Major Joint Research Articles

725 Case Series: New Porcine Placental ECM for Burn Injuries

IntroductionHuman amniotic membrane (HAM) has been used as a biologic dressing for burn wounds since 1955 but limited due to availability, size, and processing costs. In 2021 a new porcine placental product was FDA-approved overcoming challenges with human-sourced products. Our study is the first case series to report outcomes using porcine placental extracellular matrix (PPECM) in the use of adult burn patients.MethodsAdults with thermal burns resulting in partial-thickness burn wounds (PTBW) were consented and included in the study from 03/2021 to 09/2021. Patients with full-thickness injures, concomitant trauma, or adverse beliefs to porcine products were not included in the study. Serial still images and initial wound measurements were obtained intraoperatively and post-operatively. PPECM trial product processed with a proprietary decellularization method to produce single sheets up to 15x20cm was approved by the facility value assessment committee. Adverse events were defined a priori as infection, increased pain or itching relative to adjacent autografts, or failure to heal. Infection was defined as a PPECM treatment site requiring any change from standard of care or initiation of local or systemic antibiotics. Pain was assessed using a visual analogue scale. Itching was assessed at discharge and follow-up. Healing was assessed using the FDA guidance for wound closure with 2 consecutive visits 2 weeks apart demonstrating 100% epithelialization without drainage or dressing requirements.ResultsFour patients were treated during the study period with wounds involving the torso and major joints such as the hands/wrists and knees. None of the PPECM wounds demonstrated failure to heal or required revision excision, or autograft. None of the PPECM wounds had evidence of infection. PPECM wounds had decreased pain/itching relative to adjacent burn wounds which were treated with split-thickness autograft, autologous skin cell suspension, or allogeneic cultured skin substitute (VAS mean 1 vs 3.1). Healing was noted in all wounds at 1-week primary dressing removal with confirmation at 2-week interval follow-up.ConclusionsPPECM treatment of PTBW was not associated with adverse events and resulted in favorable outcomes clinically. The large size, ease of use, and lower costs relative to HAM is an intriguing alternative for PTBW. Comparative studies are needed in the field to determine best practices and overall value.

747 Standardization of Upper Extremity Elevation

IntroductionElevation of burn-injured extremities is crucial to preserve function, prevent contracture and scar formation. Limited data leading to various techniques utilized across burn centers has resulted in no local, national, or international standard of practice. The absence of standardized documentation of these interventions prevents data tracking and outcome analysis.MethodsA literature review was conducted to assess the various methods of upper extremity elevation in burn patients. A request was sent to ABA verified burn centers to collect feedback on elevation practices. The interdisciplinary team was consulted for their professional expertise and opinion. The unit practice council reviewed all data to establish a standard of practice for upper extremity elevation. A procedure was written explaining the purpose, proper implementation, and potential complications. Documentation in the electronic medical record (EMR) was updated to reflect the practice change. Education will be disseminated to bedside staff. Return demonstration will be required, completed with a trained validator to ensure staff competency. Data will be collected and analyzed through EMR audits.ResultsInformation gathered via literature review proves there is inconsistent practice of upper extremity elevation post-burn injury. ABA verified burn center survey results support the current literature findings, and the importance elevation plays in preserving function and quality of life in burn survivors.ConclusionsUpper extremities are frequently impacted by burn injury, potentially resulting in significant disability. A common physical complication of burn injury is contracture of major joints, leading to further surgical intervention and/or permanent disability. Standardizing the practice of upper extremity elevation has the potential to preserve joint function and range-of-motion. A procedure has been written and published hospital-wide. Staff compliance and documentation audits will assist in evaluating the efficacy of the upper extremity elevation. Barriers to optimal outcomes include staff compliance, documentation inconsistencies, and limited sample size.

The Risk of Bleeding and Adverse Events with Clopidogrel in Elective Hip and Knee Arthroplasty Patients.

