Soft Joint Research Articles

Exceptional preservation and foot structure reveal ecological transitions and lifestyles of early theropod flyers

Morphology of keratinised toe pads and foot scales, hinging of foot joints and claw shape and size all inform the grasping ability, cursoriality and feeding mode of living birds. Presented here is morphological evidence from the fossil feet of early theropod flyers. Foot soft tissues and joint articulations are qualitatively assessed using laser-stimulated fluorescence. Pedal claw shape and size are quantitatively analysed using traditional morphometrics. We interpret these foot data among existing evidence to better understand the evolutionary ecology of early theropod flyers. Jurassic flyers like Anchiornis and Archaeopteryx show adaptations suggestive of relatively ground-dwelling lifestyles. Early Cretaceous flyers then diversify into more aerial lifestyles, including generalists like Confuciusornis and specialists like the climbing Fortunguavis. Some early birds, like the Late Jurassic Berlin Archaeopteryx and Early Cretaceous Sapeornis, show complex ecologies seemingly unique among sampled modern birds. As a non-bird flyer, finding affinities of Microraptor to a more specialised raptorial lifestyle is unexpected. Its hawk-like characteristics are rare among known theropod flyers of the time suggesting that some non-bird flyers perform specialised roles filled by birds today. We demonstrate diverse ecological profiles among early theropod flyers, changing as flight developed, and some non-bird flyers have more complex ecological roles.

Dynamic Modeling of Underwater Snake Robot by Hybrid Rigid-Soft Actuation

For decades, underwater vehicles have been performing underwater operations, which are critical to the development and upgrading of underwater robots. With the advancement of technology, various types of robots have been developed. The underwater robotic snake is a bioinspired addition to the family of underwater robotic vehicles. In this paper, we propose an innovative underwater snake robot actuated by rigid propulsions and soft joints, which can improve the swimming efficiency and flexibility of the robot and reduce the probability of collision leading to damage. Existing math models of robotic snakes typically incorporate only planar motion, rarely considering spatial motion. So, we formulate a complete three-dimensional dynamic model for the robotic snake, which is extended by deriving expressions for the geometric Jacobians. This modeling approach is well suited since it provides compact matrix expressions and easy implementation. We use the constant curvature method to describe the configuration of the soft joint, use the Lagrangian method to obtain its dynamic characteristics, and focus on deriving the visco-hyperelastic mechanical energy of the soft material. Next, the local dynamics of soft members are extended as a nonholonomic constraint form for modeling the snake robot. Finally, the multi-modal swimming behavior of the robot has been verified by simulations, including forward and backward rectilinear motion, yaw turning, pitch motion, and spiral rising motion. The overall results demonstrate the effectiveness and the versatility of the developed dynamic model in the prediction of the robot trajectory, position, orientation, and velocity.

Lower Extremity Malformations.

Lower Extremity Malformations.

SMART Silly Putty: Stretchable, Malleable, Adherable, Reusable, and Tear-Resistible Hydrogels.

Cell engineering, soft robotics, and wearable electronics often desire soft materials that are easy to deform, self-heal readily, and can relax stress rapidly. Hydrogels, a type of hydrophilic networks, are such kind of materials that can be made responsive to environmental stimuli. However, conventional hydrogels often suffer from poor stretchability and repairability. Here, hydrogels consisting of boronic ester dynamic covalent bonds in a double network of poly(vinyl alcohol)/boric acid and chitosan are synthesized, which demonstrate extreme stretchability (up to 310 times the original length), instant self-healing (within 5 s), and reusability and inherent adhesion. Their instant stress relaxation stems from a low activation energy of the boronic ester bond exchange (≤20kJ mol-1 ) and contributes to the extreme stretchability and self-healing behaviors. Various water-dispersible additives can be readily incorporated in the hydrogels via hand kneading for potential applications such as soft electronics, bio-signal sensing, and soft artificial joints.

