Joint Status Research Articles

Эффективность ритуксимаба в терапии системного ювенильного идиопатического артрита

Эффективность ритуксимаба в терапии системного ювенильного идиопатического артрита

Quantification of pre-existing radiographic damage and its relationship with joint activity and long-term clinical outcomes with secukinumab therapy in patients with psoriatic arthritis

BackgroundPsoriatic arthritis (PsA) patient data from two phase 3 secukinumab trials (FUTURE 1, 5) were analysed to quantify the prevalence and extent of pre-existing radiographic damage (RD) at baseline; investigate the association of RD with swollen/tender joint counts (SJC/TJC) at baseline; and investigate the extent to which RD at baseline correlated with response to secukinumab.MethodsPooled data (N = 1554) provided baseline radiographic bone erosion and joint space narrowing (JSN) scores at pre-specified locations per the van der Heijde-modified total Sharp score (vdH-mTSS) for PsA and swollen and tender joint scores in the same joints at multiple visits. Overall patient RD and individual joints RD bone erosion and JSN scores were assessed. The association between joint activity (tenderness, swelling) and vdH-mTSS was assessed at the overall patient-level and individual joint tender, swollen scores (yes/no) and RD joint JSN and bone erosion scores at the individual joint-level. Treatment response was assessed using SJC/TJC at weeks 16 and 52 and the proportion of patients achieving minimal disease activity (MDA) over all assessments within 1 year from FUTURE 5 alone.ResultsA substantial prevalence of pre-existing RD with higher prevalence of erosion than JSN was observed (86% and 60% of patients had positive erosion and JSN scores, respectively); higher RD prevalence was associated with longer time since PsA diagnosis. Joint activity was weakly associated with RD at baseline at the patient-level (Pearson’s coefficients: range 0.12–0.18), but strongly associated at the individual joint-level, with a higher probability of tender/swollen joints to associate with higher JSN/erosion scores: all 42 analysed joints showed statistical significance at the 0.05 level (unadjusted) for the relationship between joint tenderness (yes/no) and its JSN score, all but one for tenderness and bone erosion scores, and all but 2 for swollen and JSN scores and for swollen and bone erosion score. Secukinumab (150/300 mg), reduced TJC and SJC across all values of baseline erosion and JSN scores at weeks 16 and 52. Patients with higher levels of RD were less likely to achieve zero tender/zero swollen joint status and had lower chance of achieving MDA.ConclusionsPsA patients showed substantial prevalence of RD at baseline that correlated with time since diagnosis, but patient’s individual joint activity was strongly associated with pre-existing RD at those joints. Patients with the highest RD at baseline had a reduced likelihood of achieving zero joint count status.

3D hand pose estimation from a single RGB image by weighting the occlusion and classification

In this paper, a new framework for 3D hand pose estimation using a single RGB image is proposed. The framework is composed of two blocks. The first block formulates the hand pose estimation as a classification problem. Since the human hand can perform numerous poses, the classification network needs a huge number of parameters. So, we propose to classify hand poses based on three different aspects, including hand gesture, hand direction, and palm direction. In this way, the number of parameters will be significantly reduced. The motivation behind the classification block is that the model deals with the image as a whole and extracts global features. Furthermore, the output of the classification model is a valid pose that does not include any unexpected angle at joints. The second block estimates the 3D coordinates of the hand joints and focuses more on the details of the image pattern. RGB-based 3D hand pose estimation is an inherently ill-posed problem due to the lack of depth information in the 2D image. We propose to use the occlusion status of the hand joints to solve this problem. The occlusion status of the joints has been labeled manually. Some joints are partially occluded, and we propose to compute the extent of the occlusion by semantic segmentation. The existing methods in this field mostly used synthetic datasets. But all the models proposed in this paper are trained on more than 50 K real images. Extensive experiments on our new dataset and two other benchmark datasets show that the proposed method can achieve good performance. We also analyze the validity of the predicted poses, and the results show that the classification block increases the validity of the poses.

