Joint Stiffness Research Articles

Efficient performance analysis and rapid evaluation for spot-welded stainless steel vehicles

Abstract The structural performance analysis and solder joint strength evaluation of spot-welded stainless-steel vehicles are associated with many working conditions, significant data, and repeated work. This will help researchers evaluate and improve calculation efficiency quickly. Taking the body structure of a spot-welded stainless-steel vehicle as the research object, this study conducted a finite element simulation analysis of its stiffness, static strength, mode, fatigue strength, and solder joint strength by the EN12663 standard. A rapid evaluation system for the solder joint strength was developed. The results showed that the performance of the vehicle body under various working conditions can meet the design requirements, and the evaluation results of the solder joint strength confirm the practicability and rapidity of the system, which can provide technical support for the subsequent improvement and optimization of vehicle body structures.

Clinical Outcomes of Arthroscopic Adhesiolysis: A Case Series of 40 Patients With Postoperative Knee Stiffness.

Introduction Restricted range of motion over the knee joint is a known complication following the surgical procedure. Aggressive rehabilitation protocols can initially manage knee stiffness due to arthrofibrosis. If conservative management fails, surgical (open or arthroscopic) release is the preferred modality of management. We present a series of 40 patients with postoperativeknee stiffness who were treated with arthroscopic adhesiolysis. Material and methods This is a retrospective study conducted at Phoenix Orthopedic Superspeciality Hospital, Nagpur, India, from 2017 to 2021. Our study included 40 patients with postoperative knee joint stiffness, of whom 27 were males and 13 were females. The study considered the duration of stiffness, which ranged from six months to five years. All patients underwent arthroscopic knee release. A rigorously supervised physical therapy program followed this procedure. Patients were examined at three months, six months, and one year to assess improvement in knee range of movement. Results Out of 40 patients, six were classified as Shelbourne type 4, and the remaining were Shelbourne type 3. Twenty-three of 40 patients developed arthrofibrosis following intra-articular or peri-articular fracture fixation surgery; 11 patients were operated on arthroscopically for anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction. Three patients developed stiffness following total knee replacement, one following patellectomy, and three following infection after fracture fixation. The mean pre-op knee range of motion (ROM) was 48.875 degrees. Following arthroscopic release, the mean improvement in ROM was 60 degrees intra-operatively. The average postoperative range was 108.25 degrees. Conclusion Arthroscopic adhesiolysis and quadriceps release are reliable methods for dealing with postoperative knee stiffness. It prevents wound complications and increases the chances of surgical site infection due to smaller incisions. Postoperatively, we achieved an average increase of 60 degrees in ROM over the knee joint.

Autoimmune Syndrome Induced by Adjuvants and Breast Implant Associated Anaplastic Large Cell Lymphoma: An Analysis

The Adjuvant-Induced Autoimmune/Inflammatory Syndrome is caused by humoral mediators that lead to capsular contracture and fibrosis by the oxidation that occurs in the silicone. Anaplastic Large Cell Lymphoma occurs through the development of a seroma, with the formation of periprosthetic effusion or by an infiltration of the pathology itself, causing a tumoral growth inside and outside the capsule. The development of lymphoma occurs through the formation of a subclinical biofilm, capsular contracture, recurrent trauma, genetic predisposition or autoimmune etiology. To analyze these affections, a literature review was carried out on the symptomatology and pathophysiology of the Adjuvant-Induced Autoimmune/Inflammatory Syndrome and Anaplastic Large Cell Lymphoma, which was searched using the terms “ASIA breast silicone” “Lymphoma” “Adjuvants” “Immunologic” “Breast Implants” in the platform PubMed. Analyzing the data obtained, it was noted that the symptoms of Adjuvant-Induced Autoimmune/Inflammatory Syndrome are nonspecific, such as fatigue, neurasthenia, myalgia, arthralgia, morning stiffness and night sweats, and, therefore, need attention. On the other hand, Anaplastic Large Cell Lymphoma presents with breast pain, periprosthetic effusion, palpable mass, among others. In view of these aspects, it is concluded that a good investigation must be carried out when nonspecific symptoms appear, regardless of the time the surgery was performed, since these complications can appear years after the surgery.