Osteoregenerative efficacy of a novel synthetic, resorbable Ca/P/S-based bone graft substitute in intra- and peri-articular fractures: a brief medical image-based report

BackgroundWhen a fracture goes into or around a joint, it usually damages the cartilage at the ends of bones and other joint tissue. As a result, the affected joints are prone to traumatic arthritis, leading to stiffness. Repairing bone damage, maintaining joint integrity, and avoiding subchondral and metaphyseal defects caused by comminuted fractures is often a great challenge for orthopedic surgeons. Tissue engineering of synthetic bone substitutes has proven beneficial to the attachment and proliferation of bone cells, promoting the formation of mature tissues with sufficient mechanical strength and has become a promising alternative to autograft methods. The purpose of this study is to retrospectively evaluate the clinical outcome and efficacy of a novel synthetic, highly biocompatible, and fully resorbable Ca/P/S-based bone substitute based on medical image findings.Materials and methodsA synthetic, inorganic and highly porous Ca/P/S-based bone-substituting material (Ezechbone® Granule, CBS-400) has been developed by National Cheng-Kung University. We collected fourteen cases of complex intra- and peri-articular fractures with Ezechbone® Granule bone grafting between 2019/11 and 2021/11. We studied the evidence of bone healing by reviewing, interpreting and analyzing the medical image recordings.ResultsIn the present study, CBS-400 was observed to quickly integrate into surrounding bone within three weeks after grafting during the initial callus formation of the early stage of repair. All of these cases healed entirely within three months. In addition, the patient may return to daily life function after 3.5 months of follow-up and rehabilitation treatment.ConclusionsEzechbone® Granule CBS-400 was proved capable of promoting bone healing and early rehabilitation to prevent soft tissue adhesions and joint contractures. Moreover, it has a high potential for avoiding ectopic bone formation or abnormal synostosis.Trial registrationThe Institutional Review Board at National Cheng Kung University Hospital (NCKUH) approved the study protocol (A-ER-109-031, 3-13-2020).

Efficacy and Safety of Viral Vector Based Gene Therapy in Patients with Hemophilia a: A Systematic Review

Background: Hemophilia A results from a mutation in the gene for coagulation factor VII and serious disease can cause bleeding in soft tissues and joints. These patients rely on exogenous factor VIII. However, frequent infusions are needed due to the short half-life of factor VIII which can lead to non-compliance to therapy and poor quality of life. Gene therapy aims to safely impart the expression of stable factor VIII. In this review, we will assess the efficacy and safety of gene therapy in hemophilia A. Methods: We searched PubMed, Web of Science, and clinicaltrials.gov with mesh terms, "hemophilia A" and "genetic therapy" from the inception of data till May 30, 2022. Out of 6,699 articles, 4 clinical trials (N=173) were included based on inclusion criteria measuring the efficacy and safety of gene therapy in hemophilia A. Case reports, review articles, systematic reviews, meta-analyses, pre-clinical studies, and clinical trials with irrelevant treatment or population were excluded. Results: In 4 clinical trials, 173 adult patients (<18 years old) were treated with vector-based gene therapy. Adeno-associated virus serotype 5 (AAV5) vector was used in 155 patients while SPK-8011 was used in 18 patients. 146 patients were treated at a high dose of 6x1013 vg/kg. All patients had a factor VIII activity of <1 IU/dl before therapy. In 2 clinical trials (N=139), mean factor VIII activity significantly increased to 45.42 IU/dl on treatment with 6x1013 vg/kg of AAV5-hFVIII-SQ. However, the activity level was ≤2 IU/dl after treatment at lower doses. On three years follow-up by Pasi et al. (N=7), the mean factor VIII activity level was 31 IU/dl. The mean annual bleeding rate decreased from 5.95 (N=139) to 0.95 after therapy. Mean consumption of factor VIII decreased from 4130.8 (N=139) to 21.84 IU/kg after treatment with 6x1013 vg/kg of AAV5-hFVIII-SQ. In one clinical trial by George et al., 18 patients were treated with SPK-8011-FVIII-SQ and the median annual bleeding rate decreased from 8.5 to 0.3. Mean factor VIII activity was 8 at a dose of 2x1012. ALT elevations, adrenal insufficiency, pyrexia, diarrhea, rectal hemorrhage, and progression of arthropathy were among the serious side effects reported in patients with gene therapy. Table 1. Conclusion: Gene therapy was well tolerated by most of the patients and ALT elevation was the most common adverse effect reported. AAV5-hFVIII-SQ and SPK-8011-FVIII-SQ significantly improved the endogenous production of factor VIII, bleeding rate, and factor VIII concentrate consumption, especially at doses of 6x1013 and 2x1012 vg/kg, respectively. AAV5-hFVIII-SQ was safe and effective in patients with hemophilia A on long-term follow-up. More randomized double-blind clinical trials are needed to confirm these results. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Soft joint shape measurement device based on FBG with a simple demodulating system.

