Impact of Covid-19 pandemic on injection-based practice: report from an Italian multicenter and multidisciplinary survey.

Background: There are no papers exploring the impact of COVID-19 pandemic on the injection-based practice in patients affected by different rheumatic diseases, including osteoarthritis. The aim was to investigate the impact of COVID-19 pandemic on injection-based practice trough the Italian country. Study design: A survey-based retrospective cross-sectional study. Methods: An Italian-language questionnaire was developed by a group of senior researchers and distributed by e-mail to some Rheumatology, Orthopedic and Rehabilitation Units from different geographic areas of Italy. The survey included information about the number of injections performed during COVID-19 pandemic (stratified by injected agents and injected joint), in comparison to the pre-pandemic period, and the possible reasons behind an eventual reduction. Responses were collected and descriptive analysis calculated. Results: Eleven centers of the National Health Service completed the survey. The activities of the injections services significantly decreased across the country with a percentage of reduction of 60% compared to the pre-pandemic period. A significant reduction of both intra-articular and peri-articular injections was registered. Among intra-articular. treatments, the most affected ones were the hyaluronic acid injections, when compared to corticosteroids. A significant decrease of the total amount of peri-articular injections was observed. The strict government restrictions and the fear of patients to become infected represented the most limiting factors. Conclusions: The reported decrease of the injection-based practice in our country during the COVID-19 pandemic highlights the detrimental effects of the COVID-19 pandemic on the management of chronic musculoskeletal diseases with possible negative consequences in terms of disability and quality of life.

Novel directions in the study of osteoporosis: focus on gut microbiota as a potential therapeutic target.

Osteoporosis is a significant social health problem, not only in terms of pain and disability but also in terms of mortality rate. In recent years, there is an increasing interest in studying the relationship between gut dysmicrobiosis, immune system and bone health, therefore the term "osteomicrobiology" has been recently coined. This review aims to summarize the current knowledge about the link between gut dysbiosis and osteoporosis, in order to define a potential preventive and therapeutic strategy. Gut microbiota (GM) plays a major role in maintaining body homeostasis, since it is involved in several physiological processes; in recent years, the gut microbiota has shown to modulate not only local processes but also systemic responses including bone metabolism. Several potential mechanisms may explain how gut microorganisms could affect bone metabolism, i.e. influencing the host metabolism, immune system and hormone secretion. The relationship between gut dysbiosis, immunological dysfunction and bone loss could be explained by mainly focusing on T cells. Moreover, it should be noted that the relationship between GM and the endocrine system could also explicate how the microbiome influences bone status. In this context, Insulin-Like Growth Factor-1 (IGF-1), vitamin D, serotonin and leptin might play a central role. GM could have a significant impact on bone metabolism, therefore future clinical studies are necessary to develop a new multidisciplinary approach for osteoporosis treatment and prevention.

Humeral shaft butterfly fractures managed with intramedullary nail: could the third fragment features predict the fracture healing time?

To assess the impact of the radiological features of the third fragment on the outcome of humeral shaft fractures type 12-B managed with endomedullary nails. We retrospectively evaluated a series of 80 patients, divided into 3 groups, according to the fracture healing time: within 6 months (group-A), between 6 and 12 months (group-B) or fracture non-union after 12 months (group-C). In 26 patients out of 80 the fracture healing was observed at 6 months follow-up; in 47 out of 80 at 12 months after trauma and in 7 out of 80 no fracture healing was observed at 12 months follow-up. Regression analysis showed that the third fragment displacement and angulation are the most important features that affect the fracture healing. The mean third fragment dislocation (cut-off: 12 mm) is the main parameter to influence the fracture healing within or in more than six months.

The limits and potentials of presepsin in orthopaedic surgery: state of the art and future directions.

Presepsin, i.e. the soluble cluster of differentiation 14-SubType (sCD14-ST), is an emerging biomarker for the diagnosis and evaluation of sepsis and infection. In 2004, Yaegashi et al. originally described presepsin as a potential biomarker; since then, several studies have investigated the role of presepsin in different infectious conditions, including neonatal sepsis, severe acute pancreatitis, infections in patients with haematological malignancies, severe community-acquired pneumonia, pacemaker and implantable cardioverter-defibrillator (ICD) pocket infections, surgical site infections (SSIs) and periprosthetic joint infects (PJIs). Moreover, presepsin has been also studied in the risk stratification in cardiac surgery patients, and as a biomarker in the perioperative management of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This review aims to summarize the current knowledge about presepsin, focusing on the limits and potentials that the use of this biomarker could have in daily clinical practice. Presepsin is could be useful in daily clinical practice in orthopaedic surgery in the diagnosis and prevention of SSIs and PJIs. It is a cost-effective biomarker, but to improve its accuracy, it is important to carefully recalculate presepsin circulating values in patients with chronic kidney disease. However, further studies with larger patients' samples are needed to better validate the use of this biomarker in orthopaedics. In the future, synovial fluid presepsin might be a useful biomarker in the diagnosis of septic arthritis and PJIs.