Wounds from sharp objects of the upper limb (About 504 Cases)

Introduction: Assaults by stabbing constitute a growing problem, leading to serious trauma to the upper limb. This study examines the characteristics, management and consequences of upper limb wounds caused by such attacks. Material and methods: This is a retrospective study of 504 cases of wounds of the upper limb caused by stabbing, collected over four years at the IBN ROCHD University Hospital in Casablanca. Data were collected from medical records and included information on injuries, surgical management, complications, and functional outcomes. Results: The lesions predominated on the left upper limb, mainly affecting the hand, wrist, and forearm. The injuries were varied, often involving tendons, nerves, muscles, bones, and vessels. Surgical management was carried out according to established principles, with specific repair techniques. Postoperative complications were common, including sensorimotor disorders, infections, and joint stiffness. Discussion: The results highlight the extent of upper limb trauma caused by stabbing attacks. The complexity of the lesions requires multidisciplinary care. Postoperative complications highlight the ongoing challenges faced by patients. In addition, the psychological consequences of aggression are significant and require special attention. Conclusion: This study highlights the importance of understanding and treating upper limb wounds caused by stabbing attacks. The results provide essential information to improve management strategies and prevent long-term complications, while highlighting the medical and psychological challenges associated with these traumas.

Heterotopic ossification following COVID-19 infections: systematic literature review of case reports and case series

BackgroundThis review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19 infection.MethodsA literature search for eligible articles was conducted using MEDLINE/Pubmed, Global Health, and Scopus databases (January 12th, 2023), including all case reports and case series from any country and language. The criteria for inclusion in this review were cases of COVID-19 infection subsequently developing heterotopic ossification.ResultsThis systematic review analysed 15 reports (n = 20 patients) documenting cases of heterotopic ossification following COVID-19 infection. 80% of the patients were male, with a median age of 59 years. All patients required intensive care unit stay with an average duration of 48.5 days. Mechanical ventilation was necessary for all patients and 30% of them underwent tracheostomy. Common symptoms included stiffness and pain, most frequently affecting multiple locations (70%), with the hips and shoulders being predominantly involved. X-rays were the most commonly used imaging modality, followed by computed tomography. Although treatment was given, some of the patients continued to experience symptoms, particularly stiffness.Conclusion20 patients who developed heterotopic ossification after COVID-19 have been reported, the majority of which had at least two independent risk factors for this condition. The link between those two clinical entities is therefore uncertain, requiring further investigation. It is nonetheless important to suspect heterotopic ossification in patients with severe COVID-19 infection, prolonged immobilisation, mechanical ventilation, who develop joint pain and stiffness, as this condition can significantly impact patients’ quality of life.Protocol registrationCRD42023393516.

Clinical characteristics and risk factors of connective tissue disease complicated with bronchiectasis and pulmonary infection.

The clinical data from 118 CTD patients with bronchiectasis were collected and categorized into two groups: pulmonary infection present (n = 67) and absent (n = 51), for comparative analysis of characteristics and risk factors. Then, we analyzed and compared their demographics, disease characteristics, and risk factors for infection. Among the whole cohort (n = 118), the incidence of pulmonary infections was 56.78%. The occurrence of rheumatoid arthritis, systemic lupus erythematosus, and vasculitis was found to be associated with an increased risk of pulmonary infection. Sputum culture identified Pseudomonas aeruginosa and Klebsiella pneumoniae as the predominant pathogens in the infected group. Notably, symptoms such as joint pains (p = 0.018) and morning stiffness (p = 0.017) were significantly more common in the infected group compared to the noninfected group. Moreover, our findings revealed that elevated levels of C-reactive protein and complement C3, along with bronchial expansion observed on high-resolution computed tomography (HRCT), were significant independent factors in the infection group. Conversely, pulmonary interstitial changes identified through HRCT (OR: 0.135, 95% CI: 0.030-0.612, p = 0.009) were significantly associated with the non-infection group. Overall, this study provides valuable insights into managing CTD patients with bronchiectasis, emphasizing early detection and tailored approaches to prevent and treat pulmonary infections for better outcomes.

