Musculoskeletal Disorders Research Articles

Musculoskeletal Disorders in COVID-19 Surveillance Staff Members: An Analysis of Prevalence, Risk Factors, and Coping Strategies

Aims/Background During the coronavirus disease 2019 (COVID-19) pandemic, the COVID-19 surveillance staff members experienced an increased risk for musculoskeletal disorders. Thus, it is necessary to further investigate the causal factors stemming from COVID-19 surveillance work, especially nucleic acid testing, and establish their relationship with work-related musculoskeletal disorders (WMSDs) by building upon the previous research. This study aimed to determine the prevalence of WMSDs and the major risks faced by the COVID-19 surveillance staff members. Methods This cross-sectional study was conducted in May 2022. The Quick Exposure Check (QEC), Nordic Musculoskeletal Questionnaire (NMQ), and Maslach Burnout Inventory (MBI) were used to evaluate ergonomic factors, musculoskeletal symptoms and pressure among 131 COVID-19 surveillance staff members in four hospitals in South-central Henan Province. Additionally, data regarding the coping strategies adopted by the respondents for lowing the risk of developing WMSDs were collected using a self-report questionnaire. Results The QEC results showed that the back, neck, and should/arm of the COVID-19 surveillance staff members bore high ergonomic loads, while the wrist suffered a medium load. The neck (75.6%), shoulder (66.4%), upper back (58%), and wrist (55.7%) were at higher risk for musculoskeletal disorder. Most of the respondents claimed a low sense of achievement (124, 94.7%) and slightly less than half of them had endured emotional exhaustion at work (61, 46.6%). Prolonged period of maintaining the same posture at work, awkward bending or twisting of back side, task repetition and so on were the perceived job risk factors precipitating WMSDs among the participants in this study. The top three coping strategies for lowering the risk of WMSDs included adjusting the plinth/bed height (49.6%), utilizing different parts of the body at work (47.3%), and taking short breaks when required (33.6%). Conclusion Prolonged large-scale nucleic acid detection can aggravate the musculoskeletal injuries of the neck, shoulder, upper back, and wrist in COVID-19 surveillance staff members. Prevention measures for musculoskeletal injuries factors must be in place to deter such incidence at work.

Association of long working hours and multi-site work-related musculoskeletal disorders among transportation industry workers in Beijing, China

Association of long working hours and multi-site work-related musculoskeletal disorders among transportation industry workers in Beijing, China

Machine learning insights into scapular stabilization for alleviating shoulder pain in college students

Abstract Non-specific shoulder pain is a common musculoskeletal condition, especially among college students, and it can have a negative impact on the patient’s life. Therapists have used scapular stabilization exercises (SSE) to enhance scapular control and mobility. This study investigates the prediction of the impact of scapular stability exercises in treating non-specific shoulder pain, leveraging advanced machine learning techniques for comprehensive evaluation and analysis. Using a diverse range of regression models, including Gamma Regressor, Tweedie Regressor, Poisson Regressor, and others, the study examines the relationship between the effectiveness of various exercises and their impact on shoulder pain management. Furthermore, the study employs optimization techniques, such as Hyperopt, scikit-optimize, optunity, GPyOpt, and Optuna, to fine-tune the exercise protocols for optimal outcomes. The results reveal that scapular stabilization exercises, when optimized using machine learning algorithms, significantly contribute to reducing shoulder pain in college students. Among the optimization techniques, scikit-optimize demonstrated the best performance, resulting in a mean squared error of 0.0085, a mean absolute error of 0.0712, and an impressive R2 score of 0.8501. This indicates that the scikit-optimize approach yielded the most accurate predictions and effectively captured the relationship between the exercises and shoulder pain management. The findings highlight the critical role of scapular stabilization exercise interventions in ameliorating non-specific shoulder pain and underscore the potential of machine learning techniques in optimizing therapeutic strategies for musculoskeletal health management. The utilization of scikit-optimize, in particular, showcases its effectiveness in fine-tuning the exercise protocols for optimal outcomes. The study’s results serve as a crucial stepping stone in developing personalized rehabilitation programs for non-specific shoulder pain, emphasizing the importance of integrating machine learning methodologies in the assessment and treatment of musculoskeletal disorders among college students.