Orthopedic surgeons often face a clinical dilemma on how to manage antiplatelet therapies during the time of surgery. This retrospective study is aimed to investigate the bleeding risk and adverse events in patients who hold or keep clopidogrel during elective major joints arthroplasty. Two hundred and ninety-six patients that were treated with clopidogrel while undergoing total hip or knee joint replacement between January 2009 and December 2018 were studied. Group 1 included 56 patients (18.9%) who kept using clopidogrel preoperatively. Group 2 included 240 patients who hold clopidogrel use ≥5 days preoperatively. Blood transfusion rates, estimated blood loss, complication rates, and adverse cardiocerebral events were collected and analyzed. The mean total blood loss was more in the group 1 patients as compared with that in the group 2 patients (1212.3 mL (685.8 to 2811.8) vs. 1068.9 mL (495.6 to 3294.3), p = 0.03). However, there was no significant difference between the two groups of patients regarding transfusion rates, bleeding-related complications, and infection rates. There was a trend toward a higher incidence of adverse cardiocerebral events in patients withholding clopidogrel for more than 5 days before surgery. The results of this study suggest that clopidogrel continuation could be safe and advisable for patients at thrombotic risk undergoing primary major joint replacement. Acute antiplatelet withdrawal for an extended period of time might be associated with an increased risk of postoperative thromboembolic events. More studies are required in the future to further prove this suggestion.

Could sea wave-like sign be used in the diagnosis of adult simple elbow dislocations?

Purpose: The elbow is the second most dislocated major joint in adults. This study aimed to evaluate the reliability of the use of ‘sea wave-like sign’ in adult simple elbow dislocation. Methods: The study included 12 randomly selected adults with simple elbow dislocation cases. All patients were evaluated with pre-reduction and post-reduction radiographs. The definitive diagnosis of reduction was made with post-reduction CT. Evaluations were performed by five orthopedic residents (Group I), five orthopedic specialists with less than 10 years of professional experience (Group II), and five orthopedic specialists with more than 10 years of professional experience (Group III). They were requested to fill out a questionnaire including the reduction and ‘sea wave-like sign’. Results: The specificity of the sea wave-like sign on radiography was 96.6% and the positive predictive value of this evaluation was 99.1%. There were statistically significant differences between the groups in terms of evaluation of the reduction of the elbow joint. The correct response rates in young specialists were significantly lower than the other two groups (p<0.05). There were no statistically significant differences between the groups in terms of evaluation of the presence of ‘sea wave-like sign’ (p=0.266). Conclusion: Sea wave-like sign could be used for adult simple elbow dislocation. The ‘sea wave-like sign’ could reduce the need for CT in a simple elbow dislocation.

A Robotic Test Rig for Performance Assessment of Prosthetic Joints.

Movement within the human body is made possible by joints connecting two or more elements of the musculoskeletal system. Losing one or more of these connections can seriously limit mobility, which in turn can lead to depression and other mental issues. This is particularly pertinent due to a dramatic increase in the number of lower limb amputations resulting from trauma and diseases such as diabetes. The ideal prostheses should re-establish the functions and movement of the missing body part of the patient. As a result, the prosthetic solution has to be tested stringently to ensure effective and reliable usage. This paper elaborates on the development, features, and suitability of a testing rig that can evaluate the performance of prosthetic and robotic joints via cyclic dynamic loading on their complex movements. To establish the rig’s validity, the knee joint was chosen as it provides both compound support and movement, making it one of the major joints within the human body, and an excellent subject to ensure the quality of the prosthesis. Within the rig system, a motorised lead-screw simulates the actuation provided by the hamstring-quadricep antagonist muscle pair and the flexion experienced by the joint. Loads and position are monitored by a load cell and proximity sensors respectively, ensuring the dynamics conform with the geometric model and gait analysis. Background: Robotics, Prosthetics, Mechatronics, Assisted Living. Methods: Gait Analysis, Computer Aided Design, Geometry Models. Conclusion: Modular Device, Streamlining Rehabilitation.

