Severe Joint Research Articles

Effect of Stiffening the Printed Circuit Board in the Fatigue Life of the Solder Joint.

Predictive analysis of the life of an electronic package requires a sequence of processes involving: (i) development of a finite element (FE) model, (ii) correlation of the FE model using experimental data, and (iii) development of a local model using the correlated FE model. The life of the critical components is obtained from the local model and is usually compared to the experimental results. Although the specifics of such analyses are available in the literature, a comparison among them and against the same electronic package with different user printed circuit board (PCB) thicknesses does not exist. This study addresses the issues raised during the design phase/life analysis, by considering a particular package with a variable geometric thickness of the user PCB. In this paper, the effect of stiffening the user PCB on the fatigue life of a ball grid array (BGA), SAC305 solder joint is studied. The board stiffness was varied by changing the thickness of the PCB, while the size of the substrate, chips, and solder balls were kept constant. The test vehicle consisted of BGA chips soldered to a user PCB. The thickness of the user PCB was varied, but the surface area of the BGA chip remained identical. The test vehicle was then modeled using a finite element analysis tool (ANSYS). Using a global/local modeling approach, the modal parameters in the simulations were correlated with experimental data. The first resonance frequency dwell test was carried out in ANSYS, and the high-cycle fatigue life was estimated using the stress-life approach. Following the simulation, the test vehicle was subjected to resonance fatigue testing by exciting at the first mode resonance frequency, the mode with the most severe solder joint failure. The resistance of the solder joint during the experiment was monitored using a daisy-chain circuit, and the point of failure was further confirmed using the destructive evaluation technique. Both the experimental and simulation results showed that stiffening the board will significantly increase the fatigue life of the solder joint. Although the amplitude of the acceleration response of the test vehicle will be higher due to board stiffening, the increase in natural frequencies will significantly reduce the amplitude of relative displacement between the PCB and the substrate.

One-year results of minimally invasive fusion surgery of the sacroiliac joint as an alternative treatment after failed endoscopic thermal coagulation.

While pain in the severe sacroiliac joint (SIJ) is a common cause of lower back pain, SIJ disease is often overlooked as a diagnosis. This study examines the extent of sufficient long-term pain relief and functional improvement in patients with SIJ syndrome that are treated with thermocoagulation. Some patients treated with thermocoagulation noted initial improvement, but the functionality and pain relief had limited duration and efficacy. Patients with insufficient improvement were recommended to undergo fusion surgery as an option for better and longer lasting results. Patients with a long history of back or pelvic problems were selected for the study. Endoscopic thermal coagulation of the SIJ was carried out. The follow-up examinations took place after 1, 3, 6, 12 months. In patients with insufficient pain relief and functionality after thermocoagulation, a fusion surgery was performed. The results of the fusion surgery were documented over a 12-month follow-up period. To carry out the statistical evaluation visual analog scale (VAS), Oswestry-Disability-Index (ODI) and the consumption of opioids were recorded. Forty-eight patients were included. The mean VAS values 12 months after thermocoagulation were 68.9. The ODI after 12 months was very near or somewhat higher than their baseline prior to the thermocoagulation. Thus, a fusion surgery was recommended. Thirty-three patients agreed to the fusion operation. The VAS values 12 months after fusion surgery decreased to 53.1. Analogous to the VAS values, the Oswestry index (ODI) showed a significant improvement after the fusion operation. The success of surgical intervention in 88% of the SIJ syndrome patients with inadequate results 12 months after thermocoagulation proves the superiority of SIJ fusion surgery. This study showed long-lasting pain relief by an average of 65% and a median improvement in functional impairments of 60%. In view of these results, fusion surgery should be considered for patients without sufficient success of thermocoagulation.

Short-term Effectiveness of a Modified Osteotomy for Total Elbow Joint Replacement in Patients of Hemophilic Elbow Arthritis with Severe Flexion Contracture Deformity: A Three-Cases Series Report.

