Trochleoplasty and à-la-carte procedures for patellar instability in young and active patients: Clinical outcomes at minimum 2 Years follow-up.

Introduction: Patellar instability is a common condition affecting approximately 6 individuals per 100,000, but among adolescents, this incidence is notably higher. Trochlear dysplasia has been recognized as the pathoanatomic risk factor exerting the most significant biomechanical influence. Over time, various surgical techniques have been developed to address trochlear dysplasia. The purpose of this study is to evaluate the clinical outcomes, return to sport, as well as complications and re-operation rate of sulcus deepening trochleoplasty performed in a cohort of young and active patients using the Bereiter technique. Materials and methods: Between January 2019 and February 2022, 11 cases of recurrent patellar dislocations underwent trochleoplasty. Preoperative radiological assessment included X-rays, CT scans following the Lyons and MRI. Inclusion criteria for the study and trochleoplasty indications included patients aged 10-25 with recurrent patellar dislocations unresponsive to nonoperative treatment and minimum type B trochlear dysplasia. Clinical follow-up occurred at 1-3-6 months and annually, with control X-rays at these intervals. Patient-reported outcome scores included the Knee Society Score, Kujala score, and Karnofsky performance status scale. Results: Between January 2019 and February 2022, 11 patients underwent trochleoplasty and were included in this study. Preoperative radiological measurements indicated mean values: sulcus angle (152.5°), trochlear depth (3.4 mm), Caton-Deschamps index (1.2), tibial tuberosity to trochlear groove (TT-TG) distance (17.5 mm), external patellar tilt angle (6.8°), femoral anteversion (11.5°), and tibial torsion (32°). All patients were followed up for at least 2 years, with an average of 43 months. Concurrent surgeries included tibial tuberosity transposition (100 %), MPFL reconstruction in 9 cases (81.8 %) and 2 patients also underwent division of the external alar ligament (18,2 %). PROMs at final follow-up showed mean values: Knee Society Score (KSS) (80.5), Kujala score (88.3), and Karnofsky performance status scale (88.8). Return to sport was reported by all active patients. Three cases required secondary surgical intervention for removal of the screws. Conclusion: Trochleoplasty, especially with the Bereiter "thin flap" approach, improves patellofemoral congruency. Combining trochleoplasty with tibial tuberosity transposition addresses mal-tracking related to severe dysplasia and other à-la-carte procedures like medial patellofemoral ligament (MPFL) reconstruction enhance stability. In young and active patients, it resolves instability issues and reduces the likelihood of further dislocations with high return to sport rates.

Diagnosis and Treatment of Acute Periprosthetic Infections with the BioFire® System within a Time-Dependent and Bacterium-Dependent Protocol: Review and Prosthesis-Saving Protocol.

Despite ongoing efforts to enhance diagnostic and treatment processes, the success rate for eradicating infections, particularly prosthetic joint infections (PJIs), currently stands at around 50%. For acute infections occurring shortly after arthroplasty, guidelines recommend a treatment known as DAIR (debridement, antibiotics, and implant retention). This approach is suggested for infections within 30 days post-arthroplasty or with less than 3 weeks of symptoms, provided that there is a stable implant and adequate soft-tissue mass. Several authors have suggested extending the use of DAIR beyond the initial 3-week period in specific cases. This extension practice seems increasingly feasible due to the rapid diagnostic capabilities offered by BioFire®. This technology allows for quick pathogen identification, aiding in the exclusion of cases that do not fit the criteria for the DAIR/DAPRI (debridement, antibiotic pearls and retention of the implant) protocol based on pathogen identification. The aim of this review is to re-examine the current literature on acute infections and present our proposed "prosthesis-saving" protocol, which integrates the BioFire® molecular diagnostic system. Continued research and assessment of the efficacy and safety of these protocols, especially regarding extended treatment timelines, are crucial for advancing the management of acute infections and enhancing outcomes for PJI patients.

Bilateral Total Knee Arthroplasty (TKA) in a One-Stage Procedure Versus Two-Stage Procedure: A Retrospective Study.