Profile evaluation of rail joint in a 3‐m wavelength based on unsupervised learning

AbstractPreviously, electronic straightedges with a length of 1 m were widely used to measure the longitudinal profiles of rail joints. However, owing to the lack of an efficient measurement device, rail joints with 3‐m wavelengths are seldom studied. In this study, a rail measurement trolley based on the chord‐reference method was developed with a measurement wavelength of up to 3 m. A field measurement was performed on a 53‐km metro line, and the waveforms of 4340 rail joints were obtained. First, to visualize the distribution of the dataset and to find out the common features, t‐distributed stochastic neighbor embedding dimensionality reduction was applied to the rail joint dataset, and each rail joint waveform was mapped to a point in a two‐dimensional space. Second, K‐means was applied to the rail joint dataset, and six categories of rail joints were obtained. The results indicated that there are two types of rail joints: M‐type and W‐type, accounting for 18.41% and 76.08% of the total number of joints, respectively, and the remainder are bolted rail joints. Third, to better evaluate rail joint status, the concept of rail joint triangle (RJT) is proposed, and five shape‐based features of a rail joint in 3‐m wavelength are defined. Finally, using RJT distribution analysis, we observed that the shape‐based features provide more essential information about a rail joint, such as symmetry, asymmetry, M‐type, or W‐type, compared with conventional indexes such as the quality index. Notably, compared with the waveform of a rail joint at 1 m, a 3‐m waveform provides significantly more essential information, which can be meaningful for future research on the dynamic impact of rail joints, as well as profile grinding around rail joints. To help other researchers follow our research, our dataset is available on Mendeley Data (RWJ‐3 m dataset).

Joint Status and Bleeding Phenotype Characterization in Severe and Non-Severe Hemophilia a and B

Introduction: Persons with hemophilia (PwH) A and B are known to have variable bleeding phenotypes and may have joint bleeding that is less clinically apparent. In recent years, musculoskeletal ultrasound (MSKUS) has become an established modality useful for evaluating joint status. Further, determination of individual bleeding phenotype can be challenging, but clinical tools including the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT), self-BAT, and the Beighton Hypermobility Score (BHS) have been developed. Methods: We hypothesize that presence and degree of joint disease, evaluated with MSKUS and physical assessment scoring, will correlate with severity of bleeding phenotype as characterized through clinical history, BAT assessment, and presence of joint hypermobility in PwH A and B. This will be accomplished through assessing baseline joint status and disease progression over time with MSKUS, as well as through use of the ISTH-BAT, self-BAT, and assessment of hypermobility with the BHS. Up to 100 individual subjects with severe, moderate, or mild hemophilia A or B will be enrolled and assessed at baseline and annually during the study period at our institution. Correlation of joint status with BHS and BAT scores will be analyzed with the generalized estimating equation (GEE) and other statistical methods. Results: Thus far, 15 male patients have been enrolled (Table 1). All moderate and severe hemophilia patients are on prophylactic therapies for bleed prevention, and 3 patients have history of inhibitors. Target joints were reported only in severe PwH. MSKUS measurements were completed using the JADE protocol1. Patient enrollment remains ongoing. Discussion: Knowledge pertaining to joint status and bleeding phenotype is PwH A and B is limited. This pilot study will assess the presence and degree of joint disease, evaluated with MSKUS and physical assessment scoring, and its correlation with severity of bleeding phenotype as characterized through clinical history, BAT assessment, and presence of joint hypermobility in PwH hemophilia A and B. The results will be used to justify a larger, multicenter study to expand understanding of joint status and bleeding phenotype in PwH.