ObjectiveTo report the modified osteotomy and the short‐term effectiveness of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity.MethodsThis study introduced the therapeutic approach of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity, and assessed the short‐term effectiveness in three cases (three elbows) of end‐stage hemophilic elbow arthritis admitted from October 2020 to December 2020. The included patients were all diagnosed with hemophilia A (factor VII deficiency), accompanied by severe bilateral elbow joint flexion contracture, which seriously affects daily life and requires surgical intervention. Clinical data and follow‐up results were analyzed before total elbow arthroplasty and 1, 3, and 6 months postoperatively. Pre‐ and postoperative range of motion, pain score, and function score were compared, and intraoperative and postoperative complications are reported.ResultsAll three patients were male, with an average age of 31 years. The main clinical manifestations were bilateral elbow arthritis with flexion contracture. Two of the patients underwent right elbow replacement, and one patient underwent left elbow replacement. All cases were followed up for 6 months postoperatively. No incision infection or ulnar nerve injury occurred. Postoperative triceps brachii muscle strength was slightly weakened compared with preoperative muscle strength. Average elbow flexion and extension range of motion was 60° (30°–100°) preoperatively and increased to 127° (110°–140°) postoperatively; rotational range of motion of the affected forearm was 47° (10°–85°) preoperatively and increased to 117° postoperatively. The mean visual analogue scale (VAS) was 6 (5–8) preoperatively and decreased to 3 (2–4) postoperatively. The mean MEPS score was 62 (55–75) and increased to 87 (80–95) postoperatively. During the follow‐up, anteroposterior and lateral radiographs showed no signs of prosthesis loosening in the elbow.ConclusionsFor severe hemophilic elbow arthritis patients, the short‐term treatment effect of total elbow replacement is good, following the strict adherence to the surgical indications and proper preparation for the perioperative period. The modified osteotomy can fully expose the visual field and reduce complications of ulnar nerve injury. The long‐term effects need to be study future.

Lactic Acid Regulation: A Potential Therapeutic Option in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic, persistent autoimmune disease that causes severe joint tissue damage and irreversible disability. Cumulative evidence suggests that patients suffering from RA for long durations are at risk of functional damage to cardiovascular, kidney, lung, and other tissues. This seriously affects the quality of work and life of patients. To date, no clear etiology of RA has been found. Recent studies have revealed that the massive proliferation of synoviocytes and immune cells requires a large amount of energy supply. Rapid energy supply depends on the anaerobic glucose metabolic pathway in both RA animal models and clinical patients. Anaerobic glycolysis can increase intracellular lactic acid (LA) content. LA induces the overexpression of monocarboxylate transporters (MCTs) in cell membranes. MCTs rapidly transport LA from the intracellular to the intercellular or articular cavity. Hence, a relatively high accumulation of LA could be formed in the intercellular and articular cavities of inflammatory joints. Moreover, LA contributes to the migration and activation of immune cells. Immune cells proliferate and secrete interleukins (IL) including IL-1, IL-2, IL-13, IL-17, and other inflammatory factors. These inflammatory factors enhance the immune inflammatory response of the body and aggravate the condition of RA patients. In this paper, the effects of LA on RA pathogenesis will be summarized from the perspective of the production, transport, and metabolism of synoviocytes and immune cells. Additionally, the drugs involved in the production, transport, and metabolism of LA are highlighted.

Natural course of severe temporomandibular joint osteoarthrosis evaluated by a novel condylar remodelling scoring system and quantitative volumetric analysis

Temporomandibular joint osteoarthrosis (TMJ-OA) frequently causes mild, moderate, or severe condylar morphological changes. A novel condylar remodelling scoring system (CRSS) based on three-dimensional cone beam computed tomography images is proposed, which is used to grade condylar morphological changes. In the CRSS, the condyle is divided into 10 regions by 11 reference points. For each increase in the number of regions involved in TMJ-OA, one point is subtracted from the full score of 10. The intra-class correlation coefficients for intra- and inter-observer agreement (range 0.656–0.898 and 0.841–0.906, respectively) indicated that the CRSS had good reliability. Cephalometric analysis showed that the condyles with severe morphological changes were prone to present with a retrognathic and clockwise rotating mandible, shorter ramus height, reduced mandibular length, larger mandibular angle, and maxillary retrusion. Qualitative CRSS evaluation and quantitative volumetric analysis were performed to evaluate the stability of severe TMJ-OA in its natural course (343 condyles). The continuous cortex group showed no remarkable changes with an average follow-up of 2 years. In the discontinuous cortex group, most (74.4%) converted into a continuous cortex during follow-up (mean 2 years).

Celastrol ameliorates osteoarthritis via regulating TLR2/NF-κB signaling pathway.