Work-Related Muscluskeletal Disorders and Work Ability Among Hospital Employees in Southeast of Iran

Background: The Work Ability Index (WAI) evaluates how well workers cope with the physical and mental demands of their jobs. Objectives: This study aims to explore how demographic factors and work-related musculoskeletal disorders (WMSDs) influence work ability among employees at the largest specialized hospital in southeast Iran. Methods: This cross-sectional study was conducted at the largest specialized hospital in Zahedan. A sample of 194 clinical staff and support personnel, including nurses, nursing assistants, patient transporters, and cleaning staff, were randomly selected through a stratified random sampling method. Work ability and musculoskeletal discomfort were assessed using the Persian versions of the WAI and Cornell Questionnaires. Quantitative data were presented as mean ± SD, while qualitative data were expressed as numbers and percentages. Pearson correlation, Kruskal-Wallis, Mann-Whitney U, and one- and multi-factor General Linear Models were used for data analysis in SPSS version 19. Results: Work ability decreased with age (P < 0.001). Significant associations were found between work ability and age, job category, education, and Body Mass Index (BMI) (P < 0.05). After adjusting for age, job, education, and BMI, lower back pain (P = 0.002), thigh pain (P = 0.004), and knee pain (P = 0.026) were significantly linked to work ability. There was a notable negative correlation between work ability and discomfort score (r = -0.337, P < 0.001), with nursing assistants reporting higher discomfort scores compared to nurses, cleaning staff, and patient transporters (P < 0.05). Conclusions: Our findings suggest a potential link between musculoskeletal disorders (MSDs) and work ability. Therefore, it is recommended to implement a program focused on identifying and addressing the risk factors associated with MSDs.

A consensus-based agreement on a definition of a process variable: findings from a New Zealand nominal group technique study.

Musculoskeletal pain and disability are leading causes of reduced health and significant economic costs worldwide. Individualised, and evidence-based treatment approaches for specific musculoskeletal conditions aimed at improving patient outcomes and costs have not been successful. Recently authors have suggested that the 'process' of how care is implemented within a health system needs to be considered as an influencer on patient outcomes. With the rising prevalence of musculoskeletal conditions and the burgeoning costs associated with their treatment, it seems timely that new research focusing on process variables and their influence on patients with musculoskeletal conditions is explored. Before such studies can take place, a modern definition of a process variable within a musculoskeletal care pathway is needed to anchor future research endeavours. Therefore, the aim of this study was to establish a consensus-based definition of a process variable within a musculoskeletal care pathway, based on a New Zealand setting. This study used a virtual nominal group technique and took place in July 2023 using a Microsoft Teams platform. A nominal group technique employs a structured approach to generate information and solutions to problems that can then be prioritised through group discussion and consensus. It is unique because it allows expert participants to explore using in-depth inquiry, areas previously unidentified or not yet investigated. There was an inclusion criterion and the participants completed pre-work before the two-hour five stage virtual meeting. The Auckland University of Technology Ethics Committee (AUTEC) approved this study (AUTEC 23/94). The study included eight participants (five male, three female) who had extensive experience with the New Zealand ACC insurance scheme and the design, implementation, and administration of musculoskeletal care pathways. The consensus definition was 'A health process variable is any modifiable factor in a health process or pathway that can be quantified and measured and that if varied may achieve a different operational or patient outcome'. This study of New Zealand-based experts has formed a consensus-based agreement for a definition of a process variable in a musculoskeletal care pathway. This is an important first step in developing our understanding of process variables, and further research is needed to establish the link between process variables and their influence on the outcomes of patients with musculoskeletal conditions.

Design and Biofunctionalization of Cloud Sponge-Inspired Scaffolds for Enhanced Bone Cell Performance.