Preventable Causes Dominate Mortality in Hemophilia : A Retrospective Observational Study from India

Background and Objective: Bleeding symptoms in people with Hemophilia (PwH) can range from mild ecchymosis to fatal Central Nervous System (CNS) bleeding. With the advent of Clotting Factor Concentrates (CFCs) and prophylaxis there has been improved life expectancy in PwH in developed countries. However, in low middle income countries (LMIC) like India with a huge hemophilia burden (22,594 cases as per the data by World Hemophilia Federation global survey 2020, with probably far more undiagnosed/ undocumented cases), the mean per-capita factor use(Factor VIII -0.27IU,Factor IX 0.01) is far less than developed countries. Lack of access to safe and effective treatment is a major factor that influences the mortality rate in Hemophilia. This retrospective observational study was done to assess the cause of death in PwH in Kerala state of India. Methods: PwH with Hemophilia A and B registered under patient organizations (PO) in different districts of Kerala from 2015 January to 2022 April were included in the study. A questionnaire was structured and telephonic interview done to collect information on date of birth, Hemophilia type, severity, inhibitor status, target joint, HIV and HCV status, family history, type of treatment (prophylaxis/episodic).Hemophilia severity was categorized as severe (<0.01 IU/mL), moderate (0.01-0.05 IU/mL), or mild (>0.05-0.40 IU/mL). Information on Hemophilia severity, type and inhibitor status were verified with medical reports available with PO. Further data on immediate cause of death, place of death, availability of CFCs at the time of death and the distance of the patient's home to the hospital were collected over telephone. Cause of death was categorized into death due to bleeding, death due to other causes related to hemophilia and death due to causes not related to hemophilia. Statistical analysis was done using the IBM SPSS software version 20. Results: Out of 1032 PwH contacted during this study period there were total 34 death reported, which estimates to 32.9 deaths per 1000 patients.25 (73.5 %) were cases of Hemophilia A and 9 (26.5 %) cases of Hemophilia B. Twenty four patients (70.6%) had severe disease; three(8.8 %) had inhibitors. The cause of death was bleeding in 19(55.88 %) cases, Hemophilia related but not bleeding in 8 (23.52 % cases) and in 7 cases (20.6 %) death was due to causes not related to Hemophilia. The most common cause of death due to bleeding was intracranial bleed seen in 14 (41.17 %) cases, followed by death due to gastrointestinal bleed in 3 cases (8.82 %), hemoptysis and chronic bleed from wound comprised 1 (2.95%) each of all causes of death. In non-bleeding but Hemophilia related category hepatitis C associated liver failure was the cause of death in 8 (23.52 %) cases. In not Hemophilia related causes, cause of death was pneumonia in 4 (11.76 % causes), Myocardial infarction in 2(5.88 %) (refer figure 1). The age at death varied from 1 year to 77 years with mean age being 39.6 years. Out of these 5(17.64 %) deaths occurred in children less than 18 years of age of which 4(80 % )were due to bleeding. Three (8.8 %) deaths were reported at home. The distance from home to hospital ranged from 17.3 kilometer (km) to 257 km with a mean distance of 118 km. All the patients who died were neither on prophylaxis nor on home therapy. Conclusion: Majority of the patients who died had a preventable cause of death. Access to prophylaxis would have prevented deaths caused due to bleeding. None of the patients who died were on prophylaxis which is the standard of care for Hemophilia. None of these patients received home therapy and had to travel for long distances to acquire the factors. Improved access to safer clotting factor concentrates will help to prevent transfusion transmitted infection related deaths. Adequate sustainable supply and availability of factors at affordable costs, along with implementation of prophylaxis for PwH will be useful to bring down the mortality rate among hemophilia patients in LMICs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Flexible application of scar tissue flaps in scar contracture release surgery: A retrospective study.

Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient. To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue. Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6-24 months. Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%. Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.