Objectives: Osteoarthritis (OA) is a joint disease characterized by degeneration of joint cartilage and is a significant cause of severe joint pain, physical disability, and impaired quality of life in the aging population. Celastrol, a Chinese herbal medicine, has attracted wide interests because of its anti-inflammatory effects on a variety of diseases. This study aimed to investigate the effect of celastrol on OA as well as the mechanisms in vivo and in vitro. Methods: A rat knee OA model was established using “medial collateral ligament transection (MCLT) + partial meniscectomy (pMMT)”. Eight weeks after surgery, the OA rats started to receive intra-articular injection of celastrol (1 mg/kg) once a week. Safranin O-fast green (S&F) and hematoxylin and eosin (H&E) staining were used to estimate histopathological changes. Micro-CT was used to evaluate bone volume of the subchondral bone of the knee joint. Chondrocytes were isolated from the knee cartilage of rats and OA patients. Enzyme linked immunosorbent assay (ELISA), Western Blot (WB), Polymerase Chain Reaction (PCR), and Immunohistochemistry (IHC) were used to detect the expression of inflammatory factors and stromal proteins, respectively. Results: We found that celastrol treatment significantly delayed the progression of cartilage damage with a significant reduction in osteophyte formation and bone resorption in OA rat model. In IL-1β-stimulated rat chondrocytes, celastrol significantly suppressed the production of inflammatory factors such as cyclooxygenase-2 (COX2), interleukin-6 (IL-6), and prostaglandin E2 (PEG2), and reduced IL-1β-induced matrix degradation by down-regulating the expression of matrix metalloproteinase 13 (MMP13). In addition, we found that toll-like receptor 2 (TLR2) was up-regulated in OA patients and rat knee OA models, while celastrol inhibited TLR2 signal and its downstream nuclear factor-kappa B (NF-κB) phosphorylation. Conclusion: In summary, celastrol may improve OA by inhibiting the TLR2/NF-κB signaling pathway, which provides innovative strategies for the treatment of OA.

Hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion in breast cancer survivors during the first 24 months of tamoxifen therapy: a prospective observational study.

PurposeThis study aimed to explore symptom trajectories over 24 months for hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion experienced by premenopausal women diagnosed with tamoxifen-treated breast cancer.MethodsA total of 104 patients participated in the study. The menopausal symptoms were examined using the Menopausal Rating Scale at baseline, 3–6, 12, and 18–24 months after initiating tamoxifen. The changes over four time points were analyzed using repeated measures analysis of variance. The chi-square test was used to examine the differences between “no symptom-to-mild” and “moderate-to-extremely severe” 3–6 months after initiating tamoxifen according to the patients’ chemotherapy treatment experiences.ResultsAll menopausal symptoms occurred in > 70% of patients with breast cancer and persisted until 24 months. More than 50% of patients experienced four menopausal symptoms, with at least two at a serious severity level after initiating tamoxifen. Hot flushes and sweating occurred in the highest number of patients, recording high scores. Sleep problems and physical and mental exhaustion exhibited relatively high scores, even before tamoxifen initiation. There were significant changes over four time points in all symptoms. Young patients aged < 40 years experienced more severe sleep problems, and patients who had previously received chemotherapy experienced more severe joint and muscular discomfort.ConclusionsThis study’s findings may assist in alerting healthcare providers to menopausal symptoms that develop during tamoxifen therapy and the need for early and active intervention to minimize symptom occurrence and distress.

Bouldering: a sport with a high risk of intraarticular fractures

Bouldering is a famous new sport with an increasing number of athletes. It became an Olympic sport in 2020. As no major sports equipment is required, everybody can take up bouldering even with little knowledge. However, despite the low climbing height there is a high risk of severe joint injuries, especially in the lower limb. Increasing numbers of climbers have led to an increase in injuries. New floor designs are supposed to reduce these risks. Improved documentation and specific research in bouldering should provide more insight into risks, injury patterns and prevention.

