Cartilage Integrity: A Review of Mechanical and Frictional Properties and Repair Approaches in Osteoarthritis.

Osteoarthritis (OA) is one of the most common causes of disability around the globe, especially in aging populations. The main symptoms of OA are pain and loss of motion and function of the affected joint. Hyaline cartilage has limited ability for regeneration due to its avascularity, lack of nerve endings, and very slow metabolism. Total joint replacement (TJR) has to date been used as the treatment of end-stage disease. Various joint-sparing alternatives, including conservative and surgical treatment, have been proposed in the literature; however, no treatment to date has been fully successful in restoring hyaline cartilage. The mechanical and frictional properties of the cartilage are of paramount importance in terms of cartilage resistance to continuous loading. OA causes numerous changes in the macro- and microstructure of cartilage, affecting its mechanical properties. Increased friction and reduced load-bearing capability of the cartilage accelerate further degradation of tissue by exerting increased loads on the healthy surrounding tissues. Cartilage repair techniques aim to restore function and reduce pain in the affected joint. Numerous studies have investigated the biological aspects of OA progression and cartilage repair techniques. However, the mechanical properties of cartilage repair techniques are of vital importance and must be addressed too. This review, therefore, addresses the mechanical and frictional properties of articular cartilage and its changes during OA, and it summarizes the mechanical outcomes of cartilage repair techniques.

Red LED light therapy for telogen effluvium in the course of long COVID in patients with and without androgenetic alopecia.

INTRODUCTION AND OBJECTIVE: Photobiomodulation with the use of light-emitting diodes (LEDs) seems to be a promising option for long COVID. This retrospective study evaluates the efficiency of LED irradiation in the treatment of TE in the course of long COVID in patients with and without androgenetic alopecia. MATERIAL AND METHODS: A retrospective single-centre chart review of patients with post-COVID hair loss was performed. 140 patients enrolled to the study were divided into four groups depending on the type of alopecia and treatment: 1) telogen effluvium with LED therapy (TE LED+), 2) telogen effluvium without LED therapy (TE LED-), 3) telogen effluvium and androgenetic alopecia with LED therapy (TE+AGA LED+), and 4) telogen effluvium and androgenetic alopecia without LED therapy (TE+AGA LED-). Clinical and trichoscopic parameters were compared. RESULTS: After 12 weeks, cessation of hair loss and a negative hair pull test were more common in TE LED+ and TE+AGA LED+ in comparison to the patients without LED therapy (p<0.001, p=0.035, respectively). An increased number of thick hairs and an increased number of hairs within follicular units were more common in patients treated with LED irradiation, regardless of the type of alopecia, compared to the patients without LED therapy. CONCLUSIONS: The study revealed that LED therapy is safe, well tolerated and seems to be a promising therapeutic option for TE in patients with long COVID. It can be used as adjuvant therapy leading to faster reduction of hair loss, enhancing hair regrowth as well as hair shaft thickness and density.

Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review.

Knee osteoarthritis (OA) is one of the leading causes of disability around the globe. Osteoarthritis is mainly considered a disease affecting the elderly. However, more and more studies show that sports overuse, obesity, or congenital disorders can initiate a pathologic cascade that leads to OA changes in the younger population. Nevertheless, OA mostly affects the elderly, and with increasing life expectancy, the disease will develop in more and more individuals. To date, the golden standard in the treatment of the end-stage of the disease is total joint replacement (TJR), which restores painless knee motion and function. One of the weakest elements in TJR is its bonding with the bone, which can be achieved by bonding material, such as poly methyl-methacrylate (PMMA), or by cementless fixation supported by bone ingrowth onto the endoprosthesis surface. Each technique has its advantages; however, the most important factor is the revision rate and survivor time. In the past, numerous articles were published regarding TJR revision rate, but no consensus has been established yet. In this review, we focused on a comparison of cemented and cementless total knee replacement surgeries. We introduced PICO rules, including population, intervention, comparison and outcomes of TJR in a PubMed search. We identified 783 articles published between 2010 and 2023, out of which we included 14 in our review. Our review reveals that there is no universally prescribed approach to fixate knee prostheses. The determination of the most suitable method necessitates an individualized decision-making process involving the active participation and informed consent of each patient.

Descriptive Analysis of Trauma Admission Trends before and during the COVID-19 Pandemic.