Time to improvement of pain, morning stiffness, fatigue, and disease activity in patients with ankylosing spondylitis treated with tofacitinib: a post hoc analysis

BackgroundTofacitinib is an oral Janus kinase inhibitor for treatment of ankylosing spondylitis (AS). Time to improvement in core domains of AS was estimated in tofacitinib-treated patients with AS.MethodsThis post hoc analysis used phase 3 trial data from patients with AS receiving tofacitinib 5 mg twice daily or placebo to week (W)16; all patients received open-label tofacitinib W16–48. Outcomes: nocturnal pain; total back pain; fatigue, spinal pain, peripheral joint pain/swelling, enthesitis, and morning stiffness (Bath AS Disease Activity Index [BASDAI] questions 1–6); BASDAI total score; AS Disease Activity Score (ASDAS). Median time to improvement events was estimated using non-parametric Kaplan-Meier models. Improvement events were defined as initial (first post-baseline observation) and continued (sustained for 2 consecutive visits) ≥ 30% and ≥ 50% improvement in back/nocturnal pain or BASDAI questions/total scores, or ASDAS improvement ≥ 1.1 and ≥ 2.0 points.Results269 patients (tofacitinib: n = 133; placebo-to-tofacitinib: n = 136) were assessed. Median time to improvement was shorter, and more patients experienced improvements with tofacitinib vs. placebo-to-tofacitinib; differences observed from W2 (first post-baseline assessment). Median time to initial (continued) ≥ 30% pain improvement was 4 (4–8) weeks for tofacitinib vs. 24 (24) weeks for placebo-to-tofacitinib (8 [8] weeks post-switch). Median time to initial (continued) ≥ 50% improvement of pain, peripheral joint pain/swelling and enthesitis, morning stiffness, BASDAI total score, and fatigue was 8–24 (12–40) weeks with tofacitinib vs. 24–32 weeks (32 weeks–not estimable [NE]) with placebo-to-tofacitinib. Median time to initial (continued) ASDAS improvement ≥ 1.1 points was 4 (8) weeks for tofacitinib vs. 24 (24) weeks for placebo-to-tofacitinib, and NE for improvement ≥ 2.0 points with either treatment.ConclusionsImprovements in AS core domains occurred more rapidly with tofacitinib vs. placebo-to-tofacitinib. Half of tofacitinib-treated patients with AS will likely experience improvements ≥ 30% in pain and ≥ 1.1 points in ASDAS during month (M)1, ≥ 50% improvement in nocturnal pain and enthesitis by M2, and in morning stiffness by M3. Results show that initiating tofacitinib as soon as possible is associated with quicker improvements in AS core domains vs. delaying treatment.Trial registrationClinicalTrials.gov, NCT03502616, 11 April 2018.

Mechanical performance of elliptical one-sided bolted joints for T-stub and hollow section members under tension

This paper presents experimental and numerical investigations on the tensile performance of the elliptical one-sided bolted joints in building applications. Two types of joints are examined including the T-stub joints and T-hollow joints, where T-stub joints are formed by two T-stubs connected together through elliptical one-sided bolts at their flanges; and T-hollow joints are formed by two T-stubs connected to a square hollow section (SHS) member with the help of the elliptical one-sided bolts. A group of T-stub joints with ordinary bolts is also comparatively studied. Similar failure modes were observed for either elliptical one-sided or ordinary bolted joints while the yield capacity for elliptical one-sided joints was 9% lower than that of ordinary bolted joints for the T-stub joints. Parametric studies are further carried out on the key parameters such as flange thickness of the T-stubs and wall thickness of the hollow section members in the T-stub and T-hollow joints. It is found that the joint stiffness and strength can be improved with the increase of flange thickness or wall thickness for T-stub and T-hollow joints. Analytical models based on the yield line mechanisms are then presented, providing mechanism-based understanding for such elliptical one-sided joints in structural assembly. Detailed finite element (FE) models were constructed with considerations of bolt pre-tensioning and contact behaviours such as those between T-stub flange and bolt head. The deformed configurations of specimens can be successfully described by the FE modelling and the differences on initial stiffness and yield capacity between experimental and FE results are within about 10%.