The Boltzmann project.

The International Committee for Weights and Measures (CIPM), at its meeting in October 2017, followed the recommendation of the Consultative Committee for Units (CCU) on the redefinition of the kilogram, ampere, kelvin and mole. For the redefinition of the kelvin, the Boltzmann constant will be fixed with the numerical value 1.380 649 × 10-23 J K-1. The relative standard uncertainty to be transferred to the thermodynamic temperature value of the triple point of water will be 3.7 × 10-7, corresponding to an uncertainty in temperature of 0.10 mK, sufficiently low for all practical purposes. With the redefinition of the kelvin, the broad research activities of the temperature community on the determination of the Boltzmann constant have been very successfully completed. In the following, a review of the determinations of the Boltzmann constant k, important for the new definition of the kelvin and performed in the last decade, is given.

Cardiopathy and osteoporosis: the epidemiology in a region of Italy.

Cardiopathies and osteoporosis are inter-related due to pathogenetic, hormonal, genetic features as well as an increased risk of fragility. An important feature is attributed to the process of atherosclerosis, which is responsible for an osteopenia effect and degeneration of vascular walls. To date the study populations have been limited. To verify the incidence of cardio-vascular disease in a larger osteoporotic population, we designed a retrospective clinical study analyzing the “Hospital Discharge Data” (HDD) in Apulia between 2006 and 2010. All patients over 55 years with a hospitalization for a fragility fracture and/or drugs prescription for osteoporosis were crossed with the diagnosis and/or drugs prescription for cardiovascular disease. We observed that between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures, 66.3% had a diagnosis of cardiopathy, with a higher prevalence in males and in patients over 80 years. The incidence of fractures were as follows: femur (51.9%), spine (20.2%), humerus (10.6%), forearm (9%), tibial pilon (7.2%) and tarsus and metatarsus (1.1%). Cerebrovascular diseases were the most frequent, followed by arrhythmias, heart failure and cardiomyopathies. In these patients, the most prescribed drugs were anti-coagulants, ACE inhibitors and diuretics. In patients affected by cerebral circulation disorder there is a greater propensity to fall and thus have a fragility fracture, particularly of the femur. The vertebral fracture, misdiagnosed in 60-70% of patients, may compromise the cardio-respiratory function of these patients. We verified a higher incidence of fragility fractures in patients who were prescribed certain categories of drugs for the treatment of cardio-vascular disease. This hypothesis is not supported by the literature, where contradictory results on the potential effects of these drugs on bone have been published. The high incidence of heart disease found in patients with fragility fractures supports the need for specific screening for osteoporosis in the population with cardio-circulatory pathology.

Autologous lipotransfer versus stromal vascular fraction enriched lipoinjection for diabetic foot wounds healing: a pilot study.

Chronic ulcers of the lower limbs represent a significant social and economic burden. Diabetes is a strong risk factor for development of chronic lesions. Adult stem cells and growth factors derived from the adipose tissue are among the most promising therapeutic strategies for hard to heal wounds. Fat grafts have been used for several decades to treat soft tissue deformities, but despite its excellent characteristics, the outcome was unpredictable, due to partial necrosis and resorption of the graft. Stem cells' enrichment of these grafts or their injection into the edges of the ulcers have shown encouraging results in various experimental settings. In this pilot study, we compared the standard of care to autologous lipotransfer and stromal vascular fraction (SVF) enriched lipoinjection in 30 patients with diabetic foot ulcers, showing clear superiority of SVF enriched lipoinjection in terms of percentage of reduction of ulcers size and healing time.

Irisin levels correlate with bone mineral density in soccer players.

