Platelet-rich plasma treatment for talar cartilage repair: a systematic review and meta-analysis.

PURPOSE: To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair. METHODS: A systematic review was performed by searching PubMed, Web of Science, OVID and EMBASE to identify studies that compared the clinical efficacy of PRP for talar cartilage repair. Main outcome was the American Orthopedic Foot and Ankle Society (AOFAS) score for function and Visual Analog Scale (VAS) for pain was the second outcome. RESULTS: A total of 10 studies were included in this systematic review, including 4 randomized controlled trials, 1 controlled trial, 3 case series and 2 cohort studies. Four RCTs were analyzed using meta-analysis. For all outcomes, statistical results favored PRP group (AOFAS: MD = 7.84; 95% CI= [-0.13, 15.80], I2 = 83%, P < 0.01; VAS: MD = 1.86; 95% CI= [0.68, 3.04], I2 = 85%, P < 0.01). There were almost no reports of adverse events related to PRP intervention. Subgroup analysis showed that whether PRP was used alone or combined with other treatments could result in high heterogeneity but no more specific factors were identified to contribute to this. CONCLUSION: PRP is safe and effective for talar cartilage repair. In addition to the standardization of PRP preparation and application, it is necessary to distinguish the effects of PRP used alone or in combination with other treatments. In PRP studies, surgical treatment of talar cartilage repair remains the mainstream. The regulation of PRP in surgical applications are worth exploring. The most relative component is the mesenchymal stem cell because it is the only exposed chondrocyte precursor in the articular cavity whether it is microfracture or cell transplantation. TRIAL REGISTRATION: The study was registered in the PROSPERO International prospective register of systematic reviews (CRD42022360183).

RESULTS OF HIP REPLACEMENT IN PATIENTS WITH DYSPLASTIC COXARTHROSIS WITH VARIOUS SURGICAL ACCESS OPTIONS.

In order to study the features of surgical approaches for hip arthroplasty in patients with dysplastic coxarthrosis, an analysis of the course of the disease was carried out in 80 patients with dysplastic coxarthrosis who were treated at the Therapeutic Surgical Clinic of the Azerbaijan Medical University. The average age of the patients was 52.2±0.65, 51.6±0.55 and 50.3±0.71 years with overweight (BMI>=25 and <30. In order to determine the activity of the inflammatory process and the effectiveness of treatment a complete blood count and assessment of ESR, total WOMAC index and visual analog pain scale VAS were performed after 6 and 12 months. (operative technique No. 3) According to VAS, ESR and WOMAC, when using the proposed mini surgical access to the affected joint in the main group, a more pronounced decrease in quantitative indicators was achieved compared to the control group and the comparison group (p<0.001), which allows talk about a more significant decrease in the intensity of the pain syndrome (20.1±0.38 mm), the risk of developing an inflammatory process (8.7±0.28 mm/h) and a reduction in the rehabilitation period.

Imaging of Anatomical Variants Around the Elbow.

The elbow is a synovial joint able to perform flexion, extension, supination, and pronation. Knowledge of anatomical variants is crucial to avoid misinterpretation during the evaluation of the elbow joint. We address those anatomical variants simulating pathologic conditions.

Morphologic analysis of the 1st and 2nd tarsometatarsal joint articular surfaces.

Tarsometatarsal joint arthrodesis is used to treat a variety of injuries and deformities in the midfoot. However, the surgical technique has not been optimized, in part due to limited knowledge of morphologic features and variation in the related joints. Previous research has relied primarily on dissection-based anatomical analysis, but quantitative imaging may allow for a more sophisticated description of this complex. Here, we used quantitative micro-CT imaging to examine dimensions, distance maps, and curvature of the four articular surfaces in the first and second tarsometatarsal joints. Image segmentation, articular surface identification, and anatomic coordinate systems were all done with semi or fully automatic methods, and distance and size measurements were all taken utilizing these anatomic planes. Surface curvature was studied using Gaussian curvature and a newly defined measure of curvature similarity on the whole joint and on four subregions of each surface. These data show larger articular surfaces on the cuneiforms, rather than metatarsals, and define the generally tall and narrow articular surfaces seen in these joints. Curvature analysis shows minimally curved opposing convex surfaces. Our results are valuable for furthering knowledge of surgical anatomy in this poorly understood region of the foot.

Monitoring recovery of joints after bleeding: Physical examination and ultrasound are complementary.