Soft joint shape measurement is challenging because, in most cases, it relies solely on internal sensors. Existing shape estimation methods commonly take measurements at discrete points and utilize curve-fitting schemes, which are inefficient for complex joint shapes that require continuous measurements. Therefore joint shape measurement sensors rely on the fiber Bragg grating (FBG) due to its sensitivity, immunity to electromagnetic interference, and flexibility. Nevertheless, FBG demodulation is still an open research case. Hence, we propose a shape measurement device appropriate for FBG-based continuous measurements that employs a sensor with only three FBGs thrusting inside the soft joint to measure its 3D shape. Moreover, we develop a simple demodulating system exploiting the FBG's filter overlapping properties and design a calibrating process for FBG signals. Soft joint shape measurement experiments highlight our method's effectiveness, providing a relative error within 0.7%. Further tests involving continuum robot measurement reveal that the achieved precision is of the same level as a motion-capturing system.

Physical capability limits for right-angle power tool operation

Automotive assembly operations require power tools to secure fasteners and these operations have been linked to increased risk of musculoskeletal disorders. This work was designed to develop physical capability limits for direct current right-angle power tool (RAPT) operations using psychophysics. Forty females fastened joints of different hardness’s using three fastening strategies, at three fastening frequencies. Participants chose to fasten, independent of orientation, joints up to 89 (10.6) Nm using Atlas Copco’s TurboTight®, compared to 51.8 (8.1) Nm using Atlas Copco’s Quickstep and 48.6 (10.2) Nm using Stanley’s Automatic Tightening Control. The differences between fastening strategies were not as large when fastening soft joints; 59.2 (16.2), 52.3 (14.6), and 53.5 (11.3) Nm, respectively. As fastening frequency increased, participants chose lower target torque magnitudes to fasten. Based on this work, RAPT manufactures can adjust fastening strategies to improve their tool’s ergonomics performance. Practitioner summary: Fastening tasks was identified as posing an injury risk to workers performing automotive assembly, yet presently there are no published physical capability limits for direct current right-angle power tool operation. Using a psychophysical methodology, physical capability limits for RAPT fastenings were established for different joint hardness, fastening frequencies and RAPT position/orientation.

Modular Bioinspired Hand with Multijoint Rigid-Soft Finger Possessing Proprioception.

Soft robot hands have the advantage of remarkable adaptability for grasping. Especially for the soft and fragile objects, soft fingers had presented their much excellent potential compared with their rigid counterparts. However, less degree of freedom, lower force output, lack of proprioception, and poor controllability still limit the application. Inspired by the anatomical structure of the human hand and following the idea of combining soft joints, rigid skeletons and embedded soft curvature sensors, modular dexterous hands composed of multijoint fingers are proposed in this study. Each finger has three quasi-joints, in which metacarpophalangeal soft-joint can realize adduction/abduction and bending motions, and distal two interphalangeal soft-joints are actuated by one actuator. Similar to human hand, soft-joint so-called quasi-joint has a short length of constant curvature segment. The integrated Indium Gallium Alloy sensors with Kelvin Bridge for proprioception can accurately detect joint angles, while closed-loop control based on proprioception was accomplished. Kinematics and statics modeling method of the rigid-soft finger is proposed. To further verify the performance of this design, prototypes of three-fingered and five-fingered hands are developed. The multifingered hands had demonstrated their capability of adaptive grasp and dexterous manipulation, while the force output of the three-fingered hand is up to 31.82 N, and 32 grasp types had accomplished by the five-fingered hand.