Irisin, a novel myokine produced in response to physical exercise by skeletal muscle, displays anabolic effect on bone and can improve the bone-loss-induced osteoporosis in hind limb suspended mice. It is well known that muscles positively impact the skeleton and in different sports, including soccer, total body bone mineral density (TB-BMD) is elevated. Therefore, we have investigated the correlation between irisin serum levels and total and bone sub-regional BMD in soccer players never studied before. In this study, Caucasian football players of Bari team have been enrolled. Their sera were collected to measure by ELISA kit irisin levels and by dual-energy X-ray absorptiometry (DEXA) analysis measurements of BMD (g • cm−2) in the whole body and different bone sub-regions (head, arms, legs, ribs, dorsal vertebrae, lumbar vertebrae, pelvis) were performed. The BMC (g) was measured in the whole body. By means of Pearson's (R) and Cohen's (d) coefficient we investigated the linear association between the irisin serum levels and BMD. In soccer players, we have found a positive correlation between irisin and TB-BMD as demonstrated by the values of Pearson and Cohen's (d) coefficient. Furthermore, linear association was detected between irisin and BMD of different bone-site such as right arm, lumbar vertebrae and head. A positive trend was also observed analyzing circulating levels of irisin and bone mineral content as well as total Z-score. In conclusion, we have demonstrated the correlation between irisin and total or bone sub-regional BMD in soccer players for the first time, an additional systemic effect of the "sport-hormone" defined myokine.

Highly accurate intensity factors of pure CO2 lines near 2 µm.

Line intensities for carbon dioxide are measured with a novel spectroscopic approach, assisted by an optical frequency comb synthesizer for frequency calibration purposes. The main feature of the spectrometer consists in the exploitation of optical feedback from a V-shaped high-finesse optical resonator to effectively narrow a distributed feedback diode laser at the wavelength of 2 µm. Laser-gas interaction takes place inside an isothermal cell, which is placed on the transmission from the cavity. High quality, self-calibrated, absorption spectra are observed in pure CO2 samples at different gas pressures, in coincidence with three lines of the R-branch of the ν1 + 2ν2 + ν3 band. Line intensities are determined using a global fitting approach in which a manifold of spectra are simultaneously analyzed across the range of pressures between 5 and 100 Torr, sharing a restricted number of unknown parameters. Various sources of uncertainty have been identified and carefully quantified, thus leading to an overall uncertainty ranging between 0.17% and 0.23%. The measured values are in a very good agreement with recent ab initio predictions.

Tendonitis of the rotator cuff treated with extracorporeal shock wave therapy: radiographic monitoring to identify prognostic factors for disintegration.

Extracorporeal shock wave therapy (ESWT) is widely used for calcific tendonitis of the shoulder. The initial rationale for this therapy was to break the calcification, but this effect does not always occur. To date, we do not know how calcifications evolve or why they may be less responsive to the action of the shock waves. One hundred and seventy-four shoulders with calcific tendinitis were prospectively evaluated before and after ESWT, using the radiographic classifications according to Gartner and Heyer, to Bosworth and to Molè. Three months after ESWT therapy, we observed the disappearance of calcification in 36.8% of the shoulders, a reduction in size in 21.8% and no change in 41.4%. The calcifications that disappeared were large according to Bosworth (p=0.004). The probability of disappearance of calcification increased with increasing age (p=0.011), for medium calcifications according to Bosworth (p=0.001), and calcifications of type A according to Molè (p=0.043). The results of our study suggest that the radiographic aspects of calcific tendonitis of the rotator cuff could influence the disruptive effects after ESWT. With this knowledge we could define the timing of treatment and therapeutic choice for each patient.

High level laser therapy for the treatment of lower back pain: clinical efficacy and comparison of different wavelengths.

High energy laser therapy (HELT) could be a new alternative treatment for lower back pain (LBP), which is a significant public health problem. Nevertheless, differences between the various light waves of HELT have not yet been fully researched. Sixty-six patients with lower back pain were treated using a high energy laser therapy. They were randomized into three different protocols which differed according to wave length (650 nm, 810 nm and TRIAX, which is simultaneous emission of 810 nm, 980 nm e 1064 nm). The other parameters remained constant (5 W and 50 J/cm2 for ten daily sessions). The visual analogue scale (VAS), the Roland Scale, and the Oswestry Score were measured before treatment (T0), and at end of the treatment session (T1) and 1 month (T1), 2 months (T2) and 4 months of follow-up (T4). In each group we verified a statistically significant improvement over time and that there was a relationship between the time and treatment (p less than 0.01). At T1 for all wavelengths we found a statistically significant improvement of three scores (p less than 0.01), which was maintained up to T4. The group treated with 810 nm HELT, showed a better remission of pain on the VAS scale, and disability on the Oswestry Scale at T4 (p=0.01). Comparing T0-T1 the variation in the Roland Score was significant in the patients treated with 810 nm (p less than 0.01). All the wavelengths analyzed proved to be efficacious for LBP. The greater efficacy of 810 nm in promoting nerve regeneration and in modulating the nociception transmission could explain the better outcomes.