Numerical Simulation Study Considering Discontinuous Longitudinal Joints in Soft Soil under Symmetric Loading

In shield tunneling, the joint is one of the most vulnerable parts of the segmental lining. Opening of the joint reduces the overall stiffness of the ring, leading to structural damage and issues such as water leakage. Currently, the Winkler method is commonly used to calculate structural deformation, simplifying the interaction between segments and soil as radial and tangential Winkler springs. However, when introducing connection springs or reduction factors to simulate the joint stiffness of segments, the challenge lies in determining the reduction coefficient and the stiffness of the springs. Currently, the hyperstatic reflection method cannot simulate the discontinuity effect at the connection of the tunnel segments, while the state space method overlooks the nonlinear interaction between the tunnel and the soil. Therefore, this paper proposes a numerical simulation method considering the interaction between the tunnel and the soil, which is subjected to compression rather than tension, and the discontinuity of the joints between the segments. The model structure and external load are symmetrical, resulting in symmetrical calculation results. This method is based on the soft soil layers and shield tunnel structures of the Shanghai Metro, and the applicability of the model is verified through deformation calculations using three-dimensional laser scanning point clouds of sections from the Shanghai Metro Line 5. When the subgrade reaction coefficient is 5000 kN/m3, the model can effectively simulate the deformation of operational tunnels. By adjusting the bending stiffness of individual connection springs, we investigate the influence of bending stiffness reduction on the bending moment, radial displacement, and rotational displacement of the ring. The results indicate that a decrease in joint bending stiffness significantly affects the mechanical response of the ring, and the extent and degree of this influence are correlated with the joint position and the magnitude of joint bending stiffness.

Impact of Surgical Timing on Functional Outcomes after Anterior Cruciate Ligament Reconstruction.

Objectives: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery time and can have a negative impact on physical function due to detraining. This study aimed to determine the effects of acute ACLR on postoperative outcomes, including muscle strength, performance, and return to sports. Methods: A total of 110 patients who underwent anatomical ACLR using hamstring autografts were included in this study and were divided into three groups: acute (ACLR performed within 2 weeks after ACL injury), 2-6 weeks (ACLR performed between 2 and 6 weeks after injury), and 6-12 weeks (ACLR performed between 6 and 12 weeks after injury). Several parameters were evaluated, including range of motion, knee joint stability, isokinetic knee strength, performance, and return to sports. Results: No significant differences were found in the range of motion or knee joint stability between the groups. The acute group exhibited significantly greater quadriceps strength at 3 months postoperatively than the other groups (p < 0.05). The single-leg hop test showed that 66.7%, 38.7%, and 33.3% of the patients in the acute, 2-6 weeks, and 6-12 weeks groups, respectively, recovered to an LSI of 90% or greater (p = 0.09, Cramer's V = 0.27). All patients in the acute group were able to return to sports (p = 0.14; Cramer's V = 0.28). Conclusions: Acute ACLR is advantageous for the early recovery of strength and performance without adverse events. Acute ACLR may shorten the time spent away from sports activities.

