Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review.

PURPOSE: To obtain detailed information on the outcomes of patients with rheumatoid arthritis (RA) undergoing reverse shoulder arthroplasty (RSA) METHODS: A literature search was conducted for studies reporting on the use of RSA in RA patients from 1990 to 2014. The inclusion criteria were a report of sufficient information on pre-operative status and surgical outcome allowing evaluation of the therapeutic potential of RSA in RA. The literature search resulted in 586 hits, but only five studies that met the inclusion criteria were assessed. RESULTS: There were 100 shoulders that had been operated on, of which 87 were followed for a mean of 55.4 months, the longest follow-up being 11.9 years Most patients had glenohumeral erosive lesions of Larsen Grade III or IV. The Delta III prosthesis was implanted in most cases and in three studies bone graft was used for severe glenoid lesions. The main outcome measures employed were the Constant score (Cs) and ASES questionnaire. The mean increase in Cs and ASES score after surgery was 42.4 and 54 points, respectively. The mean post-operative forward elevation was 120.6°, the average increment being 51° and the mean increase of abduction was 58.5°. The mean prevalence of scapular notching was 35.4 %. The rate of adverse events was 31 %, but the vast majority were of minor severity. Eight prostheses underwent revision, due to infection in four. CONCLUSIONS: RSA implanted in RA patients would appear to give similar results to those obtained in massive cuff tears with or without arthropathy.

The evolution of the meningeal vascular system in the human genus: From brain shape to thermoregulation.

OBJECTIVES: The imprints of the middle meningeal vessels make it possible to analyze vascularization in fossil specimens. The association between changes in the cortical anatomy and vascular organization raises questions about the actual physiological meaning of these features, most of all when dealing with the origin of the modern human brain. Metabolism and thermoregulation may be relevant factors in influencing morphological adaptations between brain and vessels. This study is aimed at investigating the relationships between endocranial morphology and endocranial vessels in modern humans and to analyze the pattern of heat dissipation through the endocranial surface in fossil specimens. METHODS: Through angiotomography, it is possible to make an anatomical reconstruction of the meningeal and cerebral vessels, providing information on the morphology of the endocranial vascular system. At the same time, digital modeling can be performed to investigate the relationships between the endocranial geometry and physical properties such as heat dissipation patterns in extinct hominids. RESULTS: The middle meningeal network is largely independent from the cerebral vascular system. Furthermore, in adults, the medium and upper tracts of the middle meningeal artery shows scarce or absent blood flow. Parietal bossing in modern humans involves relative cooling of the cortical surface at the supramarginal gyrus. CONCLUSIONS: The evidence does not support a thermoregulatory role for the meningeal vascular network, at least in adult normal blood flow conditions. On the other hand, biomechanical protective functions (hydraulic skeleton for shock adsorption) cannot be ruled out.

Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo-controlled double-blind clinical trial.

PURPOSE: To investigate the effects of hyperthermia on knee osteoarthritis (OA) in a randomized placebo-controlled double-blind clinical trial. METHODS: Sixty-three patients with clinical evidence and radiographic confirmation of knee OA (Kellgren and Lawrence grades II and III) were randomized to either three 30-min sessions of hyperthermia per week for 4 weeks were administered using a 433.92 MHZ microwave generator or receive placebo treatment (machine not turned on) for same number of sessions. The Western Ontario McMaster Universities (WOMAC) questionnaire and the Timed Up and Go test (TUGT), a performance-based measure of function, were obtained at baseline (week 0), at the end of treatment (week 4), and at final follow-up (week 16). RESULTS: The treatment group showed a significant decrease in the overall WOMAC score and each of its components, and in the TGUG test between the beginning (week 0) and the end of treatment (week 4), as well as at final follow-up (week 16). In the placebo group, a significant fall was only visible in the pain subscore at week 4. However, the mean improvement was only 1 point and was lost at final follow-up (P=0.332). There was a significant difference in pain -7.4 pre-post (P<0.01), -8.1 pre-follow-up (P<0.01); stiffness -4.6 pre-post (P<0.01), -5.1 pre-follow-up (P<0.01); activities daily living (ADL) -30.9 pre-post (P<0.01), -33.2 pre-follow-up (P<0.01); and WOMAC total score -43 pre-post (P<0.01), -46.4 pre-follow-up (P<0.01); and in TGUG test -2.4 pre-post (P<0.01), -2.9 pre-follow-up (P<0.01) between the treatment and placebo group over the whole length of the trial. CONCLUSIONS: A 433.92 MHz microwave hyperthermia regimen showed beneficial effects in patients with moderate knee OA to reduce pain and to improve their physical function. LEVEL OF EVIDENCE: I.

