Focused ultrasound for the treatment of facet joint pain: a systematic review.

OBJECTIVE: Chronic low-back pain (LBP) is a leading cause of disability worldwide, and traditional pharmacotherapy fails to provide relief for many individuals with this condition. An estimated 15% of chronic LBP cases can be attributed to the facet joint. High-intensity focused ultrasound (HIFU) is a recent technology that enables noninvasive thermal ablation of tissue and has shown efficacy in treating tumors, neuropathic pain, and painful bone metastases. In this systematic review, the authors summarize the literature on lumbar facet joint-mediated pain treated with HIFU and report the effectiveness of HIFU on pain outcomes. METHODS: All full-text English-language articles describing the use of focused ultrasound for facet joint pain were screened using the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases. Clinical studies were assessed for bias using the methodological index for nonrandomized studies. RESULTS: Eleven studies (6 preclinical and 5 clinical) reporting on 50 patients were included. Eight of these studies (73%) used MR-guided focused ultrasound ablation and 3 used fluoroscopy. The medial branch nerve and posterior facet joint capsule were the most common targets for focused ablation. Although the energy used ranged from 300 to 2000 J, clinical studies predominantly operated in the range of 1000 to 1500 J. Pain reduction was seen in all clinical studies, with multiple-point reductions from average baseline pain scores in 6-12 months. No study reported any adverse events or complications. CONCLUSIONS: HIFU can be effective in treating chronic low-back pain arising from the facet joint. Further clinical studies should explore the long-term effects of HIFU and monitor changes in pain reduction over time.

The joint associations of physical activity and ultra-processed food consumption with depression: A cohort study in the UK Biobank.

BACKGROUND: Despite substantial evidence regarding independent associations between physical activity (PA) and ultra-processed foods (UPF) consumption with depression, the joint effects of these two factors remain unknown. METHODS: This study included 99,126 participants without depression in the UK Biobank at baseline. A 24-h recall method was used to assess UPF consumption, and self-reported total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed by metabolic equivalent task (MET). A series of Cox proportional hazard regression models were used to explore the independent and joint effects of TPA, MVPA, VPA and UPF consumption on depression. RESULTS: The incidence rate of depression was 1.94 % [95 % confidence interval (CI): 1.80 %-2.10 %] per 1000 person-years after an average follow-up of 12.10 years. We found that MVPA and UPF consumption had additive interactions on depression risk (p < 0.05). Participants in Q1 of TPA and Q4 of UPF consumption (HR: 1.83, 95%CI: 1.45-2.31) showed a higher risk for depression than those in Q4 of TPA and Q1 of UPF consumption. Compared with the participants with WHO guideline-recommended MVPA and the lowest UPF consumption, those below recommended MVPA (HR: 1.51, 95%CI: 1.20-1.89) or above recommended MVPA (HR: 1.40, 95%CI: 1.10-1.78) and with the highest UPF consumption had a higher risk for depression. LIMITATIONS: Study limitations include use of self-reported data, observational study and concerns regarding generalizability. CONCLUSION: Higher UPF consumption, accompanied by lower PA levels regardless of TPA, MVPA, and VPA, is associated with a higher risk of depression. Our study offers insights on public health priorities to decrease the risk of depression in the population by addressing both PA and UPF consumption together.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons.

OBJECTIVES: To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. METHODS: This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. RESULTS: For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. CONCLUSION: Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.

[Lower limb joint contact forces and ground reaction forces analysis based on Azure Kinect motion capture].

Traditional gait analysis systems are typically complex to operate, lack portability, and involve high equipment costs. This study aims to establish a musculoskeletal dynamics calculation process driven by Azure Kinect. Building upon the full-body model of the Anybody musculoskeletal simulation software and incorporating a foot-ground contact model, the study utilized Azure Kinect-driven skeletal data from depth videos of 10 participants. The in-depth videos were prepossessed to extract keypoint of the participants, which were then adopted as inputs for the musculoskeletal model to compute lower limb joint angles, joint contact forces, and ground reaction forces. To validate the Azure Kinect computational model, the calculated results were compared with kinematic and kinetic data obtained using the traditional Vicon system. The forces in the lower limb joints and the ground reaction forces were normalized by dividing them by the body weight. The lower limb joint angle curves showed a strong correlation with Vicon results (mean ρ values: 0.78 ~ 0.92) but with root mean square errors as high as 5.66°. For lower limb joint force prediction, the model exhibited root mean square errors ranging from 0.44 to 0.68, while ground reaction force root mean square errors ranged from 0.01 to 0.09. The established musculoskeletal dynamics model based on Azure Kinect shows good prediction capabilities for lower limb joint forces and vertical ground reaction forces, but some errors remain in predicting lower limb joint angles.

Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes.

BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion.

Impact of gender, posture and phase on back and lower extremity moments and muscle excitation during lifting task: a cross-sectional study.

Purpose: The aim of this work was to investigate and compare back and lower extremity joint moments and muscle excitation during stoop and squat postures by incorporating gender-based differences and analyzing lifting phases. Methods: 18 healthy adults (9 males and 9 females; age: 24.44 ± 4.96 years, body mass: 66.00 ± 12.10 kg, height: 170.11 ± 9.20 cm, lean body mass: 48.46 ± 7.66 kg) lifted an object 30% of their lean body mass using squat and stoop postures. Marker-based motion capture, force plate, and surface electromyography were synchronously used to acquire joint moments and muscle excitation. A 3-way mixed model analysis was performed to determine the effect of gender, posture, and phase on internal joint moments and muscle excitation of the lower back and extremities. Results: Significant differences were observed in the interaction of lifting posture and phase on lower extremity moments and excitation of rectus femoris and medial gastrocnemius. Individual effects of posture were significant for peak internal joint moments of the lower extremities only. Anterior lower extremity muscles showed significantly increased excitation during squat, whereas medial gastrocnemius was higher in stoop. Joint moments and muscle excitations were all higher during the lifting than the bending phase. Gender differences were found only in the peak lumbosacral sagittal plane moment and rectus femoris muscle excitation. Conclusions: The study identified significant variations in the joint moments and muscle excitation in lifting, influenced by gender, posture, and phase, highlighting its complex nature. Overall interactions were lacking, however individual effects were evident, necessitating larger future studies.

Preoperative low serum albumin increases the rate of perioperative blood transfusion in patients undergoing total joint arthroplasty: propensity score matching.

BACKGROUND: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA). METHODS: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes. RESULTS: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888-0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50-2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30-37.3 g/L, 25-30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37-1.99, P < 0.001), 5.4 (95% CI 3.08-9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively. CONCLUSION: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion. TRIAL REGISTRATION: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.

Role of unilateral partial facet joint preservation in postero-lateral approach lumbar interbody fusion for patients with degenerative lumbar spinal stenosis presenting bilateral lower limb symptoms: a retrospective study.

BACKGROUND: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. METHODS: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. RESULTS: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05). CONCLUSION: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients.

Joint and interactive associations of body mass index and genetic factors with cardiovascular disease: a prospective study in UK Biobank.

BACKGROUND: Both body mass index (BMI) and genetic factors independently contribute to cardiovascular disease (CVD). However, it is unclear whether genetic risk modifies the association between BMI and the risk of incident CVD. This study aimed to investigate whether BMI categories and genetic risk jointly and interactively contribute to incident CVD events, including hypertension (HTN), atrial fibrillation (AF), coronary heart disease (CHD), stroke, and heart failure (HF). METHODS: A total of 496,851 participants from the UK Biobank with one or more new-onset CVD events were included in the analyses. BMI was categorized as normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥ 30.0 kg/m2). Genetic risk for each outcome was defined as low (lowest tertile), intermediate (second tertile), and high (highest tertile) using polygenic risk score. The joint associations of BMI categories and genetic risk with incident CVD were investigated using Cox proportional hazard models. Additionally, additive interactions were evaluated. RESULTS: Among the 496,851 participants, 270,726 (54.5%) were female, with a mean (SD) age was 56.5 (8.1) years. Over a median follow-up (IQR) of 12.4 (11.5-13.1) years, 102,131 (22.9%) participants developed HTN, 26,301 (5.4%) developed AF, 32,222 (6.9%) developed CHD, 10,684 (2.2%) developed stroke, and 13,304 (2.7%) developed HF. Compared with the normal weight with low genetic risk, the obesity with high genetic risk had the highest risk of CVD: HTN (HR: 3.96; 95%CI: 3.84-4.09), AF (HR: 3.60; 95%CI: 3.38-3.83), CHD (HR: 2.76; 95%CI: 2.61-2.91), stroke (HR: 1.44; 95%CI: 1.31-1.57), and HF (HR: 2.47; 95%CI: 2.27-2.69). There were significant additive interactions between BMI categories and genetic risk for HTN, AF, and CHD, with relative excess risk of 0.53 (95%CI: 0.43-0.62), 0.67 (95%CI: 0.51-0.83), and 0.37 (95%CI: 0.25-0.49), respectively. CONCLUSIONS: BMI and genetic factors jointly and interactively contribute to incident CVD, especially among participants with high genetic risk. These findings have public health implications for identifying populations more likely to have cardiovascular benefit from weight loss interventions.