Epidemiology of diabetes mellitus in the fragility fracture population of a region of Southern Italy.

Increased risk of osteoporosis and its clinical significance in patients with diabetes is controversial. This study aims to increase the data which are available regarding the prevalence of diabetes mellitus in patients affected by fragility fracture in Italy. We retrospectively studied Hospital Discharge Data (HDD) in the Apulian database for the period 2006–2010 to identify a fragility fracture diagnosis in males over 65 years of age and in females over 50. The database was then checked for drug prescriptions to identify those persons who had taken at least one osteoporosis drug. Within this latter group, thanks to hospital admission and prescription records, the subjects affected with diabetes mellitus were identified. Between 2006 and 2010 in Apulia 177,639 patients were hospitalized and diagnosed as having fragility fracture. The greatest number of those fragility fractures were found to be in the 70 to 79 age range (64,917 total; females 56,994, males 7,923). The prevalence of diabetes subjects in Apulia in this period was estimated at 6.5%. In the same region and period 21.1% of subjects affected by diabetes experienced a fragility fracture; in particular, this number was 27% for males and for 20.5% females. This is the first study providing data on the prevalence of fragility fractures and diabetes in the Apulian population. The data confirm that diabetes is a risk factor which influences bone density and risk of fractures and therefore the need of osteoporosis screening and treatment in diabetic patients.

Thyroid and shoulder diseases: the bases of a linked channel.

The association between thyroid disorders and musculoskeletal diseases has long been suspected, but it is still debated whether they have a role in the pathogenesis of shoulder diseases. In vivo and in vitro studies describe the role of thyroid hormones in bone, cartilage and tendon biology. Retrospective studies and case reports suggest that thyroid diseases should be considered as risk factors and hold prognostic value in some of the most common causes of shoulder pain. Thus, it is advisable to search for underlying thyroid disorders in these patients. The pathophysiologic mechanisms by which thyroid hormone imbalance affects the onset, progression and response to treatment of these diseases are yet to be thoroughly defined and demand further studies.

Single-row and transosseous sutures for supraspinatus tendon tears: a retrospective comparative clinical and strength outcome at 2-year follow-up.

INTRODUCTION: Rotator cuff tears commonly necessitate surgical repair; however, the optimal technique for repair continues to be investigated. Recently, double-row repairs have been considered an alternative to single-row repair, allowing a greater coverage area for healing and a possibly stronger repair. AIM: We performed a study to compare single-row repair and suture-bridge (SB) technique (a TOE technique) in terms of the recovery of the strength and functional outcome. MATERIAL AND METHOD: The purpose of the retrospective study was to compare 44 patients treated for a rotator cuff repair with the single-row (24) or suture-bridge techniques (20). At 24-month FU, there were not statistically significant differences for the UCLA score, Individual Constant Score, pain, ROM, and strength on the treated and contra-lateral arm. Comparing the mean values of the differences in strength obtained between the treated arm and the contra lateral in each group, the final results appeared significantly different in favor of SB (p = 0.03). CONCLUSION: Patients treated with DR could expect to regain the same strength of the contra-lateral side, while patients treated with SR could expect globally good results, overall in terms of pain relief and functionality, but lower strength.

PAIN MANAGEMENT AFTER TOTAL KNEE ARTHROPLASTY: THE GOOD, THE BAD AND THE UGLY.

Improvement in pain management after knee replacement surgery has made progress in the last years, improving the results of this type of operation. Among these techniques, multimodal have shown the best results. In this study we try to compare the results of a combination of intravenous analgesia (IA), oral controlled analgesia (OCA) and periarticular injection (PAI) with our traditional protocol consisting in intravenous analgesia and femoral nerve block (IA/FNB). ne-hundred patients, undergoing primary unilateral total knee arthroplasty between June 2014 and June 2015 were randomized into 2 groups. Mean patient age was 69.4. The first group received the intravenous analgesia combined with continuous femoral nerve block, while the second group received the new combined protocol. We used the same technique with standard medial parapatellar approach for all patients and they all received pre-emptive analgesia and postoperative pain protocols. All patients were interviewed daily postoperatively at 3 days, at discharge and at 3 months. The 2 groups had a similar discharge period (traditional group 7.3 days, combined group 6.9 days). In both groups, the results indicated no statistical difference in regards to rest and continuous passive movement. Pain on ambulation was the only category that was statistically lower in the PAI/IA/OCA group compared to traditional group.