Biomechanical maturation of foot joints in typically developing boys: Novel insight in mechanics and energetics from a cross-sectional study

BackgroundA growing body of quantitative evidence has been provided regarding age-related differences in plantar foot loading, multi-segment foot kinematics and muscle activity. Fundamental insight into the joint mechanics and energetics of the maturing foot has yet to be provided.Research question/HypothesisIt was hypothesized that so-called ‘biomechancial maturation’ joint kinetics would be observed in children underneath the age of eight and that older age-groups would not differ from each other in these parameters.MethodsFourty-three typically developing boys were recruited and allocated to three different age groups: 1) an early childhood group, 2) a middle childhood group, and 3) an early and late adolescence group. Multi-segment joint kinematics and kinetics of the Ankle-, Chopart-, Lisfranc- and Hallux joint were collected during barefoot walking. One-way Analysis of Covariance was conducted to examine differences among the outcome measures with group as a fixed factor and walking cadence as covariate.ResultsThe youngest group differed significantly from the other two age groups with respect to their ankle and chopart joint peak plantarflexion moment (p < 0.05). Ankle and chopart joint peak power generation as well as the lisfranc peak plantarflexion moment was found to be significantly lower in the youngest age group compared to the oldest group (p < 0.05). At the lisfranc joint, the youngest age group demonstrated a significantly higher peak plantarflexion velocity compared to the two older age groups (p < 0.05).SignificanceThis study provides novel insight into the biomechanical maturation of the developing foot which may guide clinical interventions in paediatric cohorts.     

The emerging role of ultrasound in detecting interstitial lung disease in patients with rheumatoid arthritis

ObjectiveTo investigate the potential role of US in the detection of ILD in a cohort of patients with RA.MethodsPatients with diagnosis of RA were consecutively enrolled. All patients underwent pulmonary examination, laboratory data, DLCO measure, chest HRCT and radiographs, and US examination. A healthy group was included as control group. US was performed according the 14-intercostal space scanning protocol using the following semiquantitative scale [0 = normal (≤ 5 B-lines); 1 = slight (≥ 6 and ≤ 15 B-lines); 2 = moderate, (≤ 16 and ≥ 30 B-lines); 3 = severe (≥ 30 B-lines)].ResultsA total of 74 RA patients and 74 healthy controls were included. Thirty of 74 patients (40.5%) showed US signs of ILD with respect to the healthy controls (3 subjects, 4.1%) (P < 0.001); whereas HRCT showed ILD in 27 (36.4%) of 74 patients. Among the 30 patients that showed US findings of ILD, 17 (56.6%) were asymptomatic from respiratory view-point. The sensitivity and specificity of US were 92% and 89% respectively. A positive correlation between US and HRCT findings were found (P < 0.001) whereas no correlation was found with chest radiographs and DLCO findings. Positive association between US findings and DAS28-ESR, anti-CCP and RF (P < 0.01 for each respectively) was found. Feasibility, represented by the mean time spent to perform the pulmonary US assessment was 7.8 minutes (± SD 1.2, range 6 to 10 minutes).ConclusionsOur results support the potential of US in detect accurately ILD in patients with RA and provide a rationale to consider it as a friendly screening tool to be implemented in early phases of the disease.     

重型血友病A患儿关节出血与关节评估的相关性研究

目的了解血友病患儿出血与关节病变之间的关系,为临床治疗和预后判断提供理论依据。方法选取2016年6月至2017年1月于首都医科大学附属北京儿童医院及成都市新世纪妇女儿童医院就诊的1~7岁重型血友病A且有关节出血记录的患儿,以患儿关节出血为研究关节,收集前3个月研究关节的出血次数,应用超声、X线、磁共振成像(MRI)和血友病关节健康评分(HJHS)评分系统对关节进行评估。将关节出血次数与超声、X线、MRI和HJHS评分进行相关性分析,并对超声、X线、MRI和HJHS评分间的相关性进行分析。结果1.共收集重型血友病A患儿18例,年龄(5.6±1.8)岁,共30个出血关节,中位年关节出血次数为4次(4~16次),中位年靶关节出血次数为8次(4~16次)。2.关节出血次数与超声、X线评估有相关性(r=0.390,P=0.033;r=0.517,P=0.008),与HJHS评估、MRI评估均无相关性(均P>0.05)。3.超声、X射线、HJHS和MRI两两之间均呈极显著正相关[r=0.815(超声与X线),r=0.510(超声与HJHS),r=0.812(超声与MRI),r=0.666(X线与HJHS),r=0.911(X线与MRI),r=0.781(HJHS与MRI),均P<0.01]。4.关节超声和/或MRI评估异常的关节中,出血次数与关节评估间均无相关性(P>0.05)。结论关节出血与关节评估获得的关节病变程度结果不一致,因此准确判断关节病变情况需综合评估关节结构、功能等,以便更加全面地指导血友病患儿的治疗。     