Chronic Bilateral Olecranon Bursitis: A Case Report.

Olecranon bursitis is a common condition that primarily affects men between the ages of 30 and 60. Although the conservative treatment of acutely inflamed olecranon bursitis is relatively straightforward, managing chronic olecranon bursitis can be challenging. In this publication, we report a case of rare bilateral chronic olecranon bursitis and discuss the rationale for choosing the best treatment option.

The Prevalence of Temporomandibular Disorders Among Dental and Medical Students in Taif, Saudi Arabia: A Cross-Sectional Study.

Objectives  This study was undertaken to investigate the prevalence of temporomandibular disorders (TMDs) and the impact of various contributing factors among undergraduate healthcare students in the region of Taif, Saudi Arabia. Methods A total of 100 undergraduate students were recruited from both the College of Medicine and the College of Dentistry at Taif University, Taif, Saudi Arabia. Data were collected on demographic parameters and the Helkimo's index (anamnestic {Ai} and clinical dysfunction {Di} component) using an anonymous self-administered questionnaire, as well as clinical examinations.  Results A significantly high prevalence (97%) of TMDs was observed among the sampled students, with most of them (44.0%) experiencing severe symptoms that might negatively impact their quality of life. On clinical examinations, most of the students (75.0%) showed signs of mild clinical dysfunction, which might indicate an early stage of TMD. Moreover, factors that include older age, majoring in "dentistry" studies, being allergic, having oral habits, poor mental health, and previous COVID-19 infections were found to be significantly associated with TMDs. Conclusion The findings indicate a relatively high TMD prevalence among the sampled undergraduate healthcare students, especially those studying "dentistry". Curriculum modifications, coupled with more awareness and education, are recommended to achieve early diagnosis and help in reducing the incidence of TMD among this population.

Assessment of Hip and Lumbar Spine Range of Motion After Total Hip Arthroplasty Using a Single Camera Markerless System.

BACKGROUND: Total hip arthroplasty (THA) is one of the most cost-effective and successful procedures in orthopedics. However, assessing the post-operative range of motion (ROM) remains a challenge due to the limitations of traditional measurement methods. This study aimed to evaluate hip and spine ROM post-operatively and single-leg balance, using a single-camera markerless motion capture system, and compare outcomes with pre-operative ROM and with an age-matched healthy control group. METHODS: An interventional study was conducted from January 2018 to December 2021. Twenty patients with hip osteoarthritis underwent THA and were assessed using a single-camera markerless system (Kinetisense software). Measurements were taken one month pre-operatively and one year post-operatively. RESULTS: Significant improvements were observed in hip and lumbar spine ROM variables after THA. The most notable enhancements were in hip and spinal flexion. Compared to the control group, the THA group showed minor deficits in hip ROM, particularly in external rotation. Single-leg balance demonstrated improved stability post-operatively. CONCLUSIONS: The single-camera markerless motion capture system offers a promising alternative for assessing hip and lumbar spine ROM, presenting potential advantages over manual goniometry and traditional 3D motion capture systems. Using this system for the evaluation of patients after THA, it seems that THA significantly enhances hip and lumbar spine ROM. Future research should focus on validating the accuracy of markerless systems.