Identification of symptom clusters in patients with ankylosing spondylitis

Symptom cluster refers to a group of 3 or more related symptoms that occur together. Our objectives were to: (1) investigate the frequency, severity and gender difference of symptoms in patients with ankylosing spondylitis (AS); and (2) identify symptom clusters in AS patients. A cross-sectional questionnaire-based survey was conducted using the Patient Health Questionnaire Symptoms Group combined with self-designed variables. Demographic and symptom variables between male and female patients in terms of C-reactive protein (CRP) and human leukocyte antigen (HLA)-B27 status were analyzed with 2-tailed independent t test for continuous variables and Chi-square or Fisher's exact test for categorical variables. Symptom clusters were extracted and analyzed by principal component analysis. There were 122 AS patients included in the study. The most severe symptoms included severe back pain, extremity or joint pain, difficulty in breathing, constipation, intestine discomfort and diarrhea. Stomachache was more prevalent in male patients in which odds ratio was 4.60 (CI 1.59-12.97) (P=.006). Patients with HLA-B27 negativity or a higher CRP value were more likely to have dry mouth. Four symptom clusters were classified, which explained 58.4% of the total variation. They were named as the gastrointestinal-cardiac cluster, the fatigue-sleep disturbance cluster, the headache-chest pain cluster, and the mouth-eye cluster. The symptoms appeared to cluster into 4 groups in AS patients, which should be noticed in clinical care.

Biglycan neo-epitope (BGN262), a novel biomarker for screening early changes in equine osteoarthritic subchondral bone

Native biglycan (BGN), which can undergo proteolytic cleavage in pathological conditions, is well known to be involved in bone formation and mineralization. This study aimed to delineate the specific cleavage fragment, a neo-epitope for BGN (BGN262), in synovial fluid (SF) from young racehorses in training, osteoarthritic (OA) joints with subchondral bone sclerosis (SCBS), and chip fracture joints. A custom-made inhibition ELISA was developed to quantify BGN262 in SF. Cohort 1: A longitudinal study comprising 10 racehorses undergoing long-term training. Cohort 2: A cross-sectional study comprising joints from horses (N=69) with different stages of OA and radiographically classified SCBS. Cohort 3: A cross-sectional study comprising horses (N=9) with chip fractures. Receiver operating characteristic (ROC) curve analysis was performed (healthy joints vs chip joints) to evaluate BGN262 robustness. Cohort 1: SF BGN262 levels from racehorses showed a statistical increase during the first 6 months of the training period. Cohort 2: BGN262 levels were significantly higher in the SF from severe SCBS joints. Cohort 3: SF BGN262 levels in chip fracture joints showed a significant increase compared to normal joints. The ROC analysis showed an AUC of 0.957 (95% C.I 0.868-1.046), indicating good separation between the groups. The data presented show that BGN262 levels increase in SF in correlation with the initiation of training, severity of SCBS, and presence of chip fractures. This suggests that BGN262 is a potential predictor and a novel biomarker for early changes in subchondral bone (SCB), aiming to prevent catastrophic injuries in racehorses.

Fecal calprotectin as a biomarker of microscopic bowel inflammation in patients with spondyloarthritis.

Microscopic bowel inflammation is present in up to 60% of all patients with spondyloarthritis (SpA) and appears to be associated with more severe joint disease and a higher risk of developing inflammatory bowel disease (IBD). This study aimed to determine the utility of fecal calprotectin (fCAL) in evaluating endoscopic and histological bowel inflammation in SpA patients. Ileocolonoscopies with biopsies and fCAL measurements were performed in 65 patients with SpA. In 47 (72.3%) patients, the fCAL levels were higher than 50μg/g, whereas in 20 (30.7%), these levels were greater than 250μg/g. A total of 38 (58.5%) patients presented with microscopic bowel inflammation, and 13 (20%) presented with signs of endoscopic inflammation. fCAL levels were significantly higher in patients with microscopic bowel inflammation than in those without inflammatory findings (P < .001); additionally, these levels were slightly higher in patients with endoscopic signs of bowel inflammation (P=.053). A fCAL cutoff value of 96μg/g predicted histological bowel inflammation with 73% sensitivity and 67% specificity. No statistically significant difference was observed in the fCAL levels between patients who had been treated or not treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Our findings confirm a high prevalence of microscopic bowel inflammation in SpA patients, regardless of the use of NSAIDs. The evaluation of fCAL levels proved to be useful in the identification of microscopic inflammation and could help in the more judicious indication of ileocolonoscopy. These results support the use of fCAL for the evaluation of microscopic bowel inflammation in SpA patients.

3D-printed porous condylar prosthesis for temporomandibular joint replacement: Design and biomechanical analysis.

Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients. The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction. A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus. The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process. A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The.

