal forces, inter-story displacement angles, joint deformations and damage of the utility tunnel is approximately 7, 6, 8, and 6 prefabricated standard segments, respectively. Since the maximum relative deformation between layers of the interchange node does not occur simultaneously, for double-layered and multi-layered interchange utility tunnels, it is necessary to comprehensively consider the maximum inter-story displacement angle between each layer to determine their most unfavorable condition. The analytical method and related research conclusions presented in this paper can provide references for the transverse seismic design of interchange utility tunnels.

Experimental investigation on the mechanical properties and failure mechanism of key joints in a new-type prefabricated pile-wall composite structure for the open-cut tunnel

To improve the failure resistance of the lining and make use of the retaining structure, this paper proposed a novel method of adding the key joints to connect the lining with the retaining structure. Usually, the joint is the weak point of the whole structure. The failure mechanism of key joints significantly influences the design and safety of the prefabricated structure. In this study, full-scale loading tests were conducted on three types of key joints: sleeve joint, spiral stirrup joint, and U-shaped rebar joint. The joint deformation, failure mechanism, concrete strain, and reinforcement strain are investigated. The results demonstrated that the deformation and failure process of the key joints can be divided into four stages. The flexural-shear failure caused by the joint opening and the sliding of lining is considered as the main failure mode of the key joints. The U-shaped rebar joint exhibited the best mechanical performance. Furthermore, the finite element modes were created to analyze the influence of axial force and the reinforcement diameter. Combining the test and numerical analysis results, the failure mechanism was revealed. In addition, the joints’ loading-carrying capacity was increased with the increase of axial force due to the axial force limiting the joint opening. The research results provide a theoretical basis and reference for the new-type prefabricated pile-wall composite structure (PPCS).

Guideline for diagnosis and non-surgical treatment of early-stage knee osteoarthritis (2024 edition)

Knee osteoarthritis (KOA) is common in middle-aged and elderly populations, with typical symptoms including knee joint pain, deformity, and restricted movement. The concept of early KOA (EKOA) is ambiguous, and clinical diagnosis and treatment are often overlooked. The diagnosis and effective prevention of EKOA can help delay the progression of the disease and reduce the incidence of mid-to-late stage KOA. To standardize the clinical diagnosis and treatment of EKOA, the Osteoarthrosis Committee of Chinese Aging Well Association has initiated the development of non-operative treatment guidelines for EKOA, selecting key clinical issues of concern to clinicians, including the definition, diagnosis, and non-operative treatment and strategies for EKOA. Ultimately, a total of 13 recommendations were formulated with the aim of raising the level and scientificity of EKOA diagnosis and treatment, thereby delaying the progression of EKOA in patients, improving their quality of life, and reducing the societal burden of the disease.

Positional Regulation, Sucking Reflex and Incidence When Given Nutrition Through OGT in High-Risk Infants with Low Birth Weight Infants in the Nicu Room: A Case Study of Waled Hospital

High-risk babies are babies born at 32 – 36 weeks of gestation/prematurely, babies whose mothers suffer from Diabetes Mellitus, babies with a history of apnea, babies with seizures, sepsis, asphyxia, babies with bleeding disorders or breathing problems. Problems that often arise in cases of LBW babies include unstable body temperature, breathing problems, digestive and nutritional disorders, liver immaturity, anaemia, intraventricular bleeding, seizures, infections, hypoglycemia, hyperglycemia and hypocalcemia. This study aims to provide nursing care to babies at high risk in the Nicu Room at Waled Hospital, Cirebon Regency, on 27 December 2023. Examination of the sucking reflex is recommended as a screening that shows intact motor neuron function in neonates. The sucking reflex is well-developed in normal babies and is coordinated with breathing. Inhibition of the sucking reflex in the first hours of life will affect the ability to suck at the beginning of life and will directly hinder the nutritional intake received by the baby. Arranging sleeping positions for newborn babies is the role of the neonatal nurse in providing routine daily care. Positioning, especially for premature babies, is not easy. Positioning errors can result in changes in physiological status (increased respiratory rate, pulse frequency, and decreased oxygen saturation), disturbed comfort and quality of sleep, drinking intolerance, hip joint deformity, and bleeding in the brain. The issues affecting all three clients have not been resolved. However, interventions such as positioning, assessing sucking reflexes in high-risk babies, and providing nutrition through OGT are ongoing, with efforts to set the supine sleep position during enteral nutrition. While the problems faced by the high-risk infants in this study are not yet resolved, ongoing nursing interventions are crucial in managing their care. Continued attention to proper positioning, monitoring of sucking reflexes, and nutritional support through OGT is vital for improving the health outcomes of these vulnerable infants.