With the increasing age of our population, which is linked to a higher incidence of musculoskeletal diseases, there is a massive clinical need for bone implants. Porous scaffolds, usually offering a lower stiffness and allowing for the ingrowth of blood vessels and nerves, serve as an attractive alternative to conventional implants. Natural porous skeletons from marine sponges represent an array of evolutionarily optimized patterns, inspiring the design of biomaterials. In this study, cloud sponge-inspired scaffolds were designed and printed from a photocurable polymer, Clear Resin. These scaffolds were biofunctionalized by mussel-derived peptide MP-RGD, a recently developed peptide that contains a cyclic, bioactive RGD cell adhesion motif and catechol moieties, which provide the anchoring of the peptide to the surface. In in vitro cell culture assays with bone cells, significantly higher biocompatibility of three scaffolds, i.e., square, octagon, and hexagon cubes, in comparison to hollow and sphere inside cubes was shown. The performance of the cells regarding signaling was further enhanced by applying an MP-RGD coating. Consequently, these data demonstrate that both the structure of the scaffold and the coating contribute to the biocompatibility of the material. Three out of five MP-RGD-coated sponge-inspired scaffolds displayed superior biochemical properties and might guide material design for improved bone implants.

Current approach to the diagnosis of sarcopenia in cardiovascular diseases

Muscle wasting syndrome, also known as sarcopenia, is an age-related geriatric condition characterized by a gradual loss of muscle mass, strength, and function. Sarcopenia can be classified into primary and secondary types. Primary sarcopenia is primarily associated with aging, while secondary sarcopenia is caused by systemic diseases such as cancer, diabetes, liver cirrhosis, musculoskeletal disorders, and disuse changes. In recent years, increasing evidence suggests that cardiovascular diseases can promote the occurrence of sarcopenia through various pathophysiological mechanisms. Additionally, sarcopenia increases the risk of adverse outcomes in patients with cardiovascular disease such as rehospitalization and mortality. Therefore, screening and diagnosing sarcopenia are particularly important for patients with cardiovascular diseases. This article provides a brief overview of the research progress on diagnostic methods for sarcopenia in patients with cardiovascular diseases.

Incident heart failure: comparing management and outcome in primary and hospital settings in Western Sweden 2008-2017.

Heart failure (HF) is a highly prevalent condition managed in both primary care (PC) and hospital care (HC)-based settings. HF patients managed in these two settings may differ in their demography, comorbidities and outcomes, so we aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden. The VEGA database is an administrative database that includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18years old between 2008 and 2017 were included. One-year mortality was used as the outcome. In total, 35375 new-onset HF cases were included with 18722 identified only in PC and 16651 in HC. HF patients in PC were older (80.7±10.9 vs. 76.1±13.6), more women (57.1% vs. 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Patients in HC had almost 4 times higher all-cause 1year mortality [3.92 (3.77-4.08), P<0.0001] compared with PC after adjustment for age and sex. Over a 10year period, despite decreasing mortality in both settings, hazard ratios for HC versus PC were significantly increased for all patients (P for interaction 0.0004), which was more marked in female and for 70-80years old patients. Over a 10year period, we demonstrated the differences in demography, comorbidities and outcomes between heart failure patients managed in hospital care versus primary care.

Effectiveness of dextrose prolotherapy for chronic musculoskeletal pain: A prospective observational study

Effectiveness of dextrose prolotherapy for chronic musculoskeletal pain: A prospective observational study

Working conditions, health status, and musculoskeletal disorders among hospital cleaning workers: a cross-sectional study in Turkey.