Prediction of prognosis in supramalleolar osteotomy with or without additional fibula osteotomy by approaching a biomechanical study: a finite element analysis.

Supramalleolar osteotomy (SMO) is a representative procedure to restore a malalignment in the varus ankle deformity by shifting the concentrated pressure on the medial ankle joint to the lateral area. Additionally, fibula osteotomy (FO) is selectively selected and performed according to the surgeon's preference. However, it is controversial whether FO is effective in shifting the abnormal pressure from the medial to the lateral area on the ankle joint. Some cadaveric studies have been performed to prove this. However, it is difficult to consistently reconstruct amount of the varus ankle deformities angle in cadavers and to guarantee reliable contact pressure between the ankle joint. Thus, the aim of this study was predicted and quantitatively compared a peak pressure between single SMO and SMO with FO procedure by using a finite element analysis as a powerful biomechanical tool to those limitations of cadaveric study. This study reconstructed total 4 3D foot and ankle models including a normal and pre-op model and 2 post-op models. The pre-op model was modified by assigning 10° varus tilting corresponding to stage 3b in the classification of varus ankle osteoarthritis based on the validated normal model. Also, the post-op models were reconstructed by applying single SMO and SMO with FO, respectively. All of the models were assumed as one-leg standing position and to mimic smooth ankle joint motion. Peak contact pressure change was predicted at the medial ankle joint by using computational simulation. As a result, 2 post-op models showed a remarkably peak pressure reduction by up to 5.5 times on the medial tibiotalar joint. However, a comparison between single SMO and SMO with FO model showed no appreciable differences. In conclusion, this study predicted that single SMO may be as effective as SMO with FO in reducing peak contact pressure on the medial tibiotalar joint in varus ankle osteoarthritis.

Isolated cuboid dislocation: case report.

Isolated cuboid dislocation without fracture is a rare injury, and there is a lack of literature describing its treatment. Studies report the use of closed or open reduction, with Kirschner wire fixation in the treatment of these injuries. This case report presents the clinical condition of a 24-year-old male patient who arrived at the emergency department with an isolated dislocation of the right foot cuboid bone without the presence of a fracture, after suffering trauma during a football game. Open reduction was performed in the surgical center with stabilization and fixation using a Kirschner wires. The patient showed an excellent response to the treatment, with no loss of the foot's range of motion.

Poncet disease in a patient with smear-negative pulmonary tuberculosis: A case report.

Pulmonary tuberculosis poses a diagnostic dilemma to clinicians especially in the absence of typical presentation. The hypersensitivity to tuberculosis infection in other parts of the body can lead to nondestructive, para-infectious arthritis. This is known as Poncet disease, one of the clinical syndromes of musculoskeletal tuberculosis. Herein, we report a case of smear-negative pulmonary tuberculosis presenting with atypical features. It started with multiple joint pain, followed by the presence of multiple tender nodular skin lesions over the bilateral shins and wrist. Subsequent investigations led to the diagnosis of smear-negative pulmonary tuberculosis. Joint pain and erythema nodosum disappeared soon after antituberculosis therapy, supporting the diagnosis of Poncet disease.

Assessing the Strengths and Weaknesses for Implementing a Place-Based Model of Care for Older People on the Central Coast, Australia: Results of a Pilot Project Using the Population Health Management Maturity Index (PHM-MI) Tool.

Introduction: Population health management is increasingly being used to support place-based models of care. This case study provides an account of the use of the Population Health Management - Maturity Index (PHM-MI) tool to inform the future development of a neighbourhood model of care for older people in the Central Coast region of Australia. Description: The PHM-MI tool comprises a set of six evidence-informed elements known to be important in enabling PHM in practice. As part of a joint strategic needs assessment, 17 selected stakeholders from key regional organizations were invited to undertake the PHM-MI tool survey. Three follow-up workshops were held to interpret the results and determine priority actions. Discussion: The PHM-MI scores revealed that the overall maturity of the Central Coast to successfully deliver PHM was low across all six elements, findings that were corroborated through participant workshops. Systemic fragmentations, most pertinently of funding and regulation, incentivised silo-based working. The need to formalise and strengthen regional collaborations, enable data integration, find creative ways to use existing funding streams, and promote community engagement were highlighted as core priorities. Conclusion: Using the PHM-MI tool was enabled by it being embedded within a pre-existing regional strategic process. The results were used to inform future regional priorities. The PHM-MI tool has the potential for use across regional or national contexts.