EVALUATION OF HAND AND WRIST JOINTS USING ULTRASONOGRAPHY AND DOPPLER IN PATIENTS OF RHEUMATOID ARTHRITIS: COMPARISON WITH CONVENTIONAL RADIOGRAPHY AND CLINICAL CORRELATION

Background- Ultrasound (US) together with power Doppler (PD) are progressively being employed to assess joint involvement in rheumatoid arthritis (RA). High-resolution US permits direct assessment of intra-articular and periarticular inammatory activity and structural damage in inammatory arthritis. To analyze the quality of point-of-care hand and wrist ultra Objective- sound (US) examination in patients with established rheumatoid arthritis, it's comparison with standard radiography and clinical correlation. This prospective study was performed in 32 Methodspatients. Gray scale and power doppler ultrasonography of bilateral hand and wrist joint were performed employing a high-frequency linear transducer. Various ndings were recorded together with synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. ResultsUltrasound detected a lot of abnormalities within hand joints than the clinical examination. Synovial hypertrophy was detected altogether in 24 (75%) patients on gray scale ultrasound, active synovitis detected by using Doppler US in 20 patients (62.5%), effusion was detected in 10 patients (37.5 %), bone erosions (mostly in DIP and PIP joints) were detected in 20 patients (62.5%) and X-ray nding was detected in 8 patients (25%). There was a positive correlation of Power Doppler with synovial hypertrophy, bone erosions, Erythrocyte Sedimentation Rate and Disease Activity Score. Ultrasound could be a helpful reliable modality for the target assess Conclusion- ment of both soft tissue and erosive joint changes occurring in early stage in rheumatoid arthritis. Power doppler scores can be applied with bigger accuracy than clinical scores of synovitis in rheumatologic practice to enable therapeutic choices and to evaluate disease outcome and response to treatment.

Bloodstream infections in Injecting drug users: A 15 year prospective single-centre study

• IDUs accounted for nearly 8% of all community acquired bloodstream infections. • S . aureus and S. pyogenes were the most common pathogens. • The commonest foci of infection were skin/soft tissue and septic thrombophlebitis. • Infective endocarditis was relatively uncommon but was associated with mortality. • Septic thrombophlebitis caused more septic pulmonary emboli than endocarditis. To describe the microbiological and clinical characteristics of bloodstream infections (BSIs) in Injecting Drug Users (IDUs). All episodes of community-acquired BSI in IDUs were reviewed. Demographic, clinical and microbiological data were analysed. Detailed analyses were performed for septic thrombophlebitis and infective endocarditis (IE). Historical analysis of microbiological characteristics of BSIs from 1970 to 2018 was performed. There were 406 episodes of BSI in IDUs accounting for 7.8 % of community-acquired BSIs from 2004 to 2018. Patients were male in 77.3 % of episodes. Median age was 38.1 years. Positive HIV status was confirmed in 14 % of episodes. The commonest infecting species were Staphylococcus aureus (45.8 %) and Streptococcus pyogenes (11.8 %). Polymicrobial BSIs accounted for 20.2 % of infections; other streptococci (12.8 %), gram-negative bacilli (4.9 %) and anaerobes (2.7 %) accounted for most of the remainder. The commonest foci of infection were skin and soft tissue (26.4 %), septic thrombophlebitis (20.4 %), bone and joint (17.5 %) and IE (11.8 %). Overall inpatient mortality was 5.9 %. IE and necrotizing fasciitis were associated with increased risk of death. IDUs accounted for a significant proportion of community-acquired BSIs. Skin and soft tissue infection and septic thrombophlebitis were the commonest foci of infection. IE is rare, but mortality is high.