Cleaning workers face many workplace risk factors and may experience many health problems. In this context, this study aimed to evaluate the musculoskeletal disorders, the health status of hospital cleaning workers, and the working conditions and risk factors affecting the workplace environment. This cross-sectional study was conducted in a university hospital of Turkey. All the cleaning workers who have been working for ≥1 year were participants. The participants' socio-demographic and occupational characteristics, health complaints, workplace risk factors, occupational accidents, and ergonomic nonconformities were observed and questioned. Four hundred thirty-eight cleaning employees participated in the study. In the past year, 19.6% of participants had an occupational accident. Of those, 24.4% did not report it, and 30.2% were absent from work. No pre-employment examination was reported by 36.8% of the participants, and periodic medical examinations were never undergone by 98.4%. Low back pain was experienced by 42.0% of the participants, while 29.5% reported shoulder pain and 28.8% knee pain. While working, 83.1% of the participants bent frequently, 82.2% repeated the same movement, and 73.2% stood for a long time. Chemical substances were the most common workplace risk factors. There were significant differences according to age and gender in almost all musculoskeletal disorders. Gender differences were observed also in various health outcomes and occupational complaints. Repeated bending and prolonged standing were associated with hip/leg and foot/ankle pains; heavy lifting with low back, back, wrist/hand, and ankle/foot pains; and failure to the breaks with shoulder, knee and hip/leg pains. This research investigated the health issues and occupational safety challenges faced by hospital cleaning personnel. Specifically, it examined musculoskeletal disorders and work-related accidents, emphasizing gaps in regular health screenings for these workers. The findings underscore gender variations in these challenges and propose strategies to mitigate ergonomic risks encountered by cleaning staff. Med Pr Work Health Saf. 2024;75(5).

Musculoskeletal pain is associated with poor sleep quality and increased daytime sleepiness in dental students: a cross-sectional pilot study.

While a bidirectional relationship between sleep health and musculoskeletal (MSK)-pain have been established among chronic pain patients, few studies explored it among dental students. This cross-sectional study assessed the relationship of self-report MSK-pain with sleep health and psychological outcomes among dental students, and whether differences existed as a function of number and location of painful body-sites. Validated questionnaires were sent through REDCap to dental students at a predoctoral dental school, assessing presence, location (head, shoulder/neck, jaw, back, body), and intensity of MSK-pain, sleep health (risk of sleep apnea, insomnia severity symptoms, sleep quality, daytime sleepiness, and chronotype), and psychological outcomes (anxiety/depression). Differences between those with and without MSK-pain, and across participants with different number and location of painful sites were tested with t-tests and ANOVA, adjusting for age/gender. Out of 80 participants (82.5% females), 76.3% reported MSK-pain (68.9% in neck/shoulders). Those with MSK-pain scored significantly worse in sleep quality (7.7±3.7 vs. 4.8±2.1, p<.001), daytime sleepiness (6.1±4.2 vs. 3.3±2.7, p<.001). Those with >3 painful body-sites reported worse sleep quality (p=.006) and daytime sleepiness (p=.003) than pain-free controls. There were no differences on sleep and psychological outcomes as a function of number of painful body-sites. Those reporting back pain scored worse in insomnia (p=.037), daytime sleepiness (p=.002), and sleep quality (p=.006) than those without back pain. MSK-pain is prevalent among dental students and associated with worse sleep health. While number of painful sites may not influence sleep/psychological health, specific locations (e.g., back pain) were associated with worse sleep functioning.

A Case of Disseminated Tuberculosis with Atypical Presentation In An Older Person

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It is a significant health concern, with millions of new cases and deaths reported each year. Disseminated tuberculosis (dTB) is a serious condition which can affect various organs and tissues, leading to widespread symptoms and complications. The diagnosis of dTB can be challenging due to its atypical presentations. We present a case of dTB in a robust older person who presented with musculoskeletal pain, weight loss, and loss of appetite. Initially, he was treated for age-related spine disease, and pain management was provided. However, his subsequent visit raised suspicion of TB, prompting further work up. The diagnosis was revised to dTB, and anti-TB treatment was initiated. The near miss or delay in diagnosis and treatment may have played a role in dissemination of disease, increased frailty and reduction of function in this patient. Healthcare workers must maintain a high index of suspicion and remain vigilant for TB as starting early treatment will prevent dissemination in the patient, reduce risk to the public and improve outcomes.

Monitoring Endoplasmic Reticulum Peroxynitrite Fluctuations in Primary Tendon-Derived Stem Cells and Insights into Tendinopathy.