Efficacy analysis of anterior debridement and bone graft fusion in the treatment of sacroiliac joint tuberculous arthritis: a retrospective analysis of 17 patients

BackgroundSacroiliac joint tuberculous arthritis is a relatively rare site of tuberculosis infection, but it can lead to severe sacroiliac joint destruction and dysfunction. Since there are few studies on the surgical methods of sacroiliac joint tuberculosis (SJT), we adopted three different surgical methods based on different degrees of destruction of sacroiliac joint tuberculous arthritis. While revealing its clinical symptoms to improve the diagnostic accuracy, and to determine the safety and feasibility of this surgical approach in the treatment of sacroiliac joint tuberculous arthritis.MethodsWe retrospectively analyzed 17 patients with tuberculous arthritis of the sacroiliac joint treated by anterior debridement. All these patients underwent anterior debridement of tuberculosis with or without bone graft fusion. Mean postoperative follow-up was 17.2 months (12–25 months). The erythrocyte sedimentation rate (ESR) was used to judge the general situation after surgery, and the fusion of sacroiliac joints was observed by X-ray films and CT scans. And VAS and ODI were used to score to observe postoperative functional recovery.ResultsAnterior approach debridement is an effective surgical approach for sacroiliac joint tuberculous arthritis. All patients achieved effective relief of lower back and hip pain. The pain was significantly relieved 3 months after the operation, and the pain basically disappeared 6 months after the operation. The erythrocyte sedimentation rate was also significantly reduced after the operation, and it can basically return to the normal level 3 months after the operation. The VAS score and ODI index of the other 16 patients after surgery were significantly lower than those before surgery, except for 1 patient who died of severe type I respiratory failure and septic shock 3 months after surgery, The surviving patients were basically able to achieve stable fusion of the sacroiliac joint at 12 months postoperatively. None of the patients reported significant pain until the last follow-up visit.ConclusionsThe anterior approach is a very effective surgical method for the treatment of sacroiliac joint tuberculous arthritis, and it is safe and feasible. A clear operative field of view facilitates complete debridement and reduces recurrence, and its function recovers well with stable arthrodesis.

Health Status of Ageing People A Case Study of Bisharanti Old Aged Home, Mulghat, Dhankuta

Health is a prime concern for the elderly people who reside in old age homes. Against this backdrop, this research has explored the condition of old aged people regarding their social and health-related issues in an old aged home. The research was carried out among the old-aged people residing at Bishranti Old Aged Home. Among the 40 participants of Bishranti Old Aged Home, 21 participants were selected purposively including 12 females and 9 males. The study concluded that the societal condition including racial, religious, familial and social-economic components were the prime reasons behind their residence in Bishranti Old Aged Home. Due to poor health of the ageing people living in the old aged home, they have been suffered from various physical, mental and social problems. More specifically, the research also indicated that the majority of the participants were victim of hypertension and severe joint pain. Moreover, many of the participants were the victims of diabetes, gastritis, depression, asthma, heart-diseases, chest pain, eye and ear problems etc.

Degenerative Spondylolisthesis Factors at Level L4–5: MR Imaging Findings

Introduction: Over time, the body, including the spine, undergoes anatomical and morphological changes. Magnetic resonance (MR) imaging is a good modality to analyse degenerative processes by evaluating joint deformity and fat accumulation in bone and muscle. We studied MR images from 22 patients diagnosed with spondylolisthesis at level L4-5 to characterise the factors that cause spondylolisthesis, including disc degeneration, facet joint osteoarthritis, fatty infiltration of the multifidus muscle and thickening of the ligamentum flavum. Materials and Methods: Twenty-two patients with degenerative spondylolisthesis diagnosed by MR imaging were enrolled in this study to characterise the following factors in the degenerative spine at level L4-5: intervertebral disc, facet joint, multifidus muscle and ligamentum flavum. Results: None of the evaluated factors were normal at level L4-5; all had degenerated to various degrees. Twelve discs (54.5%) showed a significant decrease in disc height with a hypointense signal, indicating grade IV. Fifteen cases (68.1%) showed narrowing and irregularity of the facet joint with marked osteophytes, suggesting severe joint osteoarthritis. In 11 cases (50%), fat had already infiltrated the multifidus muscles such that there was an equal amount of fat and muscle tissue, indicating grade III on the Goutallier classification. Thickening of ligamentum flavum was also observed, with maximal thickening of 6.7 mm (right) and 7.1 mm (left). Conclusion: Our study confirms that degeneration of the intervertebral disc, facet joint osteoarthritis, multifidus muscle fatty infiltration and thickening of ligamentum flava are present in patients with spondylolisthesis at level L4-5.