Hyaline Fibromatosis Syndrome Presenting with Nasal Mass: A Case Report.

Hyaline fibromatosis syndrome (HFS) is a rare, autosomally-recesfvsive disease characterized by papulonodular skin lesions, soft tissue masses, joint contractures, gingival overgrowth, and osteolytic bone lesions. Mutations in capillary morphogenesis gene 2 are responsible for both these conditions. Generally, an autosomal recessive pattern is assumed to be the most common mode of inheritance. Here, we report an unusual case of a twenty-three-year-old female patient with HFS who reported with a chief complaint of growing nasal mass for three months. There was no history of pain or bleeding associated with the nasal mass. Due to the growing mass, she experienced right nasal obstruction, which compromised her quality of life. There was an unremarkable family history. Her physical examination revealed multiple asymptomatic pinkish-white papulonodular lesions located at multiple sites. Intra orally, she had generalized gingival enlargement. Her nasal examination revealed a right sided nasal mass, bright red in color. The lesion was soft on palpation. All the results of hematological and biochemical tests were normal. However, skeletal radiographic examination showed the joint contractures on her knees and elbows without the presence of osteolytic bone lesions. The nasal lesion was surgically excised and histopathological examination revealed features suggestive of HFS.

Stretching Training Rehabilitation Has Potential to Alleviate Ankylosing Spondylitis in Mice by Inactivating the Wnt/β-Catenin Pathway.

Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by invasion of the joints of the central axis that involves soft tissues and joints surrounding the spine. Stretching training rehabilitation (STR) has been widely applied for the treatment of AS. The Wnt/β-catenin signalling pathway is closely related to AS. In this study, we aimed to explore the potential molecular mechanisms underlying the protective effect of STR on AS both in vitro and in vivo. Male DBA/1 mice were employed to establish an AS animal model. Hematoxylin-eosin staining showed that STR reversed pathological damages in bone tissues and the total antioxidant capacity of AS mice and increased the antioxidant capacity by upregulating superoxide dismutase and malondialdehyde expression in DBA/1 mice. The MTT, RT-qPCR, and Western blotting results further indicated that STR improved the survival rate of cells by downregulating the expression of target genes in the Wnt/β-catenin pathway and by inhibiting cell inflammation and apoptosis. In conclusion, our findings indicated that STR treatment might be an effective therapeutical strategy for AS.

The Impact of Treatment Method and Timing on the Long Term Outcomes of Pediatric Clubfoot Management

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Ponseti method of serial casting has been widely accepted as the new gold standard for management of idiopathic clubfoot, replacing joint invasive surgery, once the method-of-choice. While the short to midterm advantages of the method have been widely confirmed in the literature, there are limited comparative studies of the longer term outcomes. Dr. Ponseti's own definitive assessment of the long term result has not been decisively reevaluated by the literature. This systematic review compares the long-term functional outcomes of the two pediatric clubfoot management methods across different ages at treatment. Methods: A comprehensive search was conducted of PubMed, CINAHL, Web of Science, and Cochrane from inception to December 2020 to identify literature on clubfoot. Using PRISMA guidelines, the search terms clubfoot OR clubfeet OR clubbed foot OR clubbed feet OR talipes equinovarus were used. Articles containing more than three human subjects, were included. The database was searched for longitudinal studies of pediatric, idiopathic clubfoot management with the Ponseti method or joint invasive surgery. Retrospective studies of primary Ponseti treatment with serial casting or invasive soft tissue release and joint surgery that was performed on newly born and children up to twenty four months old and with reported mean follow-up of two years or longer were included. Evaluation reported according to different scoring systems were dichotomized as success (good to satisfactory results) or failure (residual or relapse that requires corrective management). Probability of less than 0.05 is considered statistically significant. Results: The initial search yielded 2907 articles, of which 29 articles reporting 2597 pediatric idiopathic clubfeet were included in this review, managed with either Ponseti casting, (group P = 1545 feet), or other surgical techniques, (group S = 1052 feet). The outcomes of 684 feet from group P with a mean long term follow up of 21+-13years were significantly superior to 1028 feet from group S with a mean follow up of 16+-5 years (p = 0.0002, odds ratio = 1.478). Multivariate analysis on 1310 feet from group P with mean age of 4.4 months (Range 1 - 8.9) against 794 feet from group S with mean age of 10.8 months (Range 1 - 22) detects no significant dependency on age (p = 0.128). Conclusion: The Ponseti method of serial casting resulted in significantly higher long term satisfaction outcomes compared with invasive surgical techniques in treatment of congenital clubfoot when performed within the first year of life. The findings supported Dr. Ponseti's own assessment regarding the high long term satisfaction rate (8+ years). Age was not found to be a significant contributor to the success of Ponseti casting over invasive surgery even though casting often started much earlier than surgery.