Inflammation mediates approximately one quarter of excess relative all-cause mortality in persons with rheumatoid arthritis: the Trøndelag Health Study

Inflammation may contribute to excess mortality in rheumatoid arthritis (RA) patients. We investigated associations to all-cause mortality of the inflammation markers high-sensitivity C-reactive protein (CRP), lactoferrin (neutrophil activation marker), and neopterin (monocyte activation marker). From the population-based Trøndelag Health Study (3rd wave 2006–2008), 316 RA patients and 43,579 controls were included. Lactoferrin and neopterin were quantified in a nested cohort (n = 283 RA patients, n = 3698 controls). Follow-up was until death found by linkage to the Norwegian Cause of Death Registry or 31.12.2018. All-cause mortality was analyzed using Cox regression and Cox regression-based mediation analysis. Having RA (hazard ratio (HR): 1.25, 95%CI: 1.00, 1.56, p = 0.048), and CRP ≥ 3 mg/L (HR: 1.50, 95%CI: 1.41, 1.60, p < 0.001) were associated with all-cause mortality. The overall excess relative mortality risk of having RA was 38%. CRP ≥ 3 mg/L mediated approximately 1/4 of this risk (p < 0.001). In the nested cohort, CRP ≥ 3 mg/L (HR: 1.51, 95%CI: 1.26, 1.80, p < 0.001) and neopterin (HR: 1.17, 95%CI: 1.01, 1.36, p = 0.031) were associated with all-cause mortality. In conclusion, CRP levels ≥ 3 mg/L mediated approximately a quarter of the 38% excess relative all-cause mortality risk associated with RA. Using definitions of RA remission with emphasis both on joint status and the level of general inflammation may help guide the most efficient treatment regimens.

Height control in shoulder hemiarthroplasty for treatment of proximal humerus fractures

To evaluate methods of reduction using fragments of the greater tuberosity, and determine the clinical efficacy of humeral head replacement prosthesis height for proximal humerus fractures. A retrospective study of patients with proximal humerus fractures who were treated and followed up from January 2015 to December 2019, 19 patients met the indications for humeral head replacement, including 7 males and 12 females;8 on the left side and 11 on the right side. The age ranged from 58 to 84 years old with an average of (71.5±5.8 ) years old. The time from injury to operation 3 to 18 d with an average of (7.9±4.3) d. According to Neer's classification, there were 2 cases of three-part fractures with dislocations and 17 cases of four-part fractures, including 6 cases with dislocation and 2 cases with head splits. All 19 patients used the modular prosthesis. The greater tuberosity fracture fragments were reduced to determine the distance from the apex of the greater tuberosity to the humerus marking point. This distance was used as the standard for the height of the prosthesis. One year after the operation, the Constant-Murley score and the University of California, Los Angeles (UCLA) shoulder score were used to evaluate the functional status of the shoulder joint and patient satisfaction. The 19 patients were followed up from 12 to 58 months with an average of (31.9±14.2) months. The length of the upper arm was 26 to 32 cm after the operation, two-sided comparison error <0.5 cm. Anteroposterior and lateral X-ray films of the shoulder joint at 3 months after operation showed that the fracture fragments were all healed. After one year follow-up, the Constant-Murley score was 80.8±8.9, and the UCLA score was 27.9±4.8. Patient satisfaction rate was 89.5%(17/19). The greater tuberosity fracture fragments reduction technique, which use the distance from the apex of the greater tuberosity of humerus to the humeral marking point as the standard for the height of the prosthesis, is a simple and effective way with good outcomes in shoulder hemiarthroplasty for treatment of proximal humerus fractures.

Approach to Knee Arthropathy through 180-Degree Immersive VR Movement Visualization in Adult Patients with Severe Hemophilia: A Pilot Study.

(1) Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion–extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = −1.05; −0.26), joint condition (SE = 18.68; 95%CI = −1.16; −0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients.

Spontaneous facet joint fusion in patients following oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation: prevalence, characteristics and significance.