全国著名骨伤专家梁铁民教授学术思想和正骨经验

总结了全国著名骨伤专家梁铁民教授的学术思想和正骨经验,简述了梁老生平。梁老学术思想表现在突出整体观念,主张辨证施术;注重调理气血,强调药物接续;重视望问切触量法五诊结合等三个方面。对于梁老正骨经验先进行了综合论述,进一步佐证其学术思想;后分别从小儿桡骨头半脱位、颈椎错位、胸腰椎小关节错位、肋骨骨折等梁老研究较深入和比较擅长的几个方面进行了阐述。特别是颈椎错位这种高难度高风险的手法操作,体现出梁老高超的手法技艺。     

Clinically applied anatomy of the pelvis

The bony pelvis is an irregular but complete bony ring made up of the right and left hip bones anterolaterally and the sacrococcygeal part of the vertebral column posteriorly. The two hip bones are firmly united anteriorly at the pubic symphysis, and together constitute the pelvic girdle. The pelvic girdle articulates with the femoral heads and thereby connects the vertebral column (axial skeleton) to the two femora (appendicular skeleton). The main functions of the pelvic girdle are to transmit weight from the upper body to the lower limbs during locomotion and while standing, and to support the weight of the upper body when seated or stationary. Another important function of the bony pelvis is to provide attachment for the powerful muscles (e.g. gluteal muscles) that act on the lower limb and those muscles that support the abdominal wall. The bony pelvis also provides ample protection to the many delicate viscera, vessels and nerves that lie within the pelvic cavity. Successful orthopaedic management of disruptions of the bony pelvis and management of associated injuries to intrapelvic viscera require a sound appreciation of the anatomy of the pelvic ring and pelvic cavity.     

A simplified relationship between the femoral trochlea and the femoral condyle: A sagittal MRI analysis by an ellipse-fitting approach

We have introduced an ellipse-fitting approach to express the shapes of trochlea and condyle on magnetic resonance imaging (MRI) and to analyze their relationship. Fifty healthy right knees were sagittal-imaged by MRI at full extension. On the deepest trochlear groove slice, the articular surface was best-fitted by a circle. Based on the center of this circle, both the most prominent slices of the medial and lateral trochleae were best-fitted by ellipses. On the most distal slice of medial condyle, the articular surface was best-fitted by a horizontal ellipse. Based on the center of this ellipse, the lateral condyle was best-fitted by a rotational ellipse. The semimajor and semiminor axes of the trochlear ellipse and the condylar ellipse constituted a rectangle that represented the relationship between the trochlea and the condyle. The anteroposterior dimension (l) of this rectangle was 12.33 ± 1.41 mm, and the superoinferior dimension (w) was 7.21 ± 1.23 mm. The average tangent angle (θ) of the rectangle was 30.1° ± 2.6°. There were significant sex differences in l, w, and θ (all P ≤ 0.006), and all correlated significantly with the height of the subject (all P ≤ 0.001). The relationship between the femoral trochlea and the femoral condyle differed significantly between males and females, but this could have been a consequence of the significant correlation with subject height. Clin. Anat. 33:500–506, 2020. © 2019 Wiley Periodicals, Inc.     

Pharmacotherapeutic considerations and options for the management of osteoarthritis in women

ABSTRACT

Introduction

Osteoarthritis is a chronic disease that leads to the destruction of articular cartilage and joints. As the most common joint disorder, osteoarthritis poses a great burden to the healthcare system. Most importantly, osteoarthritis is a heterogeneous disease characterized by a wide range of clinical features, phenotypes, and treatments. The burden of osteoarthritis is not equally distributed between men and women. Women have an increased risk of developing osteoarthritis, with worse symptoms, and poorer outcomes.