AIM: Traditionally, recovery after a joint bleed in people with bleeding disorders is evaluated by clinical symptoms. Following a bleed, however, asymptomatic joints may still show synovial hypertrophy and effusion on ultrasound. We evaluated the duration of full recovery from a joint bleed. Additionally, we determined how recovery differed when assessed by physical examination and ultrasound. METHODS: In this retrospective cohort study, we investigated joint bleeds in elbows, knees and ankles of people with haemophilia or Von Willebrand disease who attended the Van Creveldkliniek between 2016 and 2021. Physical examination (warmth, swelling, range of motion and gait) and ultrasound (effusion and synovial hypertrophy) were performed within 7 days after the onset of the bleed, 1 week after the first examination and monthly thereafter until patients had recovered fully. Joint bleeds were treated in line with the current international treatment guidelines. RESULTS: We evaluated 30 joint bleeds in 26 patients. The median recovery time was 1 month (range 0.3-5 months). In 47% of the joint bleeds, the recovery took longer than 1 month. The moment of recovery based on physical examination and ultrasound differed in 27% of bleeds. Both persistent abnormalities at physical examination in joints with normalized ultrasounds and persistent ultrasound findings in clinically recovered joints occurred. CONCLUSION: Joint bleed recovery can take long and recovery times differed per bleed. Recovery differed when assessed by physical examination or ultrasound. Therefore, both should be used to closely monitor recovery of joint bleeds and offer personalized care.

Context expectation influences the gait pattern biomechanics.

Beyond classical aspects related to locomotion (biomechanics), it has been hypothesized that walking pattern is influenced by a combination of distinct computations including online sensory/perceptual sampling and the processing of expectations (neuromechanics). Here, we aimed to explore the potential impact of contrasting scenarios ("risky and potentially dangerous" scenario; "safe and comfortable" scenario) on walking pattern in a group of healthy young adults. Firstly, and consistently with previous literature, we confirmed that the scenario influences gait pattern when it is recalled concurrently to participants' walking activity (motor interference). More intriguingly, our main result showed that participants' gait pattern is also influenced by the contextual scenario when it is evoked only before the start of walking activity (motor expectation). This condition was designed to test the impact of expectations (risky scenario vs. safe scenario) on gait pattern, and the stimulation that preceded walking activity served as prior. Noteworthy, we combined statistical and machine learning (Support-Vector Machine classifier) approaches to stratify distinct levels of analyses that explored the multi-facets architecture of walking. In a nutshell, our combined statistical and machine learning analyses converge in suggesting that walking before steps is not just a paradox.

Pathogenesis of rheumatoid arthritis and its treatment with anti-inflammatory natural products.

Introduction Rheumatoid arthritis (RA) is a common autoimmune disease across the globe that is chronic and systemic as well. The disease is linked with autoantibodies and is inflammatory, eventually targeting several molecules along with certain modified self-epitopes. The disease majorly affects the joints of an individual. Rheumatoid arthritis is manifested clinically by polyarthritis linked with the dysfunction of the joints. This chiefly affects the synovial joint lining and is linked with progressive dysfunction, premature death, along with socioeconomic implications. The macrophage activation, along with the activation of certain defense cells, results in a response to self-epitopes that helps in providing a better understanding of the disease pathogenesis.  Material and methodology For this review article, papers have been retrieved and reviewed from database including PubMed, Scopus and Web of science. Relevant papers were taken fulfilling the criteria for writing this review article. Results This has resulted in the establishment of several new therapeutic techniques that serve as potential inhibitors of such cells. Researchers have gained an interest in understanding this disease to provide strategies for treatment in the last two decades. This also includes recognition followed by the treatment of the disease at its early stages. Various allopathic treatment approaches often have chronic and toxic teratogenic effects. However, to avoid this issue of toxicity followed by side effects, certain medicinal plants have been used in treating RA.  Conclusion Medicinal plants possess active phytoconstituents that entail antioxidants as well as anti-inflammatory properties, making them a helpful alternative to allopathic drugs that are often linked with highly toxic effects. This review paper entails a thorough discussion of the epidemiology, pathophysiology, diagnosis, and management of RA. The paper will also focus on the use of herbal plants in the treatment of the disease to avoid the side effects that generally occur in allopathic treatment.

Nanomedicine is more than a supporting role in rheumatoid arthritis therapy.

Rheumatoid arthritis(RA) is an autoimmune disorder that affects the joints. Various medications successfully alleviate the symptoms of RA in clinical. Still, few therapy strategies can cure RA, especially when joint destruction begins, and there is currently no effective bone-protective treatment to reverse the articular damage. Furthermore, the RA medications now used in clinical practice accompany various adverse side effects. Nanotechnology can improve the pharmacokinetics of traditional anti-RA drugs and therapeutic precision through targeting modification. Although the clinical application of nanomedicines for RA is in its infancy, preclinical research is rising. Current anti-RA nano-drug studies mainly focus on the following: drug delivery systems, nanomedicines with anti-inflammatory and anti-arthritic properties, biomimetic design with better biocompatibility and therapeutic features, and nanoparticle-dominated energy conversion therapies. These therapies have shown promising therapeutic benefits in animal models, indicating that nanomedicines are a potential solution to the current bottleneck in RA treatment. This review will summarize the present state of anti-RA nano-drug research.