To explore the characteristics of spontaneous facet joint fusion (SFJF) in patients after oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation (OLIF-LSRF). We randomly selected 300 patients from 723 patients treated with OLIF-LSRF into a cross-sectional study based on the pilot study results. A novel fusion classification system was designed to evaluate the fusion status of the facet joints at three time points. Ultimately, the prevalence, characteristics, and significance of SFJF were analyzed. A total of 265 (333 levels) qualified cases were included in our study. The novelclassification for SFJF has excellent reliability (kappa > 0.75). The rate of SFJF was 15.20% (45/296 levels) at 3months postoperatively, 31.34% (89/284 levels) at 6months postoperatively, and 33.63% (112/333 levels) at the last follow-up. The circumferential fusion rate was 31.53% (105/333 levels) at the last follow-up. The location of SFJF was mostly on the right facet joint (P < 0.001), and the rate of SFJF increased significantly from 3 to 6months after the operation (P < 0.001). The average age of patients with SFJF was older than that of patients without SFJF (P < 0.001). There was no significant difference in Visual Analog Scale or Oswestry Disability Index scores between patients with and without SFJF. In the OLIF-LSRF procedure, SFJF occurs mostly at 3-6months postoperatively, especially in elderly patients and at the right facet joint. OLIF-LSRF has the potential for circumferential fusion.

Clinical and Radiographic Dependences of Functional Status, Indices of the Hip Joint and Femur Migration in Patients With Cerebral Palsy

Relevance. Significant incidence of hip pathology in different groups of patients with cerebral palsy and factors that may affect its formation are relevant objects of the study. The goal of the study. To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy. Materials and methods. The total number of patients was 47 persons (86 joints). We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, as well as a statistical analysis of hip parameters and factors that may have influenced their formation. Results. Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history. Conclusions. The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning of the patient’s body using our own method way can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck–shaft angle and torsion of the femur.

Status diagnosis and feature tracing of the natural gas pipeline weld based on improved random forest model

The health state of natural gas pipeline welds usually needs to be judged by experienced experts based on the results of excavation works or internal inspections. Due to the low sensitivity of internal detection method, high cost, slow speed and large amount of information of excavation work, maintenance personnel are difficult to accurately and efficiently evaluate the health status of in-service pipeline weld. This paper proposes a model based on the improved random forest for weld joint status diagnosis and feature tracing as a solution to that issue. Firstly, the raw data is cleaned and downscaled by data preprocessing, variance threshold function and correlation heat map. Then an improved random forest model based on the cross-validation is established to predict and analyze the above data. Finally, the model's scores, the features' importance scores, and scores can be acquired. And the parts of the relevant features are analyzed retroactively combined with experts' experience. The experimental results show that the improved random forest model has an average score of 0.941, which is higher than that of the support vector machine model (SVM), k-nearest neighbor classification (KNN), decision tree and random forest models, the decisions generated from the results can help maintain and exclude services of the weld joint.

The Limitations and Unmet Needs of the Five Cornerstones to Guarantee Lifelong Optimization of Prophylaxis in Hemophilia Patients.

Prophylaxis to prevent bleeding is highly recommended for hemophilia patients. The development of new drugs and tools for modeling personalized prophylaxis provides the means for people with hemophilia to lead active lives with a quality of life comparable to that of nonhemophilic individuals. The choice of regimens must be made on a highly individual basis. Unfortunately, reference guides neither always concur in their recommendations nor provide directions to cover all possible scenarios. In this review, a group of experts identify the significant limitations and unmet needs of prophylaxis, taking advantage of their clinical experience in the disease, and supported by a rigorous literature update. To perform a more systematic and comprehensive search for gaps, the main cornerstones that influence decisions regarding prophylactic patterns were first identified. Bleeding phenotype, joint status, physical activity, pharmacokinetics/medication properties, and adherence to treatment were considered as the primary mainstays that should allow physicians guiding prophylaxis to secure the best outcomes. Several challenges identified within each of these topics require urgent attention and agreement. The scores to assess severity of bleeding are not reliable, and lead to no consensus definition of severe bleeding phenotype. The joint status is to be redefined in light of new, more efficient treatments with an agreement to establish one scale as the unique reference for joint health. Further discussion is needed to establish the appropriateness of high-intensity physical activities according to patient profiles, especially because sustaining trough factor levels within the safe range is not always warranted for long periods. Importantly, many physicians do not benefit from the advantages provided by the programs based on population pharmacokinetic models to guide individualized prophylaxis through more efficient and cost-saving strategies. Finally, ensuring correct adherence to long-term treatments may be time-consuming for practitioners, who often have to encourage patients and review complex questionnaires. In summary, we identify five cornerstones that influence prophylaxis and discuss the main conflicting concerns that challenge the proper long-term management of hemophilia. A consensus exercise is warranted to provide reliable guidelines and maximize benefit from recently developed tools that should notably improve patients' quality of life.