Multi-omics analysis to reveal the synergistic mechanism underlying the multiple ingredients of Stephania tetrandra extract on rheumatoid arthritis through the PI3K/Akt signaling pathway.

Background: Stephania tetrandra has been used for treating rheumatic diseases for thousands of years in rural areas of China. Several studies have found that tetrandrine and fangchinoline can inactivate the PI3K/Akt signaling pathway by reducing the expression and phosphorylation of AKT. However, the mechanism underlying the therapeutic actions of S. tetrandra on RA is not well known. Methods: In this study, we determined the molecular mechanism of the therapeutic effects of the multiple ingredients of S. tetrandra extract (STE) on collagen-induced arthritic (CIA) rats by integrating pharmacometabolomics, proteomics, and PTMomics. Results: In the multi-omics joint analysis, first, the expression signatures of proteins, PTMs, metabolites, and STE ingredients were profiled in CIA rats PBMCs that underwent STE treatment. Bioinformatics analysis were subsequently probed that STE mainly regulated tryptophan metabolism, inflammatory response, and cell adhesion pathways in CIA rats. The interrelated pathways were further constructed, and the findings revealed that STE attenuated the inflammatory response and proliferation of PBMCs in CIA rats by mediating the key targets of the PI3K/Akt pathway, including Hint1, ACP1, FGR, HSP90@157W + dioxidation, and Prkca@220N + 845.4540 Da. The rheumatic functions of Hint1 and ACP1 were further confirmed by applying a transcriptomic data of RA patients who clinically received abatacept therapy. Furthermore, a cross-ome correlation analysis was performed and major in vivo ingredients of STE, including coclaurine-N-glucuronide, Me,coclaurine-O-glc, N-gluA-schefferine, corydamine, corypamine, tetrandrine, and fangchiniline, were found to act on these targerts to inactivate the PI3K/Akt pathway. Conclusion: These results elucidated the molecular mechanism by which the ingredients of STE mediate the expression of the key targets in the PI3K/Akt pathway, leading to anti-rheumatic functions. The findings of this study provided new insights into the synergistic effect of STE against arthritis in rats.

Comparative analysis of biomechanical characteristics between the new Tai Chi elastic band exercise for opening and closing movement and elastic band resistance training for the reverse fly movement.

Background: The objective of this study was to compare and analyze the representative opening and closing movement of Tai Chi elastic band exercise with the reverse fly movement of elastic band resistance training. The aim was to explore the biomechanical differences between the two exercises and provide theoretical support for the application of Tai Chi elastic band exercise in health intervention. Methods: A total of 26 male participants were recruited and randomly divided into two groups in a 1:1 ratio. There were 13 participants in each Tai Chi elastic band exercise group and elastic band resistance training group. Both groups of participants used an elastic band to perform movement in the experiment. Experimental data were collected using the Vicon infrared motion capture system and Delsys surface EMG system. The AnyBody software was utilized to simulate the creation of a musculoskeletal model for both exercises. Result: The study found that the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angle and flexion angle of the shoulder joint, as well as normalized RMS of the anterior deltoid and triceps brachii, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited greater elbow flexion angle, elbow flexion torque, and muscle strength of the infraspinatus, coracobrachialis, biceps brachii, brachialis and brachioradialis, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angular velocity of the shoulder joint and a lower normalized RMS of the posterior deltoid, compared to the elastic band resistance training group (P < 0.05). Conclusion: (1) The opening and closing movement of Tai Chi elastic band exercise is characterized by a large elbow flexion angle, a small shoulder joint horizontal angle and flexion angle, and a slow and uniform speed of movement. The reverse fly movement of elastic band resistance training is characterized by a large horizontal abduction angle of the shoulder joint, a large flexion angle of the shoulder joint, a small flexion angle of the elbow joint, and a fast and uneven speed. (2) The opening and closing movement exerts a greater torque on the elbow flexion, while the reverse fly movement exerts a greater torque on the shoulder joint horizontal abduction and external rotation. (3) The opening and closing movement provide greater stimulation to the infraspinatus, coracobrachialis, and elbow flexor, while the reverse fly movement provides greater stimulation to the posterior deltoid, anterior deltoid, subscapularis, and elbow extensor. In summary, the variation in joint angle, joint angular velocity, and hand position could be the factor contributing to the differences in joint torque and muscle activity between the opening and closing movement of Tai Chi elastic band exercise and the reverse fly movement of elastic band resistance training.