Fleas and lesions in armadillo osteoderms.

Armadillos are bitten by several species of flea. Females of the genus Tunga penetrate the epidermis and when in place are fertilised by males, after which the abdomen swells enormously to form a 'neosome'. Within the penetrans group, T. perforans, makes lesions that perforate the osteoderms within the integument to form ~3 mm diameter cavities occupied by a discoid neosome. We examined these lesions in carapace material from animals which had died in the wild to see whether we could recruit evidence as to how they may be generated, either by the insect or by the host. We studied one species without such lesions, the nine-banded armadillo Dasypus novemcinctus, and two species with, the greater hairy armadillo Chaetophractus villosus and the southern three-banded armadillo Tolypeutes matacus, both showing the characteristic 'flea bite' holes in the external surfaces of the osteoderms. Samples were studied by three-dimensional backscattered electron mode scanning electron microscopy and X-ray microtomography. Both methods showed resorption pit complexes in the external surfaces of the osteoderms characteristic of those made by osteoclasts in active bone resorption. Lesions involved both the syndesmoses (sutures) between adjacent bones and the central regions of the osteoderms. Many lesions showed extensive repair by infilling with new bone. We conclude that the T. perforans neosome creates a local host response which causes bone resorption, creating the space in which it can grow.

DNA Supramolecular Hydrogel-Enabled Sustained Delivery of Metformin for Relieving Osteoarthritis.

Osteoarthritis (OA) is a musculoskeletal disorder affecting ∼500 million people worldwide. Metformin (MET), as an oral hypoglycemic drug approved by the Food and Drug Administration, has displayed promising potential for treating OA. Nonetheless, in the articular cavity, MET suffers from rapid clearance and cannot circumvent the severe inflammatory environment, greatly confining the therapeutic efficacy. Herein, DNA supramolecular hydrogel (DSH) has been utilized as a sustained drug delivery vehicle for MET to treat OA, which dramatically prolonged the retention time of MET in the articular cavity from 3 to 14 days and simultaneously exerted a greater anti-inflammatory effect. Our delivery platform, termed MET@DSH, better protects cartilage than single-agent MET. Additionally, the corresponding molecular mechanisms underlying the therapeutic effects were also analyzed. We anticipate this DNA supramolecular hydrogel-enabled sustained drug delivery and anti-inflammatory strategy will reshape the current landscape of OA treatment.

Case 316.

HISTORY: A 10-year-old North Indian boy presented with swelling of multiple joints in his hands for the past 3 years. This swelling involved the small joints of his hands and some restriction of joint movement, without any associated tenderness or morning stiffness. No other joints were symptomatically involved. Prior to visiting our hospital, he had received disease-modifying antirheumatoid drugs for suspected juvenile idiopathic arthritis, without any clinical benefit. On examination, the metacarpophalangeal and interphalangeal joints were nontender but had swelling and flexion deformities. He also had a short stature (below the third centile) for his age. Inflammatory markers, including erythrocyte sedimentation rate (7 mm per hour; normal range, 0-22 mm per hour) and C-reactive protein level (1.5 mg/L; normal level, <10 mg/L), were normal, and the rheumatoid factor test result was negative. A skeletal survey of the patient was performed and is shown in Figures 1-6.

SE-TCN network for continuous estimation of upper limb joint angles.

The maturity of human-computer interaction technology has made it possible to use surface electromyographic signals (sEMG) to control exoskeleton robots and intelligent prostheses. However, the available upper limb rehabilitation robots controlled by sEMG have the shortcoming of inflexible joints. This paper proposes a method based on a temporal convolutional network (TCN) to predict upper limb joint angles by sEMG. The raw TCN depth was expanded to extract the temporal features and save the original information. The timing sequence characteristics of the muscle blocks that dominate the upper limb movement are not apparent, leading to low accuracy of the joint angle estimation. Therefore, this study squeeze-and-excitation networks (SE-Net) to improve the network model of the TCN. Finally, seven movements of the human upper limb were selected for ten human subjects, recording elbow angle (EA), shoulder vertical angle (SVA), and shoulder horizontal angle (SHA) values during their movements. The designed experiment compared the proposed SE-TCN model with the backpropagation (BP) and long short-term memory (LSTM) networks. The proposed SE-TCN systematically outperformed the BP network and LSTM model by the mean RMSE values: by 25.0 and 36.8% for EA, by 38.6 and 43.6% for SHA, and by 45.6 and 49.5% for SVA, respectively. Consequently, its R2 values exceeded those of BP and LSTM by 13.6 and 39.20% for EA, 19.01 and 31.72% for SHA, and 29.22 and 31.89% for SVA, respectively. This indicates that the proposed SE-TCN model has good accuracy and can be used to estimate the angles of upper limb rehabilitation robots in the future.