Evaluation of Knee Joint Injuries with Magnetic Resonance Imaging (MRI) and Correlation with Arthroscopy

One of the most frequent issues humans have had to deal with from the beginning of time is a knee injury. Knee injuries caused by a variety of diseases, from acute to degenerative, can affect the articular cartilage. The trauma, infection, or inflammation caused this injury. In these circumstances, a full clinical examination is not possible since the patients are in too much pain to cooperate. Then non-invasive multiplanar imaging and MRI come into play. The objective of the current study was to assess knee joint injuries using MRI and correlate those findings with arthroscopy. A total number of 225 participants were involved in this study, among them, 175 had issues with a knee injury. The patients referred with a history of knee injury were imaged with a 1.5 Tesla MRI machine. Most patients were between the ages of 35-40 years. The most frequent injuries found in the study were bone contusions, joint effusions, anterior cruciate ligament tears, and tears of the posterior horn of the medial meniscus. The accuracy percentage of ACL, PCL, LCL and MCL were 93, 100, 94.02 and 91.34%, respectively. Due to its great soft tissue contrast resolution and multiplanar imaging capabilities, magnetic resonance imaging (MRI) is a superior non-invasive investigative method for knee injuries. This allows for the most thorough evaluation of a variety of soft tissue knee joint problems. Keywords: Knee joint injury; Magnetic resonance imaging; Arthroscopy;

Foot and Ankle Conventional Radiography in Juvenile Idiopathic Arthritis: Does It Still Matter?

Objectives:The aim of this study was to evaluate the residual value of Conventional Radiography in children with arthralgia clinically suspected of Juvenile Idiopathic Arthritis (JIA).Materials and Methods:Three hundred seventy-two patients aged 1–18 years suspected of JIA were retrospectively reviewed. All patients had foot and ankle plain films performed in standard two projections: ankle in antero-posterior and lateral, and foot in antero-posterior and oblique. The cohort was divided into two groups: patients with confirmed JIA and non-JIA control group of children with foot and ankle arthralgia without diagnosis of inflammatory connective tissue disease. Radiographic findings in both groups were compared.Results:In 40% of JIA and 70% of non-JIA patients radiographs were normal. All radiographic findings were significantly more common in JIA than in non-JIA group (p = 0.000). Soft tissue swelling was the most frequent abnormality found in JIA patients (31, 51%) and only in 2.41% of non-JIA patients (p = 0.000). Osteoporosis and joint space narrowing were also significantly more common in JIA group (p = 0.000). The majority of imaging findings in non-JIA group were non-inflammatory abnormalities.Conclusion:Conventional radiography is an important tool in differential diagnosis of arthralgia of unknown etiology, as soft tissue swelling, osteoporosis and joint space narrowing are significantly more common in JIA patients as compared with patients without the diagnosis of inflammatory connective tissue disease. However, in case of high clinical suspicion of JIA and normal radiography, we recommend subsequent ultrasound (US) and/or MRI to allow early treatment.

The role of trauma and isomorphic reaction in the pathogenesis of psoriatic arthritis

The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the deep Koebner phenomenon. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 20102021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.

MiGriBot: A miniature parallel robot with integrated gripping for high-throughput micromanipulation.