INTRODUCTION: Traumatic injuries are a significant global health concern, with profound medical and socioeconomic impacts. This study explores the patterns of trauma-related hospitalizations in the Lublin Province of Poland, with a particular focus on the periods before and during the COVID-19 pandemic. AIM OF THE STUDY: The primary aim of this research was to assess the trends in trauma admissions, the average length of hospital stays, and mortality rates associated with different types of injuries, comparing urban and rural settings over two distinct time periods: 2018-2019 and 2020-2021. METHODS: This descriptive study analyzed trauma admission data from 35 hospitals in the Lublin Province, as recorded in the National General Hospital Morbidity Study (NGHMS). Patients were classified based on the International Classification of Diseases Revision 10 (ICD-10) codes. The data were compared for two periods: an 11-week span during the initial COVID-19 lockdown in 2020 and the equivalent period in 2019. RESULTS: The study found a decrease in overall trauma admissions during the pandemic years (11,394 in 2020-2021 compared to 17,773 in 2018-2019). Notably, the average length of hospitalization increased during the pandemic, especially in rural areas (from 3.5 days in 2018-2019 to 5.5 days in 2020-2021 for head injuries). Male patients predominantly suffered from trauma, with a notable rise in female admissions for abdominal injuries during the pandemic. The maximal hospitalization days were higher in rural areas for head and neck injuries during the pandemic. CONCLUSIONS: The study highlights significant disparities in trauma care between urban and rural areas and between the pre-pandemic and pandemic periods. It underscores the need for healthcare systems to adapt to changing circumstances, particularly in rural settings, and calls for targeted strategies to address the specific challenges faced in trauma care during public health crises.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

Use of neural network based on international classification ICD-10 in patients with head and neck injuries in Lublin Province, Poland, between 2006-2018, as a predictive value of the outcomes of injury sustained.

INTRODUCTION AND OBJECTIVE: Head and neck injuries are a heterogeneous group in terms of both clinical course and prognosis. For years, there have been attempts to create an ideal tool to predict the outcomes and severity of injuries. The aim of this study was evaluation of the use of selected artificial intelligence methods for outcome predictions of head and neck injuries. MATERIAL AND METHODS: 6,824 consecutive cases of patients who sustained head and neck injuries, treated in hospitals in the Lublin Province between 2006-2018, whose data was provided by National Institute of Public Health / National Institute of Hygiene, were analyzed retrospectively. Patients were qualified using International Statistical Classification of Diseases and Related Health Problems (10th Revision). The multilayer perceptron (MLP) structure was utilized in numerical studies. Neural network training was achieved with the Broyden-Fletcher-Goldfarb-Shanno (BFGS) method. RESULTS: In the designed network, the highest classification efficiency was obtained for the group of deaths (80.7%). The average value of correct classifications for all analyzed cases was 66%. The most important variable influencing the prognosis of an injured patient was diagnosis (weight 1.929). Gender and age were variables of less significance with weight 1.08 and 1.073, respectively. CONCLUSIONS: Designing a neural network was hindered due to the large amount of cases and linking of a large number of deaths with specific diagnosis (S06). With a predictive value of 80.7% for mortality, ANN can be a promising tool in the future; however, additional variables should be introduced into the algorithm to increase the predictive value of the network. Further studies, including other types of injuries and additional variables, are needed to introduce this method into clinical use.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements.

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Mortality prediction by 'Life Threat Index' compared to widely used trauma scoring systems.

INTRODUCTION AND OBJECTIVE: Injuries are an extremely important problem in public life and account for up to one-third of deaths in the entire human population. Available trauma scoring systems provide a good estimation of mortality; however, some factors affect their utility in daily practice. Therefore, a new easily applicable in any given country trauma scoring system has been developed and proposed in this study. MATERIAL AND METHODS: A retrospective study of the medical records of 485 patients were evaluated, together with diagnostic performance with regard to mortality, was calculated for the Revised Trauma Score (RTS), Injury Severity Score (ISS), The New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), International Classification based Injury Severity Score (ICISS) and the newly-developed Life Threat Index (LTI). Sensitivity, specificity, accuracy, PPV and NPV were calculated for each scoring system, and overall diagnostic performance was estimated with the use of ROC curves. RESULTS: Apart from RTS, all scoring systems showed similar performance regarding mortality prediction. TRISS and LTI showed the highest sensitivity reaching 0.998 and AUC of 0.89 and 0.87, respectively, which proved its usefulness in predicting mortality. CONCLUSIONS: LTI proved to be one of the most sensitive in comparison with widely-used and recognized trauma scoring systems. Based on LTI methodology, it can be applied in any given country or region, even without a previously developed trauma database.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part II: Patellofemoral Joint.