Xiong Fu Powder Regulates the Intestinal Microenvironment to Protect Bones Against Destruction in Collagen-Induced Arthritis Rat Models

BackgroundChanges in the intestinal microenvironment affected bone destruction in rheumatoid arthritis (RA), and spleen deficiency (SD) was closely related to the intestinal microenvironment. In this study, we aimed to explore the aggravation of SD on collagen-induced arthritis (CIA) and the bone protection of compound Xiong Fu powder (XFP) on CIA with SD (SD-CIA) based on the intestinal microenvironment.MethodAn SD-CIA rat model was established using Rheum officinale Baill. decoction combined with CIA and then treated with XFP. The aggravating action of SD on CIA rats and the efficacy of XFP were evaluated using AI scores, H&E staining of the joint, and level of serum anti–collagen type II antibody (Col II Ab). Bone destruction was assessed by micro-CT and TRACP staining. In addition, flow cytometry, qRT-PCR, and ELISA were used to evaluate gut mucosal immunity. Moreover, metagenomic sequencing was used to determine the distribution and function of the gut microbiota.ResultsCompared with that in CIA rats, bone destruction in SD-CIA rats was aggravated, as manifested by increased AI scores, more severe joint pathological changes and radiological damage, and increased number of osteoclasts (OCs) in the ankle joint. Meanwhile, the proportion of Tregs/Th17 cells was biased toward Th17 cells in Peyer’s patches. Furthermore, the gene levels of TNF-α, IL-1β, IL-6, and IL-17 were increased. In contrast, the expression of IL-10 and sIgA was decreased in the jejunum and ileum. XFP treatment improved bone damage and intestinal mucosal immune disorders compared with the SD-CIA group. In addition, the distribution and function of the gut microbiota were altered in the SD-CIA group. After XFP treatment, the community and function of the gut microbiota were regulated, manifested as increased abundance of several Lactobacillus species, such as L. acidophilus, which regulates the intestinal Tregs/Th17 cells and quorum sensing pathways, followed by promoting probiotic adhesion to the intestines.ConclusionSD can aggravate bone destruction in CIA rats. Compound XFP may attenuate bone destruction in SD-CIA rats by regulating the intestinal microenvironment. One of the mechanisms is the cross-talk between sIgA secretion regulated by intestinal mucosal Tregs and Th17 cells and adhesion of Lactobacillus mediated by quorum sensing.

Development of Highly Sensitive Sandwich ELISA for the Early-Phase Diagnosis of Chikungunya Virus Utilizing rE2-E1 Protein.

IntroductionChikungunya is caused by an alpha virus transmitted to humans by an infected mosquito. Infection is generally considered to be self-limiting and non-critical. Chikungunya infection may be diagnosed by severe joint pain with fever, but it is difficult to diagnose because the symptoms of chikungunya are common to many pathogens, including dengue fever. Diagnosis mainly depends on viral culture, reverse transcriptase polymerase chain reaction (RT-PCR), and IgM ELISA. Early and accurate diagnosis of the virus can be achieved by the application of PCR methods, but the high cost and the need for a thermal cycler restrict the use of such methods. On the other hand, antibody-based IgM ELISA is considered to be inexpensive, but antibodies against chikungunya virus (CHIKV) only develop after 4 days of infection, so it has limited application in the earlier diagnosis of viral infection and the management of patients. Because of these challenges, a simple antigen-based sensitive, specific, and rapid detection method is required for the early and accurate clinical diagnosis of chikungunya.MethodsThe amino acid sequence of CHIKV ectodomain E1 and E2 proteins was analyzed using bioinformatics tools to determine the antigenic residues, particularly the B-cell epitopes and their characteristics. Recombinant E2-E1 CHIKV antigen was used for the development of polyclonal antibodies in hamsters and IgG was purified. Serological tests of 96 CHIKV patients were conducted by antigen-capture ELISA using primary antibodies raised against rCHIKV E2-E1 in hamsters and human anti-CHIKV antibodies.ResultsWe observed high specificity and sensitivity, of 100% and 95.8%, respectively, and these values demonstrate the efficiency of the test as a clinical diagnostic tool. There was no cross-reactivity with samples taken from dengue patients.DiscussionOur simple and sensitive sandwich ELISA for the early-phase detection of CHIKV infection may be used to improve the diagnosis of chikungunya.

