High variation among clinical studies in the assessment of physical function after knee replacement: a systematic review

PurposeThe purpose of this study was to summarise the current use of outcome measures for the assessment of physical function after knee joint replacement.MethodsA systematic approach following the PRISMA guidelines was used. Literature search was performed on MEDLINE database via PubMed and on Epistemonikos. Clinical trials (level of evidence I-II) on knee joint replacement reporting data on the 'physical function' domain published between January 2017 and June 2022 were included. Descriptive statistics were used to summarise the evidence.ResultsIn the 181 articles that met the inclusion criteria, 49 different outcome measurements were used to evaluate clinical outcomes after knee joint replacement. The most frequently adopted patient-reported outcome measures (PROMs) were the Knee Society Score (KSS) (78 studies; 43.1%), the Western Ontario and McMaster Universities (WOMAC) Arthritis Index (62 studies; 34.3%), the Oxford Knee Score (OKS) (51 studies; 28.2%) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (36 studies; 20%). The most frequently used performance-based outcome measures (PBOMs) were the Timed-Up-and-Go (TUG) test (30 studies; 16.6%) and the 6-min-walk test (6MWT) (21 studies; 11.6%). Among impairment-based outcome measures (IBOMs), range of motion (ROM) was the most used (74 studies; 40.9%).ConclusionThere is considerable variation among clinical studies regarding the assessment of the physical function of patients after knee joint replacement. PROMs were found to be the most commonly adopted outcome measures; however, no single PROM was used in more than half of the papers analysed

Fat Tissue’s Graft in Osteoarthritis Treatment: Indications, Preparations, and Results

Osteoarthritis (OA) represents one of the most common causes of joint pain and disability with related changes in bone morphology. In last years, this pathology is steadily increasing due to the continuous increase in the average life expectancy and the rate of active population. In recent years, there have been many conservative treatments for symptomatic gonarthrosis in order to reduce pain and delay or avoid the implantation of a knee prosthesis. The most studied and used was infiltrating treatment. Our group has been paying attention to regenerative medicine for many years, focusing on the characteristics of adipose tissue and the presence of multipotent mesenchymal cells, particularly in the vascular stromal area. Mesenchymal stem cells (MSCs) of adipose tissue can commit toward the chondrogenic, osteogenic, adipogenic, myogenic, and neurogenic lineages. Our group has continued the studies in this field by submitting this to treatment patients with grade II–III arthrosis according to the scale of Kellgren-Lawrence or patients with IV degree of such scale inoperable for internal reasons. To date, with a 4-year follow-up, our results are satisfactory in terms of pain reduction, improvement in joint function, and recovery of daily and sports activities

Uso de planta alimentícia não convencional (PANC) na gastronomia e suas propriedades nutricionais: Ora-pro-nóbis (Pereskia aculeata Mill.)

Dentre os alimentos de origem vegetal, encontram-se as Plantas Alimentícias Não Convencionais (PANC). O termo PANC foi criado em 2008 e refere-se a todas as plantas que possuem uma ou mais partes comestíveis, sendo elas espontâneas ou cultivadas, nativas ou exóticas que não estão incluídas em nosso cardápio cotidiano, como por exemplo, a ora-pro-nóbis. O objetivo deste trabalho é descrever os achados sobre as propriedades nutricionais e a utilização do ora-pro-nóbis na alimentação humana, bem como o seu uso na gastronomia. Para isto, realizou-se uma revisão bibliográfica exploratória de artigos científicos indexados nas bases de dados científicos SciELO e PubMed. O presente trabalho traz evidências de que as PANCs possuem alto valor nutricional e podem proporcionar diversos benefícios a saúde da população. A Ora-pro-nóbis, em especial, possui propriedades nutricionais benéficas para ao ser humano, incluindo um alto teor de proteína, fibras e compostos bioativos. Além disso, observou-se que o uso do ora-pro-nóbis na gastronomia através das folhas e farinha favorece a saúde dos seus consumidores devido às suas propriedades nutricionais, principalmente por ser uma PANC e possuir fácil acesso a população. A mesma pode ser utilizada em pães, bolos, massas e carnes

FRAGILITY FRACTURES OF THE SACRUM: A SILENT EPIDEMIC

Fragility fractures of the sacrum (FFS) are caused by low-energy trauma in the elderly population. Due to the nuanced symptomatology, many FFS remains unrecognized and the prevalence is underestimated. The clinical presentation varies, typically presenting with weightbearing low back pain without even remembering of a previous trauma. Radiographs are usually insufficient for the diagnosis and second level imaging modalities are required. In particular, magnetic resonance demonstrated the highest diagnostic accuracy. Treatment should aim to guarantee early mobilization and weightbearing, efficient pain relief and early discharge from the hospital to a proper facility for rehabilitation. Conservative treatment is reserved to non-displaced fractures with an adequate pain relief within one week allowing early mobilization. Otherwise, surgical treatment must be preferred. Nowadays, minimally invasive techniques, such as ileo-sacral screws or trans-sacral bar osteosynthesis, are safe and effective procedures and have overcome open procedures. In more complex patterns, with complete dissociation between the pelvic ring and the ilio-lumbar spine, spino-pelvic fixation is the procedure of choice

Combined Arthroscopic-Assisted Lower Trapezius Tendon Transfer and Superior Capsule Reconstruction for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique

Primary or revision irreparable rotator cuff tears remain a challenge. Clear algorithms do not exist. Several joint-preserving options are available, but no technique has been definitely proven to be better than another. Although superior capsule reconstruction has been shown to be effective in restoring motion, lower trapezius transfer can provide strong external rotation and abduction moment. The aim of the present article was to describe an easy and reliable technique to combine both options in 1 surgery, aiming to maximize the functional outcome by getting motion and strength back

Modeling Nanocarrier Transport across a 3D In Vitro Human Blood‐Brain–Barrier Microvasculature

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Diffuse gamma ray constraints on annihilating or decaying Dark Matter after Fermi

We consider the diffuse gamma ray data from FERMI first year observations and compare them to the gamma ray fluxes predicted by Dark Matter annihilation or decay (both from prompt emission and from Inverse Compton Scattering), for different observation regions of the sky and a range of Dark Matter masses, annihilation/decay channels and Dark Matter galactic profiles. We find that the data exclude large regions of the Dark Matter parameter space not constrained otherwise and discuss possible directions for future improvements. Also, we further constrain Dark Matter interpretations of the e+e- PAMELA/FERMI spectral anomalies, both for the annihilating and the decaying Dark Matter case: under very conservative assumptions, only models producing dominantly mu+mu- and assuming a cored Dark Matter galactic profile can fit the lepton data with masses around 2 TeV.Comment: 16 pages, 4 figures. v2: Matches version published on Nuclear Physics B; discussion on the uncertainties related to magnetic field models added in an appendix, some typos corrected and some references added, conclusions unchange

Gamma-ray and radio tests of the e+e- excess from DM annihilations

PAMELA and ATIC recently reported an excess in e+e- cosmic rays. We show that if it is due to Dark Matter annihilations, the associated gamma-ray flux and the synchrotron emission produced by e+e- in the galactic magnetic field violate HESS and radio observations of the galactic center and HESS observations of dwarf Spheroidals, unless the DM density profile is significantly less steep than the benchmark NFW and Einasto profiles.Comment: 16 pages, 4 figures; v2: normalizations fixed in Table 2 and typos corrected (no changes in the analysis nor the results), some references and comments added; v3: minor additions, matches published versio