Semi-synthetic chondroitin sulfate CS-semi5 upregulates miR-122-5p, conferring a therapeutic effect on osteoarthritis via the p38/MMP13 pathway

Osteoarthritis (OA) is an aging-associated disease characterized by joint stiffness pain and destroyed articular cartilage. Traditional treatments for OA are limited to alleviating various OA symptoms. There is a lack of drugs available in clinical practice that can truly repair cartilage damage. Here, we developed the chondroitin sulfate analog CS-semi5, semi-synthesized from chondroitin sulfate A. In vivo, CS-semi5 alleviated inflammation, provided analgesic effects, and protected cartilage in the modified Hulth OA rat model and papain-induced OA rat model. A bioinformatics analysis was performed on samples from OA patients and an exosome analysis on papain-induced OA rats, revealing miR-122-5p as the key regulator associated with CS-semi5 in OA treatment. Binding prediction revealed that miR-122-5p acted on the 3′-untranslated region of p38 mitogen-activated protein kinase, which was related to MMP13 regulation. Subsequent in vitro experiments revealed that CS-semi5 effectively reduced cartilage degeneration and maintained matrix homeostasis by inhibiting matrix breakdown through the miR-122-5p/p38/MMP13 axis, which was further validated in the articular cartilage of OA rats. This is the first study to investigate the semi-synthesized chondroitin sulfate CS-semi5, revealing its cartilage-protecting, anti-inflammatory, and analgesic properties that show promising therapeutic effects in OA via the miR-122-5p/p38/MMP13 pathway.

EARLY MOTION AND DIRECTED EXERCISE (EMADE) VERSUS USUAL-CARE POST-ANKLE FRACTURE FIXATION: 12- AND 24-WEEK RESULTS FROM A PRAGMATIC RANDOMIZED CONTROLLED TRIAL

EARLY MOTION AND DIRECTED EXERCISE (EMADE) VERSUS USUAL-CARE POST-ANKLE FRACTURE FIXATION: 12- AND 24-WEEK RESULTS FROM A PRAGMATIC RANDOMIZED CONTROLLED TRIAL

Our Experience with Primary Trapeziometacarpal Implant Arthroplasty in Severely Comminuted Rolando Fractures

Abstract Background The concept of primary joint replacement in severely comminuted fractures in elderly patients has proven to be a suitable treatment option in the shoulder, elbow and knee joint. Comminuted intra-articular fractures of the first metacarpal base can pose significant technical challenges, and no established gold standard treatment currently exists. Conventional methods like open reduction and internal fixation or external fixation are commonly employed, emphasizing the importance of anatomical reduction for restoring the articular surface. However, achieving articular surface congruity is often unattainable in severely comminuted intra-articular fractures, leading to short-term joint stiffness and instability, as well as long-term complications like secondary osteoarthritis. Aims This case report aims to share our experience with the use of primary trapeziometacarpal implant arthroplasty in the treatment of two patients with severely comminuted Rolando fractures. Methods In two cases of comminuted Rolando fractures, a primary trapeziometacarpal prosthesis (MAÏA™) was implanted based on preoperative decision-making facilitated by 3D-CT analysis. Patient’s visual analogue score for pain, range of motion, pinch and grip strength compared to the contralateral side were asked and examined. Results Both patients exhibited successful adaptation to their daily routines within a three-month postoperative period. No complications, such as cup or stem loosening or dislocation, were identified. Both patients almost reached equal range of motion, pinch and grip strength compared to the contralateral side. Conclusion The use of primary trapeziometacarpal implant arthroplasty seems to be a viable alternative for managing severely comminuted Rolando fractures, particularly in elderly patients and those with pre-existing osteoarthritis. This approach offers promising outcomes. Studies with other implant arthroplasties have shown better outcomes in patients treated primarily, than after several failed surgeries. We suggest the same is true for the trapeziometacarpal joint. Further studies are necessary to validate the efficacy of this intervention in a larger cohort of patients.