Coronal Plane Calcaneal-Talar Orientation in Varus Ankle Osteoarthritis

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were 1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and 2) to determine if there is a TT threshold at which apparent subtalar compensation begins to fade. Methods: We retrospectively reviewed 132 ankles that underwent WBCT for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT. Results: Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status (p&lt;.001 and p=.030, respectively). The CIA of the noncompensated group varied widely, while the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel. (sensitivity, 92.6%; specificity, 89.7%). Conclusion: The position of the calcaneus has a appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is &lt; than 9.5°.

Insulation condition assessment of cable intermediate joint based topsis method with variable weight

In order to monitor the insulation deterioration of cable intermediate joint in real time, a new insulation condition evaluation method based on improved TOPSIS with variable weight is proposed. Firstly, the evaluation indicators are extracted from online monitoring signal. Next, the subjective and objective weights are combined to obtain the constant weights. Also, considering that the weights of each index may change under extreme deterioration, the variable weight theory is introduced to optimize the constant weights. Secondly, the conventional TOPSIS method is improved by adding intermediate joints with extremely good insulation and extremely severe insulation deterioration as positive and negative reference points. Finally, the proximity between the cable joint and the positive reference point are calculated, and the insulation status of cable intermediate joint is evaluated according to the interval of proximity. The case analysis shows that the improved TOPSIS method with variable weight is more accurately than the traditional TOPSIS method in assessing the insulation condition of cable intermediate joint.

An objective, automated and robust scoring using fluorescence optical imaging to evaluate changes in micro-vascularisation indicating early arthritis.

Fluorescence optical imaging technique (FOI) is a well-established and valid method for visualization of changes in micro vascularization at different organ systems. As increased vascularization is an early feature of joint inflammation, FOI is a promising method to assess arthritis of the hands. But usability of the method is limited to the assessors experience as the measurement of FOI is semi-quantitative using an individual grading system such as the fluorescence optical imaging activity score (FOIAS). The goal of the study was to automatically and thus, objectively analyze the measured fluorescence intensity generated by FOI to evaluate the amount of inflammation of each of the subject's joints focusing on the distinction between normal joint status or arthritis in psoriatic arthritis patients compared to healthy volunteers. Due to the heterogeneity of the pathophysiological perfusion of the hands, a method to overcome the absoluteness of the data by extracting heatmaps out of the image stacks is developed. To calculate a heatmap for one patient, firstly the time series for each pixel is extracted, which is then represented by a feature value. Secondly, all feature values are clustered. The calculated cluster values represent the relativity between the different pixels and enable a comparison of multiple patients. As a metric to quantify the conspicuousness of a joint a score is calculated based on the extracted cluster values. These steps are repeated for a total number of three features. With this method a tendency towards a classification into unaffected and inflamed joints can be achieved. However, further research is necessary to transform the tendency into a robust classification model.

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies.