The safe zone for avoiding suprascapular nerve injury during shoulder arthroscopy: an anatomical study on 500 dry scapulae.

HYPOTHESIS/BACKGROUND: Suprascapular nerve injury may be a complication during shoulder arthroscopy. Our aim was to verify the reliability of the existing data, assess the differences between scapulae in the 2 genders and in the same subject, obtain a safe zone useful to avoid iatrogenic nerve lesions, and analyze the existing correlations between the scapular dimensions and the safe zone. METHODS: We examined 500 dried scapulae, measuring 6 distances for each one, referring to the scapular body, glenoid, and the course of the suprascapular nerve, also catalogued according to gender and side. Differences due to gender were assessed comparing mean ± sd of each distance in males and females; paired t test was used to compare distances deriving from each couple. Successively, we calculated our safe zone and Pearson's correlation. RESULTS: We found nonsignificant differences between the right and left distances deriving from each couple; differences due to gender were stated. We defined 3 kinds of safe zones referring to: 500 scapulae; males (139 scapulae) and females (147 scapulae). The correlation indexes calculated between the axis of the scapular body and glenoid, and the posterosuperior distance (referring to the suprascapular nerve) were 0.624, 0.694, 0.675, 0.638; while those with the posterior distance were 0.230, 0.294, 0.232, 0.284. DISCUSSION/CONCLUSIONS: Knowledge of the safe zone, for avoiding suprascapular nerve injury, is important; gender and specific scapular dimensions should be evaluated, as they influence the dimensions of the safe zone. The linear predictors should be used to obtain specific values of the posterosuperior limit in each patient.

The Italian law on body donation: A position paper of the Italian College of Anatomists.

In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors' scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations.

[Genetic tests in oncology: from identification of high risk groups to therapy]. / Test genetici in oncologia: dall'identificazione dei gruppi a rischio alla terapia.

The development of genetic epidemiology in oncology has made possible more frequent analysis of high risk groups, allowing the development of promising susceptibility indicators. The main public health implications include screening and new perspectives for pharmacogenetics and nutrigenomics. The study of genetic variants allows the evaluation of individual risk of developing a disease and has important implications in primary and secondary prevention programs. The analysis of somatic mutations present in tumour cells may contribute to selecting the optimal treatment on an individual basis and to reducing the occurrence of adverse effects of chemotherapy. The authors give a summary of the state of the art of this field and analyze the potential applications of genetic tests in oncology, from identification of high risk groups to defining individualized therapies with particular emphasis on implications for prevention.

Analysis of modifications of the plantar parameters after the use of a proprioceptive insole: regular gait.

BACKGROUND: The human foot is the basis of support and propulsion for gait and it provides support and flexibility for effective weight transfer. Therefore a correct distribution of loads and pressures on the surface of the foot is of fundamental importance to ensure a correct walking and maintaining balance in both static and dynamic conditions. The aim of our study was to evaluate the effects of innovative insoles, named regular gait (RG), on plantar pressures distribution during standing position and walking in healthy subjects; therefore, we investigated whether these effects are maintained after insole removing. METHODS: Fifty subjects were tested; these were free of foot diseases or damage to the anatomical structures involved in the processes above posture. These subjects underwent rating scales and static and dynamic baropodometric examination before and after using RG. RESULTS: The results obtained shown that the RG, for as we have designed, are able to change the distribution of the parameters both in static and dynamic conditions. We have also shown that the best results were obtained only after a month of treatment with RG and that the results obtained persist even in the tests post-treatment without insoles. CONCLUSIONS: In conclusion, the data obtained in this study suggest that RG could be efficient in acting on parameters related to maintenance of upright posture and gait. This would allow the treated subjects to improve their posture both while walking and during the maintenance of the upright position.