Limb salvage surgery with endoprosthesis reconstruction in management of locally advanced primary bone tumours: a functional outcome evaluation

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endoprosthetic reconstruction using a custom-made metallic mega-endoprosthesis is one of the common modalities for limb salvage operation. The new promising advance of material science, design and fabrication of the endoprosthesis enable an immediate rehabilitation program and provide a durable and functional limb. The aim of the study was to evaluate the efficacy and functional outcome in patients with primary bone tumours treated by limb salvage surgery using endoprosthetic replacement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 14 patients with primary bone tumour in major large joints of the body, selected between January 2019 to August 2020, were managed by limb salvage surgery via endoprosthetic replacement. This was a prospective study conducted at a Tertiary care Government Hospital in Kolkata, and all patients were followed up to a minimum of 1.5 years. The evaluation system used was proposed by Enneking, recommended by the musculoskeletal tumour society in addition to the radiologic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At final follow-up, the mean musculoskeletal tumour society score was 89.71±3.58. The mean Knee Society Score of 9 patients was 85.55±3.64 and mean Harris hip score of 2 patients and Oxford shoulder score of 4 patients were 90.5 and 41.67 respectively by the end of 1.5 years. 12 (85.7%) patients did not have any complications. None of the cases had implant loosening or breakage, periprosthetic fracture, tumour recurrence or amputation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Endoprosthesis are excellent choices for the treatment of bone tumours with limb preservation in relation to pain, strength, and patient’s emotional acceptance as they reconstruct a limb with an acceptable oncologic, functional, and cosmetic result providing immediate weight-bearing capacity and generating a greater independence.&lt;/p&gt;

Hydration Lubrication in Biomedical Applications: From Cartilage to Hydrogels.

ConspectusIn the course of evolution, nature has achieved remarkably lubricated surfaces, with healthy articular cartilage in the major (synovial) joints being the prime example, that can last a lifetime as they slide past each other with ultralow friction (friction coefficient μ = the force to slide surfaces past each other/load compressing the surfaces < 0.01) under physiological pressures (up to 10 MPa or more)). Such properties are unmatched by any man-made materials. The precise mechanism of low friction between such sliding cartilage tissues, which is closely related to osteoarthritis (OA), the most widespread joint disease, affecting hundreds of millions worldwide, has been studied for nearly a century, but is still not fully understood. Traditionally, the roles of load bearing by interstitial fluid within the cartilage bulk and that of thin exuded fluid films at the interface between the sliding cartilage surfaces have been proposed as the main lubrication mechanism. More recent work, however, suggests that molecular boundary layers at the surfaces of articular cartilage and other tissues play a major role in their lubrication. In particular, in recent years hydration lubrication has emerged as a new paradigm for boundary lubrication in aqueous media based on subnanometer hydration shells which massively reduce frictional dissipation. The vectors of hydration lubrication include trapped hydrated ions, hydrated surfactants, biological macromolecules, biomimetic polymers, polyelectrolytes and polyzwitterionic brushes, and close-packed layers of phosphatidylcholine (PC) vesicles, all having in common the exposure of highly hydrated groups at the slip plane. Among them, vesicles (or bilayers) of PC lipids, which are the most widespread lipid class in mammals, are exceptionally efficient lubricating elements as a result of the high hydration of the phosphocholine headgroups they expose. Such lipids are ubiquitous in joints, leading to the proposal that macromolecular surface complexes exposing PC bilayers are responsible for the remarkable lubrication of cartilage. Cartilage, comprising ∼70% water, may be considered to be a complex biological hydrogel, and studying the frictional properties of hydrogels may thus provide new insights into its lubrication mechanisms, leading in turn to novel, highly lubricious hydrogels that may be used in a variety of biomedical and other applications. A better understanding of cartilage lubrication could moreover lead to better treatments for OA, for example, through intra-articular injections of appropriate lubricants or through the creation of low-friction hydrogels that may be used as tissue engineering scaffolds for diseased cartilage.In this Account, we begin by introducing the concept and origin of hydration lubrication, extending from the seminal study of lubrication by hydrated simple ions to more complex systems. We then briefly review different modes of lubrication in synovial joints, focusing primarily on boundary lubrication. We consider modes of hydrogel lubrication and different kinds of such low-friction synthetic gels and then focus on cartilage-inspired, boundary-lubricated hydrogels. We conclude by discussing challenges and opportunities.