Although robotic micromanipulation using microtweezers has been widely explored, the current manipulation throughput hardly exceeds one operation per second. Increasing the manipulation throughput is thus a key factor for the emergence of robotized microassembly industries. This article presents MiGriBot (Millimeter Gripper Robot), a miniaturized parallel robot with a configurable platform and soft joints, designed to perform pick-and-place operations at the microscale. MiGriBot combines in a single robot the benefits of a parallel kinematic architecture with a configurable platform and the use of soft joints at the millimeter scale. The configurable platform of the robot provides an internal degree of freedom that can be used to actuate microtweezers using piezoelectric bending actuators located at the base of the robot, which notably reduces the robot's inertia. The soft joints make it possible to miniaturize the mechanism and to avoid friction. These benefits enable MiGriBot to reach a throughput of 10 pick-and-place cycles per second of micrometer-sized objects, with a precision of 1 micrometer.

Procalcitonin Role in Musculoskeletal Infection: A Comparative Prospective Study

Early diagnosis of musculoskeletal infections is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. White blood cell count, erythrocyte sedimentation rate and C-reactive protein are not specific as they can also be elevated in conditions other than bacterial infections. Materials Culture and sensitivity is not a true gold standard due to its varied positivity rates. Serum Procalcitonin (PCT) is one of the new laboratory markers for pyogenic infections. The objective of this study is to assess the value of PCT in diagnosis of soft tissue, bone and joint infections. Patients and Methods: Patients of all age groups (seventy-four patients) with diagnosis of musculoskeletal infection are prospectively included in this study. All patients were subjected to White blood cell count, erythrocyte sedimentation rate, C-reactive protein and serum Procalcitonin measurements. Healthy non infected outpatient group (twenty-two patients) taken as a control group and underwent the same evaluation steps as the study group. Results: The study group showed mean Procalcitonin levels of 1.3 ng/ml. Procalcitonin, at 0.5 ng/ml, was (42.6%) sensitive and (95.5%) specific in diagnosing of musculoskeletal infections with (positive predictive value of 87.5% and negative predictive value of 48.3%) and (positive likelihood ratio of 9.3 and negative likelihood ratio of 0.6). Conclusion: Serum Procalcitonin, at a cut – off of 0.5 ng/ml, is a specific but not sensitive marker in the diagnosis of musculoskeletal infections, and it can be used effectively to rule in the diagnosis of infection but not to rule out it.

Clinical triad with multi-biopsy histopathology as a reliable diagnostic marker of mycetomas: a retrospective review from a tertiary care center.

Mycetoma is a neglected tropical infectious disease which runs a prolonged and protracted course. Microbiological confirmation is diagnostic yet unreliable due to poor sensitivity and variable availability of culture facilities in resource poor settings. A retrospective review was performed on electronic records (histopathology, microbiology, and radiology) of all patients who underwent skin biopsies with mycetoma as one of the clinical differential diagnoses from year 2016 to 2020. Out of 73 patients biopsied with a differential of mycetoma, 42 fit the clinical triad of swelling-sinuses-granules. After clinical, microbiological, pathological, and radiological correlation, 31 cases were of eumycetoma and seven were of actinomycetoma. Mean patient age was 37.58 ± 13.8 years with a male to female ratio 2.45 : 1 and mean disease duration of 11.31 ± 10.9 years. Histopathological findings revealed fungal hyphae in 18 cases and gram-positive bacteria in six cases. Fungal culture was positive in 13 cases with the three commonest organisms being Madurella mycetomatis in five cases, Fusarium and Aspergillus nidulans in two cases each. X-ray changes of soft tissue, bones, and joints were seen in 25 cases, and "dot-in-circle" sign was seen in eight of nine MRIs. Eumycetoma was more common than actinomycetoma in our setup, ratio being 4.43 : 1. A clinical triad of swelling, multiple sinuses and grainy discharge with any one diagnostic support (histopathology/radiology) is sufficient to make a definitive diagnosis of mycetoma in the absence of microbiological identification.