Expanding the ABCC-tool for osteoarthritis: Development and content validation

ObjectiveOsteoarthritis (OA) care should be more person-centered based on physical, emotional and social aspects, instead of the current stepped-care approach solely based on physical symptoms, according to OA patients. By developing a novel module for OA in the Assessment of Burden of Chronic Condition (ABCC)-tool, a tool based on these three aspects, experienced quality of OA care and shared-decision making are expected to improve. DesignThe development of the novel OA module involved a triangular iterative process, interviewing OA patients and healthcare professionals in the field of OA, an expert panel and a literature search to identify the needs to improve OA care. Patients provided feedback on the first version of the OA module, leading to a second version. This second version was used to evaluate content validity. OA patients and healthcare professionals in the field of OA were asked to evaluate relevance, comprehensiveness and comprehensibility, based on the COSMIN methodology. For healthcare professionals, the item-content validity index (I-CVI) was calculated. ResultsThe module includes questions about pain, kinesiophobia and joint stiffness. For all three questions, 94% of the patients found these questions important for patients with OA. The I-CVI scores of the healthcare professionals ranged from 1.0 (pain, kinesiophobia) to 0.75 (joint stiffness). ConclusionA novel, condition-specific OA module is developed for the ABCC-tool, as a supplement to the generic questions. The module includes three questions, to measure OA specific complaints. This novel module is intended to make the ABCC-tool more elaborate and useable for a larger population.

Influence of joint types on rigidity of Chebyshev elastic gridshells: A parametric analysis

Elastic gridshells (EGS) have many applications in the field of architecture. Built according to Chebyshev net geometry, the Chebyshev EGS (CGES) is a famous kind of EGS; since an arbitrary three-dimensional CEGS can be transformed into a planar state without any stretching strain. Due to its tremendous potential application in novelly deployed structures, the rigidity of CEGS is an important mechanical property to be investigated.In this study, using the analytical and finite element methods, the influence of joint types and gridshell parameters on the rigidity of CEGS subjected to point loads is studied in detail. The joint types are classified as pin joints, semi-rigidity joints, and rigid joints. A robust relation between rigidity and gridshell parameters is proposed, including Young's modulus, rod diameter, size of CEGS, joint stiffness, and rod numbers. Further, the above relation is nondimensionalized. The dimensionless rigidity is only related to the two dimensionless parameters, which are dimensionless joint stiffness and rod number. The rigidities of CEGS on four types of surfaces are calculated to verify the above relation, and satisfactory agreement is obtained. Therefore, the proposed relationship of rigidity is confirmed to be accurate and efficient for a wide range of parameters.

Effect of age on ankle biomechanics and tibial compression during stair descent

BackgroundStress fracture is a concern among older adults, as age-related decrements in ankle neuromuscular function may impair their ability to attenuate tibial compressive forces experienced during daily locomotor tasks, such as stair descent. Yet, it is unknown if older adults exhibit greater tibial compression than their younger counterparts when descending stairs. Research questionDo older adults exhibit differences in ankle biomechanics that alter their tibial compression during stair descent compared to young adults, and is there a relation between tibial compression and specific changes in ankle biomechanics? MethodsThirteen young (18–25 years) and 13 older (> 65 years) adults had ankle joint biomechanics and tibial compression quantified during a stair descent. Discrete ankle biomechanics (peak joint angle and moment, and joint stiffness) and tibial compression (maximum and impulse) measures were submitted to an independent t-test, while ankle joint angle and moment, and tibial compression waveforms were submitted to an independent statistical parametric mapping t-test to determine group differences. Pearson correlation coefficients (r) determined the relation between discrete ankle biomechanics and tibial compression measures for all participants, and each group. ResultsOlder adults exhibited smaller maximum tibial compression (p = 0.004) from decreases in peak ankle joint angle and moment between 17 % and 34 % (p = 0.035), and 20–31 % of stance (p < 0.001) than young adults. Ankle biomechanics exhibited a negligible to weak correlation with tibial compression for all participants, with peak ankle joint moment and maximum tibial compression (r = -0.48 ± 0.32) relation the strongest. Older adults typically exhibited a stronger relation between ankle biomechanics and tibial compression (e.g., r = -0.48 ± 0.47 vs r = -0.27 ± 0.52 between peak ankle joint moment and maximum tibial compression). SignificanceOlder adults altered ankle biomechanics and decreased maximum tibial compression to safely execute the stair descent. Yet, specific alterations in ankle biomechanics could not be identified as a predictor of changes in tibial compression.