Impact of TheraNow Telehealth Physical Therapy Program on Hospital Readmission Rate Post Major Joint Replacement Surgery

Background: Hip and knee replacement are two of the most commonly performed major joint replacement surgeries in orthopedic surgery. Both procedures successfully eliminate pain, correct the deformity, and improve patient mobility to regain quality of life and perform daily life activities. Rehabilitation and recovery are crucial during the 12 weeks following any major joint replacement surgery. Most people are discharged from the hospital 2–3 days after surgery to continue rehabilitation. Specific exercises aim to improve the joint’s mobility, improve strength and restore patient function.&#x0D; The primary cause of hospital readmissions after major joint replacement is infection and can hinder the patient’s functional recovery. Therefore, a comprehensive program is essential to reduce infections and promote recovery. The virtual rehabilitation program is an evolving approach to optimize care and compliance. One such program is the TheraNow telehealth physical therapy program. TheraNow integrates artificial intelligence-powered tools and highly trained physical therapists in a care-navigation platform specially designed for rehabilitation after major joint replacement surgery. The objective of this study was to evaluate the impact of the TheraNow Telehealth Physical Therapy program on patient rehabilitation and hospital readmission rate following major joint replacement surgery.&#x0D; Materials and Methods: Forty patients participated in this particular post-joint replacement virtual rehabilitation program on TheraNow application for an online and in-home physical therapy program. The program incorporated three phases of rehabilitation: pre-rehabilitation, post-surgical rehabilitation, and functional rehabilitation. A licensed physical therapist evaluated the patient via a synchronous video conferencing visit, at which time the Physical Therapist developed a customized program for each patient. Every patient booked appointment according to their own choices of time slots, and the same licensed physical therapists administered the entire program from start to finish for each patient. Physical Therapists provided customized therapy to every patient with a duration of 45-60 minutes of the personalized session. In addition, this study tracked and identified all hospital readmissions within 30 days of discharge from the patients’ medical records.&#x0D; Results: The overall mean age of the study population was 65.20+8.41. Out of the 40 enrolled patients, 3 (7.50%) are 41-50 years old, while the majority (42.5%) belonged to 61-70 years of age followed by 71-80 years (27.5%) and 51-60 years (22.5%). 23 (57.5%) were female, while 17 (42.5%) were males. Only one re-admission happened due to surgical site infection in the first 30 days after the surgery under the program brought the readmission rate to 2.5%.&#x0D; Conclusion: The study reported lower hospital readmission rate after major joint replacement surgeries. The TheraNow Telehealth Physical Therapy program reported a 2.5% readmission rate in the first 30 days of the physical therapy program for major joint replacement surgeries as compared to the previous literature where they have reported hospital readmission rate of 3.3%- 5.6% in 30 days post-surgical follow-up.

Regeneration of Jaw Joint Cartilage in Adult Zebrafish.