Background/Objectives: This retrospective study aims to evaluate the safety and functional outcomes of simultaneous bilateral total knee arthroplasty (TKA) compared to two-stage bilateral TKA procedures. Osteoarthritis is the leading cause of knee joint replacement globally, so we sought to determine whether the one-stage approach could be deemed non-inferior to the two-stage method in terms of perioperative complications and postoperative recovery. Methods: We analyzed two cohorts: 43 patients underwent one-stage bilateral TKA, while 66 patients received two-stage TKA. The data collected included demographic details, comorbidities, postoperative complications, and functional outcomes assessed by the Oxford Knee Score (OKS), European Quality of Life, and Visual Analogue Scale scores at preoperative and five years postoperative follow-ups. Results: The results showed statistically significant improvements in quality-of-life measures for both groups, with the one-stage group exhibiting greater enhancement in OKS (p < 0.05). Complication rates were similar across both procedures, with no significant differences in infection rates or other adverse events. Conclusions: This study suggests that the one-stage approach to treat bilateral knee arthritis could reduce subjective stress and healthcare costs, presenting a safe alternative for appropriately selected patients. However, the findings highlight the necessity of considering patients' overall health status when planning surgical interventions. Further research involving larger populations is recommended to validate our conclusions.

Micronized Shell-Bioaggregates as Mechanical Reinforcement in Organic Coatings.

Shells are primarily composed of calcite and aragonite, making the inclusion of micronized shells as bio-based fillers in organic coatings a potential means to enhance the mechanical properties of the layers. A water-based coating was reinforced with 5 wt.% Acanthocardia tuberculata powder, 5 wt.% Mytilus galloprovincialis powder, and 5 wt.% of an LDPE/ceramic/nanoceramic composite. An improvement in abrasion resistance was achieved using micronized seashells, as demonstrated by the Taber test (evaluating both weight loss and thickness reduction). Additionally, Buchholz hardness improved with powders derived from Mytilus galloprovincialis. No significant differences were observed among the samples in terms of color and gloss after 200 h of UV-B exposure. However, the delamination length from the scratch after 168 h of exposure in a salt spray chamber indicated that the addition of particles to the polymeric matrix resulted in premature degradation, likely due to the formation of preferential paths for water penetration from the scratch. This hypothesis was supported by electrochemical impedance spectroscopy measurements, which revealed a decrease in total impedance at 0.01 Hz shortly after immersion in a 3.5% NaCl solution. In conclusion, the particle size and shape of the micronized shells improved abrasion resistance without altering color and gloss but led to a decrease in the coating's isolation properties.

Functional Genomics in Psoriasis.

Psoriasis is an autoimmune cutaneous condition that significantly impacts quality of life and represents a burden on society due to its prevalence. Genome-wide association studies (GWASs) have pinpointed several psoriasis-related risk loci, underlining the disease's complexity. Functional genomics is paramount to unveiling the role of such loci in psoriasis and disentangling its complex nature. In this review, we aim to elucidate the main findings in this field and integrate our discussion with gold-standard techniques in molecular biology-i.e., Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-and high-throughput technologies. These tools are vital to understanding how disease risk loci affect gene expression in psoriasis, which is crucial in identifying new targets for personalized treatments in advanced precision medicine.

Navigated versus conventional medial unicompartmental knee arthroplasty: Minimum 18 years clinical outcomes and survivorship of the original Cartier design.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable option of treatment in case of osteoarthritis (OA) or avascular osteonecrosis (AVN) isolated to either the medial or the lateral compartment of the knee. The aim of this study was to retrospectively present clinical outcomes and survivorship at minimum 18 years follow up of a fixed bearing (FB) UKA comparing the results of conventional technique and navigation. METHODS: Patients treated with a medial FB UKA between June 2003 and December 2006 were retrospectively evaluated. From March 2005 all UKAs were performed using a computer navigation system. Patients were divided into two groups: UKAs assisted by navigation (n-UKAs) versus standard UKAs (s-UKAs). For all patients, at final follow up, patient-reported outcome measures (PROMs) were collected: Western Ontario and McMaster Universities (WOMAC) score, Oxford Knee Score (OKS) and Forgotten Joint Score (FJS-12). Survival rate and outcomes were compared between groups. RESULTS: Fifty-two patients were analyzed in this retrospective evaluation. All UKAs were medial and the tibial component was all polyethylene (AP) in 26 cases and metal backed (MB) in 26. Twenty-six UKAs were implanted with standard technique (AP 10, MB 16) and 26 assisted by a navigation system (AP 16, MB 10). Three patients (5.7%) underwent revision; the average time to revision was 140.7 months (standard deviation 81.2). Average follow up was 216.4 months (standard deviation 10.6). The survivorship of the implant was 94.4% at final follow up. Survivorship and PROMs were not different between groups. CONCLUSIONS: This study showed excellent survivorship and outcomes at long term follow up of the original fixed bearing Cartier designed implant in both groups with equivalent survivorship and PROMs.