Bilateral Prosthetic Knee Joint Infection Caused by Brucella melitensis: A Rare Case Report from Iran

Introduction: Brucella prosthetic joint infection is a rare condition. We report a case of bilateral prosthetic knee joint infection caused by Brucella melitensis, which was cured by prolonged antibiotic therapy without implant removal. Case Presentation: A 62-year-old woman was admitted to the Labbafinejad Hospital (Tehran, Iran), complaining of pain and swelling in her knee joints from two months ago. She was also suffering from intermittent fever and night sweats. She underwent bilateral total knee arthroplasty five years ago because of a severe degenerative joint disease. Agglutination tests (wright and 2-mercaptoethanol (2-ME)) were positive. Her knee joint fluid and blood cultures yielded B. melitensis. The polymerase chain reaction result from her knee joint fluid was positive for Brucella spp. The patient was cured after combination therapy with doxycycline, rifampin, and gentamicin. The prosthesis was retained due to the lack of loosening in radiography. Ten months after the treatment, the patient had no symptoms and could walk with no pain. Conclusions: Clinicians should consider brucellosis in the differential diagnosis of prosthetic joint infection in the endemic regions. They should also be aware that if patients have no sign of implant loosening, they can achieve favorable outcomes only by using antibiotics and with no need for implant removal.

Roll of Stem Cell Therapy in Osteoarthritis

Osteoarthritis (OA) is by far the most prevalent type of degenerative joint disease. It is a painful, long-lasting disorder that can affect any synovial joint. Over the future decades, diseases would impose a significant socioeconomic burden on society as a result of an ageing population and rising disease prevalence [1]. The fact that there are few OA therapy choices complicates this situation. Since neither pharmacological nor non-operative treatments have shown to be effective in slowing or stopping the progression of disease, treatment is limited to managing aggravating variables over the long term and managing pain. When mechanical deformity is evident, surgical alternatives such as osteotomies are available to improve alignment and reduce the risk of OA; however, these operations are of limited effect once severe degenerative changes have occurred [2]. Despite improvements in these techniques, they cannot be used to treat more severe joint degeneration brought on by OA. The hunt for disease-modifying remedies goes on in the lack of successful tactics. For degenerative musculoskeletal disorders like OA, mesenchymal stem cells (MSCs) have been recommended as the best restorative cellular treatment. These cells can quickly multiply and differentiate into musculoskeletal lineages like bone and cartilage. They can be found in a range of tissues [3]. A large body of research has also shown that these cells control crucial immunologic processes by modifying the local inflammatory response. Together, these elements lend credence to MSCs' potential to prevent degenerative joint disease. Due to the fact that this cytotype can be found in a wide variety of tissues, research has concentrated on identifying the best source for MSC generation [4]. Thus, MSC-based therapeutic approaches can be employed to treat OA as a standard treatment plan in near future

First report of SYNE1 arthrogryposis multiplex congenita from Saudi Arabia with a novel mutation: a case report

BackgroundMyogenic Arthrogryposis Multiplex Congenita type 3 (AMC-3), is a rare congenital condition characterized by severe hypotonia, club feet, and multiple joint contractures often affecting both arms and legs which start prior to birth.Case presentationWe report a full-term neonate born to first-degree cousins from fourth-generation consanguineous families, who had with antenatal history of reduced fetal movements. At birth, he was noticed to have bilateral club feet, arthrogryposis, severe hypotonia, and absent deep tendon reflexes. The patient developed difficulty in breathing probably attributed to his generalized severe hypotonia, necessitating mechanical ventilation.His creatinine-phospho-kinase, electromyogram, and brain magnetic resonance imaging were normal. Whole-exome sequencing (WES) was requested for the genetic diagnosis of the case.WES identified a novel homozygous variant c.23415-3799C > G p. in the synaptic nuclear envelope protein1 [SYNE1] gene. Seven out of 20 bioinformatic in silico programs predicted a pathogenic effect for this variant. Segregation analysis of the variant in the parents and siblings revealed that both parents and one sibling were heterozygous for the same mutation which proved the variant significance and its autosomal recessive pattern of inheritance.ConclusionsAMC3 should be suspected in patients with decreased fetal movements, severe hypotonia, absent deep tendon reflexes, and arthrogryposis. SYNE1 gene mutations can be the underlying genetic defect and molecular genetic testing can prove the diagnosis.