The poor intrinsic repair capacity of mammalian joint cartilage likely contributes to the high incidence of arthritis worldwide. Adult zebrafish can regenerate many structures that show limited or no healing capacity in mammals, including the jawbone. To test whether zebrafish can also regenerate damaged joints, we developed a surgical injury model in which the zebrafish jaw joint is destabilized via transection of the major jaw joint ligament, the interopercular–mandibular (IOM). Unilateral transection of the IOM ligament in 1-year-old fish resulted in an initial reduction of jaw joint cartilage by 14 days, with full regeneration of joint cartilage by 28 days. Joint cartilage regeneration involves the re-entry of articular chondrocytes into the cell cycle and the upregulated expression of sox10, a marker of developing chondrocytes in the embryo that becomes restricted to a subset of joint chondrocytes in adults. Genetic ablation of these sox10-expressing chondrocytes shows that they are essential for joint cartilage regeneration. To uncover the potential source of new chondrocytes during joint regeneration, we performed single-cell RNA sequencing of the uninjured adult jaw joint and identified multiple skeletal, connective tissue, and fibroblast subtypes. In particular, we uncovered a joint-specific periosteal population expressing coch and grem1a, with the jaw joint chondrocytes marked by grem1a expression during regeneration. Our findings demonstrate the capacity of zebrafish to regenerate adult joint cartilage and identify candidate cell types that can be tested for their roles in regenerative response.

Imaging Findings of Knee Trauma on Magnetic Resonance Imaging

Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Ligament (LCL) tears and grade 2 tears were more common in both. Among the meniscal injuries Medial Meniscus (MM) tears were more common than LM and grade 3 signal was more common in both. Most of the patellar retinaculum injuries were associated with Anterior Cruciate Ligament ACL tears.Conclusions:Post-traumatic pre-arthroscopic MR imaging evaluation has proved to be cost-effective. MRI is an accurate imaging modality complementing the clinical evaluation and providing a global intra-articular and extra-articular assessment of the knee.

Predictors of FabAV use in copperhead envenomation

Context Crotaline snake envenomation is a serious medical condition affecting thousands of Americans each year. Variation in the treatment of Crotaline snakebites exists among physicians in the United States. Management of copperhead snakebites is controversial with some experts advocating minimal intervention, rarely necessitating antivenom use and, even more rarely, surgical intervention. This study assessed the use of Crotaline Polyvalent Immune Fab antivenom (Ovine) (FabAV) and explored factors influencing the decision to prescribe antivenom for copperhead envenomation in patients in Northeastern Oklahoma. Methods A retrospective cohort study examining electronic medical records of patients with copperhead snakebites from July 1, 2014 to August 31, 2019. Data collected included: patient demographics, transfer information, snake species, bite site, progression of local tissue effects, additional clinical and lab results, patient comorbidities, and treatment strategy. Associations between patient variables and treatment were evaluated using the chi-square test of independence, median test, and logistic regression analysis. Associations were statistically significant if p < 0.05. Discussion Of the 130 patients bitten by a copperhead, a majority (75%) received FabAV. Symptoms of copperhead envenomation were mostly limited to the progression of tissue damage. Predictors of treatment with FabAV included progression of venom effects across major joints, younger age, comorbidities, and upper extremity bites. Conclusions Patients who have multiple comorbidities, upper extremity bites and progression of venom effects across major joints are more likely to be treated with FabAV. The high usage of FabAV at the study site underscores the need for continued work to optimize the use of antivenom for copperhead envenomations.

Assessment of gestational age by new-born joint angles

Objective: We aimed to measure the joint angles of major joints in newborn babies to explore their association with gestational age (GA). Materials and Methods: This observational study was conducted to evaluate joint angles in healthy newborn infants, born between 28 and 41 completed weeks of gestation. Healthy and hemodynamically stable babies were selected by purposive sampling up to the 2nd day of life. Six major joints of upper and lower limbs (shoulder, elbow, wrist, hip, knee, and ankle) were assessed on either side. The joint angles and range of motion (ROM) achieved through predefined passive movements were measured by a single observer using a manual acrylic goniometer. The positioning of the joints during measurement was standardized. Results: A total of 433 newborn babies, belonging to different GA, were evaluated. The joint angles and ROM did not show any significant differences between right and left sides and between male and female babies. The ROM of flexion-extension and adduction-abduction movement at shoulder, angle of palmer-flexion at wrist, and angle of dorsiflexion at ankle, were observed to correlate strongly with GA (correlation coefficient r of –0.75, –0.74, –0.73, and –0.73, respectively). The relationships were inverse. A mathematical model based upon multiple regression analysis is proposed to predict GA from these four measurements. Conclusions: Structured clinical assessment of major joint angles in newborn babies has the potential to provide relatively precise estimation of GA, which may be used to add accuracy to modified New Ballard Score.