ObjectiveTo the best of our knowledge, there has been no comparative study of changes in radiographic parameters in the sagittal plane between biplane opening wedge high tibial osteotomy (OWHTO) with plate fixation and uniplane OWHTO with spacer implantation. The aim of the study was to compare sagittal radiographs between the procedures of biplane and uniplane OWHTOs in patients with genu varum and to investigate the impact on the patellofemoral joint.MethodsA retrospective study of 71 patients (58.0 ± 5.0 years of age, 58 females and 13 males) with varus‐aligned medial compartment knee osteoarthritis treated with OWHTO was performed during the period from January 2016 to February 2019. Thirty‐three patients underwent biplane osteotomy with plate fixation (biplane group), and 38 patients underwent uniplane osteotomy with absorbable wedged spacer fixation (uniplane group). Independent t tests were used to compare the two groups according to the preoperative and postoperative radiographic parameters of hip‐knee‐ankle (HKA) angle, posterior tibial slope (PTS), tibial tubercle prominence (TTP), Caton–Deschamps (CD) index, and Blackburne–Peel (BP) index. During the last follow‐up assessment, patients were asked to rate their patellofemoral joint status using the Samsung Medical Center (SMC) patellofemoral (PF) scoring system. The visual analog scale (VAS) was also used to rate knee joint pain when walking.ResultsThere was no significant difference between the two groups in any of the demographic, clinical, or radiological characteristics at baseline (p > 0.05). Comparisons of postoperative sagittal radiographic parameters between patients in the uniplane group and patients in the biplane group showed significant differences in the PTS (13.4° vs 16.6°, t = 4.465, p < 0.001), TTP (9.0 mm vs 4.2 mm, t = 7.950, p < 0.001), and CD index (0.81 vs 0.70, t = 4.035, p < 0.001). At the final follow‐up assessment (minimum, 2 years), the SMC PF function score was significantly lower in patients in the uniplane group than in patients in the biplane group (27.8 vs. 32.1, t = 2.458, p = 0.016), but there were no significant differences in the SMC PF pain score or VAS score (p > 0.05).ConclusionThe essential difference in the postoperative sagittal radiographic changes between biplane and uniplane OWHTO was the tibial tubercle prominence, indicating the posterior displacement of the tibial tubercle. Uniplane OWHTO may yield better function of the patellofemoral joint compared to biplane OWHTO.

The value of radiosynoviorthesis for treatment of chronic synovitis in hemophilic joint disease.

Chronic synovitis is contributing to the development of arthropathy in hemophilia A and B. In most patients with severe and moderate hemophilia, during lifetime, joint damage progresses despite early prophylaxis and intense treatment with coagulation factor concentrates. Recurrent hemorrhages into the joints and subclinical bleeding lead to chronic inflammation of the synovium, neoangiogenesis and remodeling, sustaining a vicious circle of bleeding-remodeling-bleeding and progression of osteochondral damage. Imaging techniques including ultrasound and MRI are able to early visualize synovitis and osteochondral changes. Early detection and sustained therapy of synovitis are important preconditions to prevent further deterioration of joint status. Chronic synovitis requires intensified substitution of coagulation factors and concomitant analgetic, antiphlogistic and physical therapy. The value of early radiosynoviorthesis (RSO) as effective method to control ongoing synovitis is discussed here. RSO is recommended as first choice therapy in case of persistant chronic synovitis, recorded in both national and international guidelines.

Research Status and Development Prospect of Steel Truss Bridge Joints

In recent decades, with the increasing demand of long-span bridges and the continuous progress of construction technology, steel truss bridges have been more and more widely used. In general, the joint form of steel truss bridge can be divided into two types: splice joint and integral joint. The selections of the joint forms in steel truss bridges have gradually become the focus of the designers and researchers. Based on the engineering cases of steel truss bridges, this paper introduces the characteristics and advantages of the splice joint and the integral joint, respectively. The engineering performances of these two kinds of joints are compared under the same working condition. The corresponding conclusions on joint selection are obtained, and the prospect of joint design for steel truss bridges is proposed.