Impact of a Novel Antiseptic Lavage Solution on Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty.

Background: Periprosthetic joint infection (PJI) represents a challenge following hip or knee arthroplasty, demanding immediate intervention to prevent implant failure and systemic issues. Bacterial biofilm development on orthopedic devices worsens PJI severity, resulting in recurrent hospitalizations and significant economic burdens. The objective of this retrospective cohort study is to evaluate the efficacy of this novel antiseptic solution, never previously evaluated in vivo, in managing early post-operative or acute hematogenous PJI following primary hip and knee joint replacements. Methods: The inclusion criteria consist of patients with total hip arthroplasty (THA) or knee arthroplasty diagnosed with acute PJI through preoperative and intraoperative investigations, in accordance with the MSIS ICM 2018 criteria. The minimum required follow-up was 12 months from the cessation of antibiotic therapy. This novel antiseptic lavage solution is composed of ethanol, acetic acid, sodium acetate, benzalkonium chloride and water. Data included demographic characteristics, diagnostic criteria, surgical techniques, post-operative treatment and follow-up outcomes. Results: A total of 39 patients treated with Debridement, Antibiotics Pearls and Retention of the Implant (DAPRI) procedures using this solution between May 2021 and April 2023 were analyzed. At a mean follow-up of 24.6 ± 6.4 months, infection recurrence-free survival rates were 87.2%, with no local allergic reactions or relevant systemic adverse effects detected. Persistent PJI necessitated two-stage revision surgery. Conclusions: This novel antiseptic lavage solution shows promise as an adjunctive tool in the treatment of PJI, demonstrating support in infection control while maintaining a favorable safety profile.

Comparison of Machine Learning Algorithms Fed with Mobility-Related and Baropodometric Measurements to Identify Temporomandibular Disorders.

Temporomandibular disorders (TMDs) refer to a group of conditions that affect the temporomandibular joint, causing pain and dysfunction in the jaw joint and related muscles. The diagnosis of TMDs typically involves clinical assessment through operator-based physical examination, a self-reported questionnaire and imaging studies. To objectivize the measurement of TMD, this study aims at investigating the feasibility of using machine-learning algorithms fed with data gathered from low-cost and portable instruments to identify the presence of TMD in adult subjects. Through this aim, the experimental protocol involved fifty participants, equally distributed between TMD and healthy subjects, acting as a control group. The diagnosis of TMD was performed by a skilled operator through the typical clinical scale. Participants underwent a baropodometric analysis by using a pressure matrix and the evaluation of the cervical mobility through inertial sensors. Nine machine-learning algorithms belonging to support vector machine, k-nearest neighbours and decision tree algorithms were compared. The k-nearest neighbours algorithm based on cosine distance was found to be the best performing, achieving performances of 0.94, 0.94 and 0.08 for the accuracy, F1-score and G-index, respectively. These findings open the possibility of using such methodology to support the diagnosis of TMDs in clinical environments.

Biochar dust emission: Is it a health concern? Preliminary results for toxicity assessment.

Biochar is currently garnering interest as an alternative to commercial fertilizer and as a tool to counteract global warming. However, its use is increasingly drawing attention, particularly concerning the fine dust that can be developed during its manufacture, transport, and use. This work aimed to assess the toxicity of fine particulate Biochar (

Study of the Corrosion Behavior of Stainless Steel in Food Industry.

AISI 304L stainless steel is widely used in the processing equipment and food and beverage handling industries due to its corrosion resistance, hygienic properties, and cost-effectiveness. However, it is prone to pitting and crevice corrosion phenomena, the development of which can be influenced by factors such as chloride concentration, temperature, humidity, and bacterial presence. Surface treatments, including roughness levels and residual tensile stress, can significantly affect the corrosion behavior and resistance of the material. This study aims to evaluate the impact of three different surface treatments on the durability of AISI 304L steel. The correlation between surface roughness resulting from pre-treatment and pitting potential values will be examined. Additionally, the influence of different concentrations of biocide additives on surface durability will be assessed to determine the maximum effective concentration for preventing pitting phenomena. Passivation processes will also be evaluated as a potential solution for improving the pitting potential and overall durability of the components. By optimizing surface treatments and biocide concentrations, improved corrosion resistance and durability can be achieved, ensuring the long-term performance and reliability of AISI 304L steel components in critical applications such as food processing and beverage handling.