An early presentation of osteochondroma: a rare case

The most prevalent benign bone tumor, osteochondroma, accounts for 30 to 35% of all benign bone tumors. It most frequently affects teenagers and young adults, with a 1-in-50,000 incidence rate. Osteochondroma only has a 1% chance of developing into a malignant condition like chondrosarcoma. Osteochondroma has an autosomal dominant pattern, and prehypertrophic chondrocytes in the growth plate are affected by the EXT gene mutation. Osteochondroma patients typically have their knee joint affected and typically report painless swelling around major joints. These swellings result from the long bone´s metaphysis´s excessive development of cartilage and bone. This swelling could result in mechanical symptoms like compression of the neurovascular system. The mother of a 3-year-old kid brought him to the orthopaedics outpatient department with complaints of painless swelling in the right wrist, left scapula, and left ankle that had been reported two months prior. Her 5-year-old sibling has a similar, painless swelling that is only modest in size. The patient is being handled conservatively and recommended to keep regular follow-ups every three months because they currently have no additional complaints. The state and prognosis of the disease have been disclosed to the patient´s parents. Operative management needs to wait till the skeleton is fully developed.

Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis

Ulcerative colitis (UC) is an immune-mediated disease; the intestine contains an enormous colitis antigenic load derived from the food and microbial flora. There appear to be four main factors which influence the disease: host genetic susceptibility, a dysregulated immune response, impairment of intestinal epithelial barrier function, and environmental factors. According to Ayurveda, it may be correlated with Raktatisara, which is mentioned as advanced stages of Pittatisara with similar signs and symptoms. A 19-year-old female patient was diagnosed with UC in May 2018, with the complaints of frequent defecation of stool mixed with blood and pain in the abdomen. She consulted allopathic physician and where the patient was diagnosed with UC through sigmoidoscopy, colonoscopy, and biopsy. The patient was on conservative treatment for 2 months. The patient gradually developed the following symptoms like bilateral pain in all major and minor joints, hair loss, reddish discoloration on both medial aspect of thigh and hips. After getting no relief, the patient visited outpatient department of AllA, Sarita Vihar, New Delhi. The patient was admitted to the inpatient department of AIIA hospital. After the 41 days of treatment, stool examination shows no occult blood in stool, followed by 2 months follow-up and the patient got 80% relief in all the signs and symptoms. Piccha Basti along with oral medicines is highly effective in the management of Raktatisara. This case report highlights the efficacy of Piccha basti and immune enhancer medicines in the management of UC and provide a better pathway for this disease.

Gravity-Dependent Animacy Perception in Zebrafish.

Biological motion (BM), depicted by a handful of point lights attached to the major joints, conveys rich animacy information, which is significantly disrupted if BM is shown upside down. This well-known inversion effect in BM perception is conserved in terrestrial vertebrates and is presumably a manifestation of an evolutionarily endowed perceptual filter (i.e., life motion detector) tuned to gravity-compatible BM. However, it remains unknown whether aquatic animals, living in a completely different environment from terrestrial animals, perceive BM in a gravity-dependent manner. Here, taking advantage of their typical shoaling behaviors, we used zebrafish as a model animal to examine the ability of teleosts to discriminate between upright (gravity-compatible) and inverted (gravity-incompatible) BM signals. We recorded their swimming trajectories and quantified their preference based on dwelling time and head orientation. The results obtained from three experiments consistently showed that zebrafish spent significantly more time swimming in proximity to and orienting towards the upright BM relative to the inverted BM or other gravity-incompatible point-light stimuli (i.e., the non-BM). More intriguingly, when the recorded point-light video clips of fish were directly compared with those of human walkers and pigeons, we could identify a unique and consistent pattern of accelerating movements in the vertical (gravity) direction. These findings, to our knowledge, demonstrate for the first time the inversion effect in BM perception in simple aquatic vertebrates and suggest that the evolutionary origin of gravity-dependent BM processing may be traced back to ancient aquatic animals.