Pro-stride and extracorporeal shockwave therapy as treatment of lateral collateral desmopathy of the proximal interphalangeal joint in a Dutch Warmblood gelding.

A 6-year-old chestnut Dutch Warmblood gelding was presented for right front lameness 1 mo after being cast in a stall at a 1.20-meter jumping event. Lameness work-up revealed mild lameness on the right and left front legs, with diffuse swelling over the right front pastern. Ultrasonic evaluation yielded suspicion of collateral desmopathy of the proximal interphalangeal joint that was subsequently confirmed via MRI. Two weeks after initial evaluation, the proximal and distal interphalangeal joints were injected with Pro-Stride Autologous Protein Solution, immediately followed by Extracorporeal Shockwave Therapy of the lateral and medial collateral ligaments. Follow-up at 2 and 3 mo after treatment revealed reduced joint effusion of the proximal and distal interphalangeal joints, as well as improved fiber organization of the associated collateral ligaments. This should inform practitioners that multimodal therapeutic treatments including biologics and stimulation of healing through sound waves can aid in ligamentous injuries in sport horses.

Thérapie avec Pro-Stride et ondes de choc extracorporelles comme traitement de la desmopathie collatérale latérale de l'articulation interphalangienne proximale chez un hongre Warmblood hollandais. Un hongre Warmblood hollandais alezan de 6 ans a été présenté pour boiterie avant droite 1 mois après s'être blessé lors d'une compétition de sauts à 1,20 mètre. Le bilan de boiterie a révélé une légère boiterie sur les pattes avant droite et gauche, avec une enflure diffuse sur le paturon avant droit. L'examen échographique a révélé une suspicion de desmopathie collatérale de l'articulation interphalangienne proximale qui a ensuite été confirmée par imagerie par résonnance magnétique. Deux semaines après l'évaluation initiale, les articulations interphalangiennes proximales et distales ont reçu une injection de solution de protéines autologues Pro-Stride, immédiatement suivie d'une thérapie par ondes de choc extracorporelles des ligaments collatéraux latéral et médial. Le suivi à 2 et 3 mois après le traitement a révélé un épanchement articulaire réduit des articulations interphalangiennes proximales et distales, ainsi qu'une meilleure organisation des fibres des ligaments collatéraux associés.Ceci devrait informer les praticiens que les traitements thérapeutiques multimodaux, y compris les produits biologiques et la stimulation de la guérison par des ondes sonores, peuvent aider dans les blessures ligamentaires chez les chevaux de sport.(Traduit par Dr Serge Messier).

Progression of pre-rheumatoid arthritis to clinical disease of joints: Potential role of mesenchymal stem cells.

Rheumatoid arthritis (RA) related autoimmunity is developed at mucosal sites due to the interplay between genetic risk factors and environmental triggers. The pre-RA phase that leads to anti-citrullinated protein antibodies, rheumatoid factor, and other autoantibodies spread in the systemic circulation may not affect articular tissue for years until a mysterious second hit triggers the localization of RA-related autoimmunity in joints. Several players in the joint microenvironment mediate the synovial innate and adaptive immunological processes, eventually leading to clinical synovitis. There still exists a gap in the early phase of RA pathogenesis, i.e., the progression of diseases from the systemic circulation to joints. The lack of better understanding of these events results in the inability to answer questions about why only after a certain point of time the disease appears in joints and why in some cases, it simply remains latent and doesn't affect joints at all. In the current review, we focused on the immunomodulatory and regenerative role of mesenchymal stem cells and associated exosomes in RA pathology. We also highlighted the age-related dysregulations in activities of mesenchymal stem cells and how that might trigger homing of systemic autoimmunity to joints.

What is manipulation? A new definition.

BACKGROUND: Definitions are important in healthcare. Unfortunately, problems can be found withall existing definitions of manipulation. METHODS: This paper derives a set of eligibility criteria from prior definitions of manipulation to inform what should (and should not) be incorporated within a valid definition. These criteria were then used to select components from currently available empirical data to create a new definition. RESULTS: The resulting definition of manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the synovial fluid of that joint." The corresponding definition for the mechanical response of a manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint that results in cavitation within the synovial fluid of that joint." In turn, the action of a manipulation can be defined as: "A force applied perpendicularly to the articular surfaces." CONCLUSIONS: We believe these definitions to be valid (derived from and consistent with all available empirical data), complete (containing all necessary components), minimally sufficient (minimal redundancy, and sufficient to distinguish manipulation from other physical interventions), and robust (able to withstand important limitations embodied within sensible eligibility criteria). It is hoped that the simplicity and clarity of these definitions, and the transparency of their formation, will encourage their wide adoption in clinical, research, educational and professional settings.