Effects of hip abductor strengthening on musculoskeletal loading in hip dysplasia patients after total hip replacement

Hip dysplasia patients after total hip replacement show worse functional performance compared to primary osteoarthritis patients, and unfortunately there is no research on muscle and joint loads that would help understand rehabilitation effects, motor dysfunctions and failure events. We tested the hypothesis that a higher functional improvement in hip dysplasia patients who received hip abductor strengthening after hip replacement, would result in different gait function and musculoskeletal loads during walking compared to patients who performed standard rehabilitation only. In vivo gait analysis and musculoskeletal modeling were used to analyze the differences in gait parameters and hip and muscle forces during walking between the two groups of patients. We found that, in a functional scenario of very mild abnormalities, the patients who performed muscle strengthening expressed a more physiological force pattern and a generally greater force in the operated limb, although statistically significant in limited portions of the gait cycle, and likely related to a higher gait speed. We conclude that in a low-demand task, the abductor strengthening program does not have a marked effect on hip loads, and further studies on hip dysplasia patients would help clarify the effect of muscle strengthening on loads

Massive Pericardial Effusion in a 14-Year-Old Girl with Mild Fatigue and Neck Pain

Pericardial effusion is rare in pediatric patients and is characterized by a variable clinical presentation. Mild symptoms may be present despite severe effusion. We here report the case of a patient with massive pericardial effusion with mild clinical presentation. Our case points out the need not to exclude this diagnosis in patients with mild general impairment. This clinical suspicion can be lifesaving

Activity of a Pediatric Emergency Department of a Tertiary Center in Bologna, Italy, during SARS-CoV-2 Pandemic

During the SARS-CoV-2 pandemic, the pediatric emergency department (ED) of Bologna, Emilia-Romagna, Italy faced a reorganization to better deal with the new clinical needs. We herein describe the main changes in the organization and in the attendances to our pediatric ED. From the 1 March 2020 to the 31 January 2022, 796 children positive for SARS-CoV-2 presented to our pediatric ED, but only 26 required hospitalizations, of which only 9 for COVID-19 related reasons. During this period, we also registered a temporal correlation between multisystem inflammatory syndrome in children (MIS-C) admissions and the peaks of SARS-CoV-2 infection in the Italian population. Respiratory syncytial virus (RSV) remained during last year the viral infection with the highest hospitalization rate. The analysis and description of the changes in the activity of the pediatric ED during the SARS-CoV-2 pandemic may help to better understand the routinary activity and be prepared for any possible new challenge

The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot

BACKGROUND: Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. METHODS: Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. RESULTS: Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. CONCLUSIONS: The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted

Custom-made implants for massive acetabular bone loss: accuracy with CT assessment

Background: Custom-made implants are a valid option in revision total hip arthroplasty to address massive acetabular bone loss. The aim of this study was to assess the accuracy of custom-made acetabular implants between preoperative planning and postoperative positioning using CT scans. Methods: In a retrospective analysis, three patients who underwent an acetabular custom-made prosthesis were identified. The custom-made designs were planned through 3D CT analysis considering surgical points of attention. The accuracy of intended implants positioning was assessed by comparing pre- and postoperative CT analyzing the center of rotation (CoR), anteversion, inclination, screws, and implant surface in contact with the bone. Results: The three cases presented satisfactory accuracy in positioning. A malpositioning in the third case was observed due to the posterization of the CoR of the implant of more than 10 mm. The other CoR vectors considered in the third patient and all vectors in the other two cases fall within 10 mm. All the cases were positioned with a difference of less than 10° of anteversion and inclination with respect to the planning. Conclusions: The current case series revealed promising accuracy in the positioning of custom-made acetabular prosthesis comparing the planned implant in preoperative CT with postoperative CT

Analysis of clinical profiles, deformities, and plantar pressure patterns in diabetic foot syndrome

Diabetic foot syndrome refers to heterogeneous clinical and biomechanical profiles, which render predictive models unsatisfactory. A valuable contribution may derive from identification and descriptive analysis of well-defined subgroups of patients. Clinics, biology, function, gait analysis, and plantar pressure variables were assessed in 78 patients with diabetes. In 15 of them, the 3D architecture of the foot bones was characterized by using weight-bearing CT. Patients were grouped by diabetes type (T1, T2), presence (DN) or absence (DNN) of neuropathy, and obesity. Glycated hemoglobin (HbA1c) and plantar lesions were monitored during a 48-month follow-up. Statistical analysis showed significant differences between the groups for at least one clinical (combined neuropathy score, disease duration, HbA1c), biological (age, BMI), functional (joint mobility, foot alignment), or biomechanical (regional peak pressure, pressure-time integral, cadence, velocity) variable. Twelve patients ulcerated during follow-up (22 lesions in total), distributed in all groups but not in the DNN T2 non-obese group. These showed biomechanical alterations, not always occurring at the site of lesion, and HbA1c and neuropathy scores higher than the expected range. Three of them, who also had weight-bearing CT analysis, showed >40% of architecture parameters outside the 95%CI. Appropriate grouping and profiling of patients based on multi-instrumental clinical and biomechanical analysis may help improve prediction modelling and management of diabetic foot syndrome

Comparison of Bone Segmentation Software over Different Anatomical Parts

Three-dimensional bone shape reconstruction is a fundamental step for any subject-specific musculo-skeletal model. Typically, medical images are processed to reconstruct bone surfaces via slice-by-slice contour identification. Freeware software packages are available, but commercial ones must be used for the necessary certification in clinics. The commercial software packages also imply expensive hardware and demanding training, but offer valuable tools. The aim of the present work is to report the performance of five commercial software packages (Mimics®, Amira™, D2P™, Simpleware™, and Segment 3D Print™), particularly the time to import and to create the model, the number of triangles of the mesh, and the STL file size. DICOM files of three different computed tomography scans from five different human anatomical areas were utilized for bone shape reconstruction by using each of these packages. The same operator and the same hosting hardware were used for these analyses. The computational time was found to be different between the packages analyzed, probably because of the pre-processing implied in this operation. The longer “time-to-import” observed in one software is likely due to the volume rendering during uploading. A similar number of triangles per megabyte (approximately 20 thousand) was observed for the five commercial packages. The present work showed the good performance of these software packages, with the main features being better than those analyzed previously in freeware packages