МЕЖДУНАРОДНАЯ НАУЧНАЯ КОНФЕРЕНЦИЯ «ИСЛАМСКАЯ РЕСПУБЛИКА ПАКИСТАН: ПРОБЛЕМЫ И ПЕРСПЕКТИВЫ РАЗВИТИЯ (К 75-ЛЕТИЮ НЕЗАВИСИМОСТИ)»

This article is a review of the International conference «The Islamic Republic of Pakistan: Problems and Prospects of Development (on the 75th Anniversary of Independence)». The event was held on September 26, 2022 at the Institute of Oriental Studies of the Russian Academy of Sciences in a mixed part-time format by using the Zoom platform. Speeches and reports of numerous International conference participants, presented by the Head and staff of the Pakistani and Russian diplomatic missions in Moscow and Islamabad respectively, members of a high-ranking delegation of Pakistani Senators, as well as of Heads, staff, senior and junior scholars of leading Russian and Pakistani analytical centers, institutes and various institutions, covered a wide range issues on Pakistan studies. Besides the official greetings and addresses by Honorable Guests of this International forum, the conference program also reflected relevant studies of domestic and Pakistani scholars on Pakistan national statehood building, its current inner political, socio-economic problems, the main directions of this country foreign policy at the global and regional level, including the possibilities of enhancing Pakistan-Russia relations on bilateral and multilateral cooperation with the geographically close states in the vector of Eurasian integration by means of major joint investment projects implementation. Much attention at the conference was paid to the necessity of the socio-cultural communication formation between the Russian and Pakistani peoples for the increase of their mutual understanding and convergence. A separate remarkable event was devoted to this issue within the framework of the International conference, which took place at the Eastern Cultural Center of the IOS RAS. It was connected with the presentation of the Three–volume «Encyclopedia of Muhammad Iqbal’ (in Urdu) and the solemn ceremony of its donation to the Institute of Oriental Studies of the Russian Academy of Sciences by the Honorary Speaker of the conference, Chairman of the of Pakistan Senate Standing Committee on Human Rights, Senator Walid Iqbal — grandson of the outstanding Pakistani poet and thinker, the ‘Spiritual Father of Pakistan» Allama Muhammad Iqbal.

Noninvasive, Wearable, Pulsed Shortwave (Radiofrequency) Therapy for Analgesia following Knee and Hip Arthroplasty: A Case Series

Background: Minimizing pain and opioid requirements following major orthopedic surgery can be challenging. Nonthermal, pulsed, shortwave (radiofrequency) therapy is a noninvasive treatment described previously as a possible analgesic modality following minor surgical procedures. The devices may be applied in a few minutes or less, are simply taped in place over the area of pain, are less expensive than a large bottle of acetaminophen, function for 30 days without any required intervention, may be applied to any part of the body, and produce no side effects-patients cannot detect any sensations from the devices-or substantial risks. Here we present a case series to explore the use of pulsed shortwave therapy for major joint arthroplasty.

Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study.