Recurrent Left Periprosthetic Posterior Knee Dislocation in an Elderly Woman With Dementia and Altered Mental Status: A Case Report.

The case presented in this article is one of recurrent left posterior periprosthetic knee dislocation (PPKD) in a patient with altered mental status (AMS). The patient, a 69-year-old female with a complex medical history including dementia, Ménière's syndrome, and left total knee arthroplasty, presented to the emergency department with AMS whereupon a left PPKD was discovered. Less than three weeks before this presentation, she sustained a left PPKD during a previous admission. During her current admission, she sustained yet another left PPKD after trials of closed reduction and immobilization. The patient eventually underwent a left cemented revision total knee arthroplasty with a hinged prosthesis. The implant was noted to be stable, and the patient had minimal pain postoperatively with no vascular or neurological injury. Upon outpatient follow-up, the patient reported doing well. There have been few documented cases of recurrent or chronic PPKD in individuals with AMS or restricted intellect. These comorbidities create a complex approach to diagnosing and treating the aforementioned orthopedic injury, and as this injury can have devastating consequences, quickly and effectively delivering diagnosis and treatment is vital. This case highlights the importance of early identification, risk factors, preoperative management, and appropriate operative course for patients with AMS and recurrent PPKDs.

Enhancing Outcomes in Prosthetic Joint Infections: The Significance of the Periprosthetic Joint Infection Tumor, Node, and Metastasis (PJI-TNM) Classification and Biodegradable Antibiotic Beads.

BACKGROUND AND OBJECTIVES: Periprosthetic joint infections (PJIs) that occur after hip and knee arthroplasty have a major influence on patient outcomes and healthcare expenses. This study assesses the effectiveness of the PJI tumor, node, and metastasis (PJI-TNM) categorization system and the latest developments in local antibiotic delivery methods for the treatment of PJIs. MATERIALS AND METHODS: The study involved a retrospective analysis of 23 patients who received treatment for septic hip or knee prostheses at the SUUB Orthopedics and Traumatology Clinic between January 1, 2022, and February 10, 2024. Approval was gained following ethical considerations. Patients were categorized using the PJI-TNM system, and their therapy was customized based on the severity of the infection. The surgical procedures involved either one-stage or two-stage revisions, utilizing vancomycin and gentamicin antibiotic-loaded calcium sulfate beads to administer antibiotics locally. Data pertaining to demographics, clinical characteristics, and microbiology were gathered and examined. RESULTS: The study comprised 14 male and 9 female patients, with an average age of 68 years. The presence of chronic infections was mostly seen, indicating the development of mature biofilm. Prevalent coexisting medical conditions included diabetes, obesity, and heart failure. The duration of infection control measures was, on average, six months, and 65% of patients reported experiencing enhanced mobility. Acute infections with positive antibiotic responses underwent one-stage modifications. For the majority of patients, a treatment approach involving two-stage modifications, which includes the use of antibiotic-loaded spacers followed by the installation of a prosthesis, proved to be beneficial. CONCLUSIONS: The PJI-TNM classification system improves the management of PJI by offering a systematic method for customized therapy. Calcium sulfate beads, which are biodegradable carriers for antibiotics, provide notable advantages, especially for individuals with severe comorbidities. Continuous progress in diagnostic techniques and localized administration of antibiotics is essential for enhancing the therapy of PJI and improving patient outcomes.