Tendinopathy is one of the most prevalent musculoskeletal disorders, significantly affecting the quality of life of patients. Treatment outcomes can be improved with an early diagnosis and timely targeted interventions. Increasing evidence indicates that ROS and endoplasmic reticulum (ER) stress play key roles in modulating the differentiation processes of tendon-derived stem cells (TDSCs), thereby contributing to the initiation and progression of tendinopathy. However, the relationship between ONOO- and the differentiation process, as well as the various stages of tendinopathy, remains unexplored. Herein, we developed two highly specific and sensitive fluorescent probes (Rod-Cl and Rod-Br) for detecting ONOO- in the ER. Rod-Br can detect basal levels of ONOO- in the ER of TDSCs and measure ONOO- levels in primary TDSCs stimulated by interleukin-1β over various durations, allowing for comparisons between chondrogenic and osteogenic differentiation and ER stress levels. Additionally, we examined ONOO- variations in different stages of tendinopathy and treatment rat models in vivo and discussed the potential mechanisms. This research provides a robust tool for analyzing ONOO- dynamics in the tenogenic and osteogenic differentiation of TDSCs, offering new insights into the pathophysiology and treatment of tendinopathy.

Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21–60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged.

Musculoskeletal Disorders and Related Risk Factors in Iranian Military Personnel: A Systematic Review and Meta-Analysis

Background: Work-Related Musculoskeletal Disorders (WRMSDs) are prevalent and costly diseases in military occupations. WRMSDs are prevalent and costly diseases in military occupations. We investigated the exposure to ergonomic risk factors and the prevalence of musculoskeletal disorders (MSDs) among military personnel in the workplace. Method: We aimed to investigate MSDs by conducting electronic searches on Persian databases such as SID, MagIran, and IranMedex, and English databases like PubMed, Web of Sciences, and Scopus. The search was not restricted by time and was conducted until Dec 20, 2021. Two researchers independently extracted the data, and the quality of the research was evaluated using the STROBE checklist. The results of different studies were merged and incorporated into the analysis using Comprehensive Meta-Analysis (CMA) v3 software. Results: Eleven qualitative studies found that 92% of the respondents were men (83% to 96%). The mean age was 34.17 ± 0.16 yr, with a confidence interval (of 95% CI:33.85-34.48). The mean BMI was 25±0.39 with a confidence interval of 95% CI:24.28-25.84. The mean work record was 12.89±0.81 yr with a confidence interval of 95% CI:11.30-11.48. The highest outbreak of MSDs is in the knee at 38.1% (95%CI:32.1-44.4), 37.6% of the neck (95% CI:24.8-52.5), and 32.5% of the shoulder. (95%CI:22.5-44.3) was observed. Conclusion: The wide role of various dimensions of work tasks and repetitive tasks (such as lifting, moving or changing positions, standing for long periods, as well as improper postures) in causing WRMSDs. Additionally, the risk factor in the workplace has financial implications for the military organization. The reduction of physical and psychological demands, as well as the improvement of ergonomic standards in the workplace, should be addressed to decrease MSDs in military centers.

Musculoskeletal disorders among truck drivers: a systematic review and meta-analysis.

The job of truck driving exposes the drivers to various risk factors of musculoskeletal disorders (MSDs) due to unfavorable working conditions. Hence, this research was conducted to investigate the frequency of MSDs among individuals working as truck drivers. The present research followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and its protocol was registered in international prospective register of systematic review (PROSPERO) under the code CRD42024507985. Databases such as PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar were searched without time restrictions until February 7th, 2024 to identify relevant articles. Meta-analysis was conducted using a random effects model, and heterogeneity between studies was evaluated using the I2 index. Additionally, STATA (version 14) was utilized for conducting data analysis. In the initial search, 678 articles were identified. After removing duplicates and articles unrelated to the research objective and inclusion criteria, 15 articles were included in the meta-analysis, involving 2,662 truck drivers. The findings from the research show that 61.75% of truck drivers have musculoskeletal disorders (MSDs) (95% CI: 46.98-76.52, I2 = 96%, P < 0.001). Additionally, the prevalence of MSDs in various parts of the body was estimated as follows: shoulder (31.5%), neck (25.79%), lower back (23.46%), knee (22.26%), ankle (20.46%), wrist (20.25%), upper back (18.65%), elbow (11.91%), and hip (7.50%). According to the study findings, the prevalence of MSDs among truck drivers is relatively high, and several risk factors contribute to these disorders. Therefore, to decrease the prevalence of MSDs among truck drivers, it is recommended to develop and implement essential training programs, ergonomic interventions, and regular evaluations of the work environment.