Background: Although major joint replacement surgery has a high overall success rate, postoperative cognitive dysfunction (POCD) is a common complication after anesthesia and surgery, increasing morbidity and mortality. Identifying POCD risk factors would be helpful to prevent and decrease the occurrence of POCD. We hypothesized that preoperative chronic pain increases the risk of POCD.Methods: A single-center, observational, prospective cohort study was conducted from January 2018 to March 2020. All consecutive elderly patients (>65 years) who underwent elective total hip arthroplasty or hemiarthroplasty with general anesthesia by the same surgeon were enrolled. The patients underwent neuropsychological testing preoperatively and at 7 days and 2 months after surgery. To determine POCD, a nonsurgical control group was recruited from the general community.Results: Of the 141 patients who finished the neuropsychological testing 7 days after surgery, 61 (43.2%) had preoperative chronic pain. Of the 61 patients, 17 (27.9%) developed POCD; of the 79 patients with no chronic pain, 10 (12.7%) had developed POCD by 7 days after surgery. Multivariate logistic regression analysis identified preoperative chronic pain as a risk factor of POCD assessed 7 days after surgery (odds ratio 6.527; P = 0.009). There was no significant difference in the POCD incidence 2 months after surgery between patients with and without preoperative chronic pain.Conclusion: Preoperative chronic pain was a risk factor of developing POCD within 7 days after surgery in elderly patients following hip joint replacement surgery.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT03393676].

Abir's Enlightenment Revolution is the basic element leading to the end of the corrupt regime resulting from the poisoned Tunisian revolution 2011

Ten years after the launch of its 2011 revolution, Tunisia has reached a catastrophic socio-economic situation that confirms that none of major goals of this revolution have been achieved. Here, from an anthropological analysis of major events happened during this decade I reveal and discuss mysteries of this revolution, and I show how and why it got to her final stage. I qualified it as „poisoned‟ because of clandestine interventions from some foreign countries that were able to steer it on a corrupt and dangerous path from the very beginning. In fact, although it was started by young people who have no political and ideological affiliation, many opportunist politicians rode its wave and given a false revolutionary label to their parties. One of these parties, „Ennahdha‟, in a clear relationship with some countries, very likely got secretly considerable funds. The use of these moneys, coupled with dissemination of religious misinformation, during the pre-elections period permitted this party to be the first to come to power. Since then, it began (1) to support secretly those who perform the corrupt instrumentalization of Islam leading to terrorism and obscurantism, (2) not to apply laws that conflict with its interests, and (3) to develop corruption through wide networks spread in most of the national institutions particularly in judicial and security sectors. This has ensured it permanent influence over the major joints of the State even if it does not have the highest representation in the Government. At the end of this despaired decade, a glimmer of hope appeared with the emergence of the wonderful leader ‟Abir Moussi‟ who called for Enlightenment Revolution. Her heroic struggle is the basic element leading to the end of the poisoned revolution 2011 and the resulting corrupt regime, which was mainly fabricated and dominated by Ennahdha, the last dangerous stronghold of the World Brotherhood Sect. I end this study by presenting recommendations aimed at eliminating the corrupt instrumentalization of Islam and preventing its return.

The use of hyaluronic acid preparations for the treatment of osteoarthritis of the major joints

The authors of the article analyzed the experience of domestic and foreign experts in the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major joints. Background and Objective. To analyze the literature sources in order to determine the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments. Materials and methods. Articles in specialized scientific journals and collections, Internet resource.Results. The analysis of literature sources determined the important role of HA preparations in the supplying and functioning of the articular cartilage. Researchers are inclined to believe that the ideal HA preparation should be as close as possible to the physiological HA of the synovial fluid of the joint. The developed domestic drug Artro-Patch fully corresponds to these parameters. Conclusions. The use of modern injectable HA preparations is advisable at stages 1–3 of OA. Anti-inflammatory effect of HA preparations makes it possible to reduce the dose and time of administration of non-steroidal anti-inflammatory drugs and, as a consequence, reduce the risk of developing many adverse side effects of NSAIDs. The high level of safety of HA preparations, the absence of serious side effects during their long-term use determine their widespread use in the clinical practice of modern orthopedists.