The Role of Artificial Intelligence in Anterior Cruciate Ligament Injuries: Current Concepts and Future Perspectives.

The remarkable progress in data aggregation and deep learning algorithms has positioned artificial intelligence (AI) and machine learning (ML) to revolutionize the field of medicine. AI is becoming more and more prevalent in the healthcare sector, and its impact on orthopedic surgery is already evident in several fields. This review aims to examine the literature that explores the comprehensive clinical relevance of AI-based tools utilized before, during, and after anterior cruciate ligament (ACL) reconstruction. The review focuses on current clinical applications and future prospects in preoperative management, encompassing risk prediction and diagnostics; intraoperative tools, specifically navigation, identifying complex anatomic landmarks during surgery; and postoperative applications in terms of postoperative care and rehabilitation. Additionally, AI tools in educational and training settings are presented. Orthopedic surgeons are showing a growing interest in AI, as evidenced by the applications discussed in this review, particularly those related to ACL injury. The exponential increase in studies on AI tools applicable to the management of ACL tears promises a significant future impact in its clinical application, with growing attention from orthopedic surgeons.

Angle-Adjustable Dynamic Hip Screw Plate for Unstable Trochanteric Fractures in Middle-Aged Patients: Mid-Term Outcomes and Return to Sport.

BACKGROUND: There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged patients treated with the DHS plate for unstable trochanteric fractures. METHODS: Fifty-seven middle-aged patients (35-64 years) treated for proximal femoral fractures of type 31-A2 and 31-A3 according to the AO/OTA classification with the DMS Dynamic Martin Screw (KLS Martin Group, Jacksonville, FL, USA) between January 2017 and December 2019 were enrolled. RESULTS: Forty-nine patients were included in this retrospective study, and the average age was 54.1 years (SD 8.4). The average follow-up duration at final follow-up was 60.5 months (SD 8.6). Post-operative complications included only one case of aseptic loosening of the implant, with a complication rate of 2%. There were no infections, peri-implant fractures, or other complications reported. Two out of the forty-nine patients (4.1%) required treatment with a total hip arthroplasty due to post-traumatic arthritis. The Harris Hip Score at final follow-up was 77.1 (SD 20.1), and the Western Ontario and McMaster Universities Osteoarthritis Index was 21.6 (SD 13.7). The overall rate of RTS was 57.7%. CONCLUSIONS: Treatment with DHS for unstable trochanteric fractures is a safe option in middle-aged patients, ensuring a good functional recovery.

A morphometric medial compartment-specific unicompartmental knee system: 5 years follow up results from a pilot center.

BACKGROUND: Unicompartmental Knee Arthroplasty (UKA) is a valuable solution for the treatment of medial osteoarthritis of the knee. New implants feature designs for the elective substitution of a specific compartment. Aim of this study was to assess the survivorship and functional outcomes at minimum 4 years of the first 60 implanted patients in a pilot center of a new medial UKA as the evolution of a well performing long lasting fixed bearing implant. METHODS: Between June 2017 and the end of 2018, 60 medial UKA were implanted in 58 patients. All patients were available for the last follow up and were analyzed prospectively. 37 were females and 21 were males with a mean age of 67 years (SD 10,71) and a mean of BMI 27.16 (SD 3.94) for the male population and of 26.73 (SD 4.05) for the female population. RESULTS: At final follow up the mean Oxford Knee Score (OKS) was 44,02 (SD 3,1) and the mean Forgotten Joint Score (FJS) 78,6 (SD 7,9). The Knee Society Score (KSS) score was 95,2 for the "knee" score and 89.8 for the "function" score. No patients were revised. Kaplan-Meyer survival estimate showed a 100% survivorship at final follow up. No progressive radiolucent lines were found and no direct or indirect signs of polyethylene wear were registered on the final radiographs. CONCLUSIONS: This new implant demonstrated promising clinical results with an excellent survival rate at short to midterm follow- up. Further follow up is needed to confirm this trend at longer term.

Assessing the Impact of Sepiolite-Based Bio-Pigment Infused with Indigo Extract on Appearance and Durability of Water-Based White Primer.