Adverse childhood experiences, subsequent negative life events, and their impact on health in occupational rehabilitation patients: a mixed-methods study

IntroductionAdverse childhood experiences (ACEs) are prevalent globally and can negatively impact an individual's lifespan by not only increasing the likelihood of encountering other negative life events (NLEs), but also escalating the risk of illness, absenteeism due to sickness, unemployment, and reliance on disability benefits in adulthood. Therefore, the objective of this study was to explore the prevalence of ACEs and NLEs, as well as their health impacts among patients undergoing occupational rehabilitation.Materials and methodsA total of 80 participants diagnosed with musculoskeletal disorders and/or common mental disorders who participated in two occupational rehabilitation programs in Norway were included. Data were collected by questionnaire and in-depth interviews (39 participants) at the start of the intervention. Comparative quantitative and qualitative analysis was conducted between individuals with a history of ACEs and those without these experiences. Thematic analysis was used to identify the impact of ACEs and NLEs on the health of the informants.ResultsHalf of the participants reported ACEs. Of these, 18% reported one ACE, 22% reported 2–3 ACEs and 9% reported 4 or more ACEs. Also, 25% were categorized as revictimized. The two groups with ACEs had more NLEs in adulthood compared to those without ACEs (p &amp;lt; 0.001), revictimized the most (mean numbers between groups 3.1, 4.5 and 5.9). Furthermore, a history of ACEs was associated with a higher number of reported mental health issues compared to those who had not experienced ACEs (p &amp;lt; 0.01). However, there were no significant differences between the two ACE groups. NLEs had a substantial impact on the participants’ current health status, whether they occurred in childhood or adulthood. In adult life, a high workload (psychologically or physically), interpersonal challenges, and financial struggles had an especially negative impact. Additionally, accidents and complications related to surgeries were also significant NLEs causing health problems. For most, there were complex interactions between NLEs and health.ConclusionsThe prevalence of ACEs and NLEs is high among occupational rehabilitation patients. ACEs are associated with subsequent victimization, interpersonal challenges, financial struggles, and increased mental health issues in adulthood. These findings highlight the need for systematic screening and a holistic, individualized approach in occupational rehabilitation programs to potentially mitigate the adverse effects of NLEs on health and work participation.

Tramadol use for chronic pain management: A thorough analysis of safety, effectiveness, and clinical recommendations

Chronic pain, especially arthritis-related pain, represents a significant medical challenge worldwide. Tramadol, a centrally acting analgesic, has emerged as a valuable treatment option for managing chronic arthritis pain. This review article provides a comprehensive analysis of tramadol’s role in chronic pain management, emphasizing its safety, effectiveness, and clinical guidelines. Literature indicates that tramadol, whether used alone or in combination therapies, effectively treats various types of arthritis-related pain, such as musculoskeletal pain, osteoarthritis, and rheumatoid arthritis. While some clinical guidelines recommend tramadol as a first-line option for persistent knee or hip osteoarthritis, others urge caution due to concerns over potential abuse and negative effects. Tramadol’s mechanism of action involves, among other things, stimulation of opioid receptors and inhibition of serotonin and norepinephrine reuptake, contributing to its analgesic effects while attempting to minimize the side effects associated with traditional opioids. However, tramadol is not without side effects, including nausea, vomiting, constipation, respiratory depression, and withdrawal symptoms if it is suddenly discontinued. Despite these challenges, tramadol remains a valuable component in managing chronic pain, especially in patients with concurrent conditions and comorbidities. Further research is necessary to determine the optimal use of tramadol and to establish its risk-benefit profile across diverse patient populations.

Type I interferon signaling in dendritic cells limits direct antigen presentation and CD8+ T cell responses against an arthritogenic alphavirus.