Prospective phase II trial of preoperative hypofractionated proton therapy for extremity and truncal soft tissue sarcoma: the PRONTO study rationale and design

BackgroundOncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma.MethodsOur study titled “PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)” is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2–12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response.DiscussionPRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting.Trial registration: NCT05917301 (registered 23/6/2023).

Home exercise is considered essential, but patient compliance remains a mystery

BackgroundRegular exercise is essential in the treatment of Ankylosing Spondylitis (AS), as the main goals of the treatment are to reduce pain, restore function, avoid disability and structural deterioration, and improve quality of life (QoL). The purpose of this study is to ascertain whether patients adhere to exercise recommendations and to evaluate the effects of consistent exercise on patients' pain, function, disease activity, mood, and quality of life. Many studies emphasize the need for exercise in treatment of AS, but none reveal whether patients follow prescribed practices and the results of doing so.ResultsExercising group had significantly decreased pain, erythrocyte sedimentation rate and Bath ankylosing spondylitis functional index and Bath ankylosing spondylitis disease activity index (BASDAI) scores (p < 0.05). There was no significant difference between the two groups in morning stiffness, mood, spinal mobility, and QoL parameters (p > 0.05). Regular exercise was positively correlated with physiotherapy history. Regression analysis revealed that with an increase of 1 unit in visual analog scale and BASDAI, regular exercise decreased by 0.087 and 0.116 units, respectively.ConclusionOur study revealed how much the patients considers and follows the recommended exercises and concluded that regular exercise habits should be developed since they offer promising effects in treatment of AS, hence, patients should be educated in this area, and particular exercise routines should be developed to encourage them to exercise.

Static behavior of stiffened CFST KK joints of offshore wind turbines under antisymmetric loading

This study examines the static behavior of the critical joints of the new kind of offshore jacket foundations under antisymmetric loading by employing a combination of experiments, finite element analysis (FEA), and theoretical derivation. Three tests and 35 FEAs of stiffened concrete-filled steel tubular (CFST) KK joints are described. The introduction of a novel perfobond ring rib (PRB) as a stiffener, along with using a limiting fixture during loading to consider interactions among the four braces, are novelties of this research. Experiments compare the influence of stiffener rib forms (PRB and Perfobond Leister Ribs (PBL)) on the behavior of CFST KK joints, highlighting the superiority of PRB strengthening. However, the influence of the stiffener rib form on the stiffness of the CFST KK joints can be ignored. The properties of PRB-stiffened CFST KK joints are further investigated via validated FEA models, which introduce the modified Mohr-Coulomb (MMC) criterion to realize steel fracture damage. A parametric analysis is then undertaken to explore how variations in the joint's geometrical parameters, chord material strength, and thickness and quantity of the PRBs influence the punching shear capacity of PRB-stiffened CFST KK joints. Furthermore, a formula is presented for punching shear strength in PRB-stiffened CFST KK joints by employing the superposition method. Its predictions align well with both experimental and FEA results.

Experimental and numerical analysis on the post-fire flexural behavior of aluminum alloy gusset joints

Regarding the damage incurred by aluminum alloy latticed shells under fire loads, a crucial aspect in assessing structural integrity is examining the residual bearing capacity of aluminum alloy gusset (AAG) joints. Consequently, this paper conducted experimental and numerical analyses on the post-fire flexural behavior of AAG joints. Initially, twelve AAG joints underwent post-fire tests, revealing that the failure patterns differed between thin-plate joints (exhibiting block tearing of gusset plates) and thick-plate joints (exhibiting member buckling). Notably, the initial stiffness approximately remained constant, while a trilinear relationship emerged between the ultimate flexural bearing capacity and the maximum post-fire temperature. Subsequently, finite element (FE) analysis was carried out, and the accuracy of FE models was verified by comparing the FE results with the test results. A comprehensive parametric analysis, considering various plate thicknesses, post-fire temperatures, and aluminum alloy brands, was then conducted. Ultimately, employing statistical regression, theoretical equations were formulated to estimate both bending stiffness and bearing capacity for AAG joints after exposure to fire.