The objective of this study is to evaluate how two varying amounts of sepiolite-based powder, infused with indigo extract, affect the appearance and durability of a water-based, white primer. To examine the influence of this eco-friendly pigment on the coatings' overall appearance, assessments were performed for color, gloss, and surface roughness. Additionally, the coatings were investigated through optical and electron microscopic observations, to evaluate the distribution of the pigment within the polymer matrix. The effect of the pigment on the coating's durability was assessed through accelerated tests, including exposure in a salt spray chamber and a UV-B chamber. These tests aimed to evaluate the emergence of defects and changes in the appearance of the samples over time. Furthermore, the impact of different quantities of sepiolite-based powder on the coating's ability to act as a barrier was assessed using liquid resistance tests and contact angle measurements. These evaluations aimed to understand how the coating responded to various liquids and its surface properties concerning repellency or absorption. In essence, this study underscores the considerable influence of the eco-friendly pigment, demonstrating its capacity to introduce unique color and texture variations in the paint. Moreover, the inclusion of the pigment has enhanced the coating's color stability, its ability to act as a barrier, and its overall durability when exposed to harsh environments.

Unlocking cardiac motion: assessing software and machine learning for single-cell and cardioid kinematic insights.

The heart coordinates its functional parameters for optimal beat-to-beat mechanical activity. Reliable detection and quantification of these parameters still represent a hot topic in cardiovascular research. Nowadays, computer vision allows the development of open-source algorithms to measure cellular kinematics. However, the analysis software can vary based on analyzed specimens. In this study, we compared different software performances in in-silico model, in-vitro mouse adult ventricular cardiomyocytes and cardioids. We acquired in-vitro high-resolution videos during suprathreshold stimulation at 0.5-1-2 Hz, adapting the protocol for the cardioids. Moreover, we exposed the samples to inotropic and depolarizing substances. We analyzed in-silico and in-vitro videos by (i) MUSCLEMOTION, the gold standard among open-source software; (ii) CONTRACTIONWAVE, a recently developed tracking software; and (iii) ViKiE, an in-house customized video kinematic evaluation software. We enriched the study with three machine-learning algorithms to test the robustness of the motion-tracking approaches. Our results revealed that all software produced comparable estimations of cardiac mechanical parameters. For instance, in cardioids, beat duration measurements at 0.5 Hz were 1053.58 ms (MUSCLEMOTION), 1043.59 ms (CONTRACTIONWAVE), and 937.11 ms (ViKiE). ViKiE exhibited higher sensitivity in exposed samples due to its localized kinematic analysis, while MUSCLEMOTION and CONTRACTIONWAVE offered temporal correlation, combining global assessment with time-efficient analysis. Finally, machine learning reveals greater accuracy when trained with MUSCLEMOTION dataset in comparison with the other software (accuracy > 83%). In conclusion, our findings provide valuable insights for the accurate selection and integration of software tools into the kinematic analysis pipeline, tailored to the experimental protocol.

Lateral UKA can be a safe solution in a young patients' population: a 10-year follow-up report.

BACKGROUND: This study aimed to assess the long-term survivorship and functional outcomes of fixed-bearing lateral unicompartmental knee arthroplasty (UKA) in a young patients' population with osteoarthritis limited to the lateral compartment. METHODS: The study included a cohort of consecutive patients who underwent lateral UKA between January 2008 and December 2014 at a single high-volume surgical center. The surgical procedures were performed by experienced surgeons using a lateral parapatellar approach and fixed-bearing implants. Patient follow-up included a retrospective re-evaluation, clinical assessments, patient-reported outcome measures (PROMs), and X-ray analysis. RESULTS: A total of 40 lateral UKAs were analyzed, with 19 performed on the left and 21 on the right knee. The mean age of the patients at the time of surgery was 57.6 years, and the mean BMI was 24.8. At the final follow-up, 80% of patients achieved excellent outcomes (OKS > 41), and 20% had good outcomes (OKS: 34-41). No patients exhibited fair or poor outcomes. The mean FJS at the final follow-up was 82.8. The mean WOMAC was 10.5. Kaplan-Meier survival analysis revealed a survivorship rate of 93.1% at 10 years, considering revision for any reason as endpoint. CONCLUSIONS: Lateral UKA proved to be an effective treatment option for osteoarthritis affecting the lateral compartment of the knee. The study demonstrated a high survivorship rate and favorable functional outcomes at a mean follow-up of 132.7 months. These findings highlight the potential benefits of fixed-bearing lateral UKA in selected patients with lateral compartment knee pathology.