Artificial-turf surfaces for sport and recreational activities: microbiota analysis and 16S sequencing signature of synthetic vs natural soccer fields.

Synthetic fibres are used in place of the natural grass worldwide, for realizing playgrounds, soccer fields and even domestic gardens or recreational structures. An intensive use of artificial turf is currently observed in sports facilities, due to lower costs, higher sustainability in recycling of materials, and advantages related to athletic practice and performance. However, even if chemical and physical risks were studied, the microbiological component was not fully addressed, especially considering a comprehensive evaluation of the microbiota in synthetic vs natural playground surfaces. Here, we investigated the microbial community present on soccer fields, using Next Generation Sequencing and a 16S amplicon sequencing approach. Artificial and natural turfs show own ecosystems with different microbial profiles and a mean Shannon's diversity value of 2.176 and 2.475, respectively. The bacterial community is significantly different between facilities (ANOSIM: R = 0.179; p < 0.001) and surface materials (ANOSIM: R = 0.172; p < 0.005). The relative abundance of potentially pathogenic bacterial OTUs was higher in synthetic than in natural samples (ANOVA, F = 2.2). Soccer fields are characterized by their own microbiota, showing a different 16S amplicon sequencing signature between natural and artificial turfs.

A quantitative and descriptive approach to morphological variation of the endocranial base in modern humans.

The cranial base is one of the major foci of interest in functional craniology. The evolution and morphogenesis of this structure are still poorly known and rather controversial because of multifactorial influences and polyphasic stages. Endocranial dynamics are associated anteriorly with the upper facial structures, laterally with the mandibular system and midsagittally with brain development. In the present study, we investigated the endocranial morphology of modern humans using 3D landmark-based approaches, i.e. geometric morphometrics and Euclidean distance matrix analysis. The structure of endocranial variation is poorly integrated, with only weak reciprocal influences among the three fossae. Some major variations are associated with changes in the posterior fossa, with possible consequences on the anterior areas. These main patterns of integration are hypothesized to be influenced by the connective tensors of the dura layers. Static allometry and sex differences are largely related to the ontogenetic sequences, characterized by early maturation of the anterior fossa with respect to the middle and posterior regions (i.e., relatively shorter posterior part of the planum sphenoideum and vertical lengthening of the clivus in males). The relative independence between the endocranial fossae, as well as their structural connection through the meningeal tensors, must be carefully considered in studies on the evolutionary dynamics, since they lead to mosaic changes through phylogeny.

Calcific tendinopathy of the rotator cuff. Conservative management with 434 Mhz local microwave diathermy (hyperthermia): a case study.

PURPOSE: To report the effects of local microwave diathermy (hyperthermia) at 434 Mhz on calcific tendinopathy of the shoulder in two middle aged patients. METHODS: Two middle-aged women with calcific tendinopathy of the shoulder were treated with local microwave diathermy (hyperthermia) at 434 Mhz three times a week for four weeks. Plain radiographs and ultrasonography demonstrated calcific deposits in the area of infraspinatus or supraspinatus. Shoulder Pain and Disability Index (SPADI) and passive Range of Motion (ROM) were used to assess the response to treatment. RESULTS: At the end of the treatment period, the improvement as measured by the SPADI score was respectively 30% for the first patient and 40% for the second patient with an improvement of the shoulder passive ROM for both patients. The calcific deposits seen on the initial radiographs and ultrasonography were no longer visible. At 1 year follow-up, both patients continued to be symptom free. CONCLUSIONS: Hyperthermia is a safe option in the management of calcific tendinopathy of the shoulder. Prospective randomized controlled studies with long term assessment are needed to further document its therapeutic efficacy.

Economic aspects and managerial implications of the new technology in the treatment of low back pain.