Ross River virus (RRV) and other alphaviruses cause chronic musculoskeletal syndromes that are associated with viral persistence, which suggests deficits in immune clearance mechanisms, including CD8+ T-cell responses. Here, we used a recombinant RRV-gp33 that expresses the immunodominant CD8+ T-cell epitope of lymphocytic choriomeningitis virus (LCMV) to directly compare responses with a virus, LCMV, that strongly induces antiviral CD8+ T cells. After footpad injection, we detected fewer gp33-specific CD8+ T cells in the draining lymph node (DLN) after RRV-gp33 than LCMV infection, despite similar viral RNA levels in the foot. However, less RRV RNA was detected in the DLN compared to LCMV, with RRV localizing principally to the subcapsular region and LCMV to the paracortical T-cell zones. Single-cell RNA-sequencing analysis of adoptively transferred gp33-specific transgenic CD8+ T cells showed rapid differentiation into effector cells after LCMV but not RRV infection. This defect in RRV-specific CD8+ T effector cell maturation was corrected by local blockade of type I interferon (IFN) signaling, which also resulted in increased RRV infection in the DLN. Studies in Wdfy4-/-, CD11c-Cre B2mfl/fl, or Xcr1-Cre Ifnar1fl/fl mice that respectively lack cross-presenting capacity, MHC-I antigen presentation by dendritic cells (DCs), or type I IFN signaling in the DC1 subset show that RRV-specific CD8+ T-cell responses can be improved by enhanced direct antigen presentation by DCs. Overall, our experiments suggest that antiviral type I IFN signaling in DCs limits direct alphavirus infection and antigen presentation, which likely delays CD8+ T-cell responses.IMPORTANCEChronic arthritis and musculoskeletal disease are common outcomes of infections caused by arthritogenic alphaviruses, including Ross River virus (RRV), due to incomplete virus clearance. Unlike other viral infections that are efficiently cleared by cytotoxic CD8+ T cells, RRV infection is surprisingly unaffected by CD8+ T cells as mice lacking or having these cells show similar viral persistence in joint and lymphoid tissues. To elucidate the basis for this deficient response, we measured the RRV-specific CD8+ T-cell population size and activation state relative to another virus known to elicit a strong T-cell response. Our findings reveal that RRV induces fewer CD8+ T cells due to limited infection of immune cells in the draining lymph node. By increasing RRV susceptibility in antigen-presenting cells, we elicited a robust CD8+ T-cell response. These results highlight antigen availability and virus tropism as possible targets for intervention against RRV immune evasion and persistence.

Validation of computer vision-based ergonomic risk assessment tools for real manufacturing environments.

This study contributes to understanding semi-automated ergonomic risk assessments in industrial manufacturing environments, proposing a practical tool for enhancing worker safety and operational efficiency. In the Industry 5.0 era, the human-centric approach in manufacturing is crucial, especially considering the aging workforce and the dynamic nature of the entire modern industrial sector, today integrating digital technology, automation, and sustainable practices to enhance productivity and environmental responsibility. This approach aims to adapt work conditions to individual capabilities, addressing the high incidence of work-related musculoskeletal disorders (MSDs). The traditional, subjective methods of ergonomic assessment are inadequate for dynamic settings, highlighting the need for affordable, automatic tools for continuous monitoring of workers' postures to evaluate ergonomic risks effectively during tasks. To enable this perspective, 2D RGB Motion Capture (MoCap) systems based on computer vision currently seem the technologies of choice, given their low intrusiveness, cost, and implementation effort. However, the reliability and applicability of these systems in the dynamic and varied manufacturing environment remain uncertain. This research benchmarks various literature proposed MoCap tools and examines the viability of MoCap systems for ergonomic risk assessments in Industry 5.0 by exploiting one of the benchmarked semi-automated, low-cost and non-intrusive 2D RGB MoCap system, capable of continuously monitoring and analysing workers' postures. By conducting experiments across varied manufacturing environments, this research evaluates the system's effectiveness in assessing ergonomic risks and its adaptability to different production lines. Results reveal that the accuracy of risk assessments varies by specific environmental conditions and workstation setups. Although these systems are not yet optimized for expert-level risk certification, they offer significant potential for enhancing workplace safety and efficiency by providing continuous posture monitoring. Future improvements could explore advanced computational techniques like machine learning to refine ergonomic assessments further.