Cartilage loss due to osteoarthritis (OA) in the patellofemoral joint provokes pain, stiffness, and restriction of joint motion, which strongly reduces quality of life. Early diagnosis is essential for prolonging painless joint function. Vibroarthrography (VAG) has been proposed in the literature as a safe, noninvasive, and reproducible tool for cartilage evaluation. Until now, however, there have been no strict protocols for VAG acquisition especially in regard to differences between the patellofemoral and tibiofemoral joints. The purpose of this study was to evaluate the proposed examination and acquisition protocol for the patellofemoral joint, as well as to determine the optimal examination protocol to obtain the best diagnostic results. Thirty-four patients scheduled for knee surgery due to cartilage lesions were enrolled in the study and compared with 33 healthy individuals in the control group. VAG acquisition was performed prior to surgery, and cartilage status was evaluated during the surgery as a reference point. Both closed (CKC) and open (OKC) kinetic chains were assessed during VAG. The selection of the optimal signal measures was performed using a neighborhood component analysis (NCA) algorithm. The classification was performed using multilayer perceptron (MLP) and radial basis function (RBF) neural networks. The classification using artificial neural networks was performed for three variants: I. open kinetic chain, II. closed kinetic chain, and III. open and closed kinetic chain. The highest diagnostic accuracy was obtained for variants I and II for the RBF 9-35-2 and MLP 10-16-2 networks, respectively, achieving a classification accuracy of 98.53, a sensitivity of 0.958, and a specificity of 1. For variant III, a diagnostic accuracy of 97.79 was obtained with a sensitivity and specificity of 0.978 for MLP 8-3-2. This indicates a possible simplification of the examination protocol to single kinetic chain analyses.

Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements.

Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient's point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1-10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part I: Femoral-Tibial Joint.

Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I-open kinetic chain, II-closed kinetic chain, and III-open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.

The Impact of Contaminating Poly (Methyl Methacrylate) (PMMA) Bone Cements on Their Compressive Strength.

This study presents an analysis of the impact of doping bone cement with saline. The two-ingredient cement, made right before the surgery, is subject to various kinds of organic contaminants and liquids used in the operating area, such as saline used to cleanse or cool it, during the process of mounting the prosthesis or bone-filling procedures. The processes of experimental destructive testing and statistical analysis have shown that, depending on the degree of saline doping, the static compressive strength parameters may greatly improve (with a low degree of contamination) or significantly worsen (when the contamination degree is higher). The limit value of the degree of salt admixture was estimated (2%), with which no statistically significant differences were observed in the cement strength in relation to the strength of non-contaminated cement.

Use of Deep Learning Networks and Statistical Modeling to Predict Changes in Mechanical Parameters of Contaminated Bone Cements.

The purpose of the study was to test the usefulness of deep learning artificial neural networks and statistical modeling in predicting the strength of bone cements with defects. The defects are related to the introduction of admixtures, such as blood or saline, as contaminants into the cement at the preparation stage. Due to the wide range of applications of deep learning, among others in speech recognition, bioinformation processing, and medication design, the extent was checked to which it is possible to obtain information related to the prediction of the compressive strength of bone cements. Development and improvement of deep learning network (DLN) algorithms and statistical modeling in the analysis of changes in the mechanical parameters of the tested materials will enable determining an acceptable margin of error during surgery or cement preparation in relation to the expected strength of the material used to fill bone cavities. The use of the abovementioned computer methods may, therefore, play a significant role in the initial qualitative assessment of the effects of procedures and, thus, mitigation of errors resulting in failure to maintain the required mechanical parameters and patient dissatisfaction.

Effect of Physiological Saline Solution Contamination on Selected Mechanical Properties of Seasoned Acrylic Bone Cements of Medium and High Viscosity.

Bone cements play a key role in present-day surgery, including the implantation of hip and knee joint endoprostheses. The correct and durable bonding of the prosthesis to the bone is affected by both the static strength characteristics determined in accordance with ISO 5833:2002 and the resistance to long-term exposure to an aggressive environment of the human body and the impurities that may be introduced into the cement during implementation. The study attempts to demonstrate statistically significant degradation of cement as a result of the seasoning of cement samples in Ringer's solution with simultaneous contamination of the material with saline solution, which is usually present in the surgical field (e.g., during the fixing of endoprostheses). The results of statistical analysis showed the nature of changes in compressive strength and microhardness due to seasoning time and degree of contamination.

Psoriatic arthritis - new perspectives.

Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and sciatic pain. In most patients with PsA, pharmacologic treatment with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologic agents is effective. However, when pharmacological treatment fails, patients with PsA may benefit from orthopedic surgery, which can improve both joint function and quality of life. Total hip arthroplasty, total knee arthroplasty, and arthroscopic synovectomy of the knee are the most common surgical procedures offered to patients with PsA. The management of PsA requires the care of a multidisciplinary team, which should include dermatologists, rheumatologists, physiotherapists, and orthopedic surgeons.