BACKGROUND: The Human Body Posturizer (HPB), an innovative therapeutic tool able to correct postural changes dynamically, fits perfectly in this framework. OBJECTIVE: The aim of this paper is to consider the potential economic benefits of using the Human Body Posturizer both in terms of direct and indirect cost reduction in one year. METHODS: This study was carried out using an estimation method in order to investigate the possible economic impact related to the adoption of the HBP in subjects with low back pain as an attempt to quantify the costs (direct and indirect) generated at different levels of the path therapeutic. RESULTS: The use of therapy with HBP would generate a saving of € 971.40/year in case of sub-acute LBP and amounted to € 2,922.90/year in case of chronic low back pain. CONCLUSION: This paper provides guidance on the potential economic benefits resulting from the adoption of the Human Body Posturizer as an innovative therapeutic approach by the Italian Health System.

ACTN3 genotyping by real-time PCR in the Italian population and athletes.

PURPOSE: Development of two novel sets of primers and probes to detect R577X and Q523R polymorphisms of the alpha-actinin-3 (ACTN3) gene by real-time PCR. We report the allelic frequencies observed in Italian individuals from the general population and athletes. Athletic performance is influenced by training, environmental factors, and genetic predisposition. Actn3 belongs to a family of actin-binding proteins and is supposed to influence sport performance. METHODS: Primer-probe set design and protocol optimization for real-time PCR genotyping of R577X and Q523R polymorphisms. The assay was verified using a traditional PCR-RFLP approach and applied on an Italian population sample (102 male subjects and 42 athletes). RESULTS: Haplotype distribution confirmed the presence of linkage disequilibrium between the polymorphisms, both in the Italian general population and athletes (respectively: chi = 54.4, P < or = 0.001 and chi = 24.5, P < or = 0.001). Within the general population, a large percentage of homozygous subjects (21.6%) was deficient for Actn3. No significant differences were observed in athletes. The concordance between PCR-RFLP and real-time PCR results was 100and 93% for polymorphisms Q523R and R577X, respectively. CONCLUSION: Real-time PCR represents an effective approach for typing ACTN3 alleles. Allelic frequencies in the Italian population are consistent with those seen in other studies on Caucasians.

The complex arrangement of an "aorto-jejunal paraduodenal" fossa, as revealed by dissection of human posterior parietal peritoneum.

Peritoneal fossae derive from normal or anomalous coalescence of the peritoneum during fetal development, or from the course of retroperitoneal vessels. Clinically, internal abdominal hernias may be housed inside these fossae. In this report from an autopsy, a singular peritoneal fossa was delimited superiorly by an arcuate serous fold, raised up by the inferior mesenteric vein, and infero-posteriorly by two (right and left) avascular folds, extending from the abdominal aorta to the jejunum. The right fold reached the duodeno-jejunal flexure, which was located on the right side of the aorta. The left fold subdivided into two, anterior and posterior, secondary folds. The anterior fold reached the superior edge of the first jejunal loop, and the posterior fold turned medially to connect with the inferior edge of the proximal limb of the same loop. This fossa consisted of three recesses: superior, Located behind the subserous vascular arch, antero-inferior and postero-inferior, separated by interposition of the left posterior secondary fold, between the jejunum and aorta. The complex arrangement of this fossa suggests that it might have originated from a coalescence arising beyond the duodeno-jejunal flexure and including the first jejunal loop, and from the subserous course of the inferior mesenteric vein. Because of displacement to the right of the flexure, processes of coalescence in a location normally occupied by the ascending duodenum might have occurred in a similar pattern for the jejunum, involving the mesoduodenum and the proximal part of the mesentery. Labyrinthine fossae like this might cause strangulation of internal abdominal hernias and hinder intraoperative maneuvers.

A passive exoskeleton can push your life up: application on multiple sclerosis patients.

In the present study, we report the benefits of a passive and fully articulated exoskeleton on multiple sclerosis patients by means of behavioral and electrophysiological measures, paying particular attention to the prefrontal cortex activity. Multiple sclerosis is a neurological condition characterized by lesions of the myelin sheaths that encapsulate the neurons of the brain, spine and optic nerve, and it causes transient or progressive symptoms and impairments in gait and posture. Up to 50% of multiple sclerosis patients require walking aids and 10% are wheelchair-bound 15 years following the initial diagnosis. We tested the ability of a new orthosis, the "Human Body Posturizer", designed to improve the structural and functional symmetry of the body through proprioception, in multiple sclerosis patients. We observed that a single Human Body Posturizer application improved mobility, ambulation and response accuracy, in all of the tested patients. Most importantly, we associated these clinical observations and behavioral effects to changes in brain activity, particularly in the prefrontal cortex.

Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial.

OBJECTIVE: The goal of this study was to compare the effects of trigger point (TRP) mesotherapy and acupuncture (ACP) mesotherapy in the treatment of patients with chronic low back pain. DESIGN: Short term randomized controlled trial. SETTING: 62 subjects with chronic low back pain were recruited at outpatients Physical Medicine and Rehabilitation Clinic at the University of Rome "La Sapienza" in the period between July 2006 and May 2008. INTERVENTION: Study subjects were assigned to receive 4 weeks treatments with either trigger point mesotherapy (TRP mesotherapy, n=29) or acupoints mesotherapy (ACP mesotherapy, n=33). MAIN OUTCOME MEASURES: Pain intensity with a pain visual analogic scale (VAS) and verbal rating scale (VRS) and pain disability with McGill Pain Questionnaire Short Form (SFMPQ), Roland Morris Disability Questionnaire (RMQ) and Oswestry Low Back Pain Disability Questionaire (ODQ). RESULTS: ACP mesotherapy shows a more effective results in VRS and VAS measures in the follow-up (p(VRS)=<.001 and p(VAS)=<.001). The SF-MPQ measure shows a better results for ACP instead of TRP with statistically significant differences between groups and time (p=.035). Participants reported a slight discomfort at the time of the inoculation, and 15% reported slight neck pain in ACP mesotherapy group. CONCLUSIONS: Our results suggest that the response to ACP mesotherapy may be greater than the response to TRP mesotherapy in the short term follow-up. This technique could be nevertheless a viable option as an adjunct treatment in an overall treatment planning of CLBP.

Modern morphometry: new perspectives in physical anthropology.

In the past one hundred years physical anthropology has recourse to more and more efficient methods, which provide several new information regarding, human evolution and biology. Apart from the molecular approach, the introduction of new computed assisted techniques gave rise to a new concept of morphometry. Computed tomography and 3D-imaging, allowed providing anatomical description of the external and inner structures exceeding the problems encountered with the traditional morphometric methods. Furthermore, the support of geometric morphometrics, allowed creating geometric models to investigate morphological variation in terms of evolution, ontogeny and variability. The integration of these new tools gave rise to the virtual anthropology and to a new image of the anthropologist in which anatomical, biological, mathematical statistical and data processing information are fused in a multidisciplinary approach.

Landmark-based analysis of the morphological relationship between endocranial shape and traces of the middle meningeal vessels.

The morphogenesis and evolution of the cranium are the result of structural interactions among its components, leading to covariance between traits. Soft and hard tissues exert a reciprocal physical and physiological influence, leading to the final phenotype in terms of both ontogeny and evolution. The middle meningeal vessels, interfacing the brain and the braincase, provide an opportunity to study this network, even in extinct human species. Between and within-species variations of the vascular patterns may be mechanically influenced by the cranial morphology (structural hypothesis) or else by actual physiological responses and adaptations, mostly related to oxygen supply and/or thermoregulation (functional hypothesis). In this analysis, we tested the relationship between neurocranial shape and the general morphology of the traces of the middle meningeal vessels in a modern human population, by using landmark-based geometrical models. Although there are some neurocranial differences between groups with different vascular patterns, they are very small or not statistically significant. Only the depth of the imprints may be more influenced by the endocranial morphology. Even if the neurocranial differences among extinct hominids are definitely larger than those within the modern species, the present analysis suggests that it is unlikely that the differences in vascular patterns among the human species are related only to the effects of different neurocranial geometry. This is rather relevant when the marked development of the meningeal network in Homo sapiens is taken into account, compared with the patterns described for nonmodern human species.