The influence of bariatric surgery on hip and knee joint pain: a systematic review

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI’s Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.     

Extensor hallucis longus distal tenotomy for spasticity in a patient with interphalangeal joint hyperextension after stroke

BackgroundThe extension deformity of the interphalangeal (IP) joint of the hallux is a rare focal clinical entity usually detected in patients with no underlying pathology. It may be due to extensor hallucis longus (EHL) overactivity, although it has not been previously reported in patients with neurological disorders. The lesion should be differentiated from the persistent hyperextension of the great toe at the metatarsophalangeal (MTP) joint. Although MTP hyperextension of the hallux due to hypertonia of the EHL is a typical sequel of stroke, it has also been detected in a wide variety of disorders.Materials and MethodsA patient with right hemiparesis following stroke, which had an almost complete functional recovery, is presented. She was disabled by focal spasticity of the EHL, leading to persistent hyperextension of the IP joint of the hallux. The deformity appeared on the long-term follow-up, on both sides within a 3-year period. It was treated with bilateral percutaneous distal EHL tenotomy. On the left side, a percutaneous dorsal IP joint capsulotomy was additionally performed.Results and ConclusionA complete reduction of the deformity was achieved on both sides with functional rehabilitation. It is assumed that EHL hyperactivity following stroke in our patient was complicated by IP instead of MTP extension deformity, due to the coexistent flexor hallucis longus weakness. Bilateral distal EHL tenotomy, associated with percutaneous dorsal IP joint capsulotomy on the left side, provided satisfactory long-term results.     

滑膜软骨瘤病的X线病理分析

目的 探讨滑膜软骨瘤病的临床、病理与X线联系及诊断价值．方法 回顾性分析了17例滑膜软骨瘤病的临床、病理及X线表现．结果 本病好发于下肢大关节，多为单关节．膝关节10例(双侧2例)、肩关节3例、髋关节、肘关节、腕关节、指掌关节各1例．主要临床表现：关节肿痛、弹响(6例)，绞锁(3例)，触及可活动或不活动性硬块(9例)．X线特点：在关节内及其周围见数目、大小、密度、形态不一的钙化或骨化游离体．结论 正确判断和认识关节内游离体来源与发展的病理变化及X线表现对诊断本病有较重要的价值．     

严重退变性膝关节骨关节病联合手术疗法

目的 采用多种手术方式的综合治疗严重膝骨关节病。方法 对68例80膝）严重膝骨关节病采用膝关节腔清理术、硬化骨切除钻孔减压术、胫骨高位截骨术、胫骨结节前移术等多种术式组合的方法进行了治疗。其中55例（62膝）经5年1个月的随诊,对其疗效进行了评价。结果 优：40膝,占64.5%;良：16膝,占25.9%;可：6膝,占9.6%,无差级,优良率达90.4%。结论 多种术式的联合应用治疗严重膝骨关节病具有缓解疼痛,提高步行能力及恢复关节活动的明显效果。     

COVID-19 vaccine and pregnancy: A safety weapon against pandemic

The ongoing COVID-19 pandemic is raising great concern all over the world. The recent introduction of vaccines has offered reason for optimism, however, new issues have arisen, such as vaccine reluctance. The safety of vaccines for pregnant women is one of the most serious of these concerns. The purpose of this review article is to provide updated international vaccine recommendations, results of ongoing studies and clinical trials, and the role of gynecologists in counseling the women to understand the risks versus benefits as well as form an informed decision towards vaccine acceptance for COVID-19.Although COVID-19 infection increases the risk of severe morbidity and mortality in pregnant women, pregnant women were not included in the initial vaccine trials. As a result, safety information is scarce. Nations have differing recommendations, though many have recently approved the COVID-19 immunization in pregnancy following a risk-benefit analysis. The Joint Committee on Vaccination and Immunization (JCVI) of the United Kingdom recently approved an mRNA vaccination for pregnant women. Vaccination is recommended by the CDC, ACOG, ARFM, and WHO. India recently took a stand, with the ICMR and the Ministry of Health and Family Welfare recommending vaccination during pregnancy and lactation.     

Joint Attention and Toddler Characteristics: Race, Sex and Socioeconomic Status

In studies of joint attention and sequences of interaction that foster joint attention, limited focus has been placed on toddler characteristics such as race, sex and socioeconomic status (SES). The purpose of the present study was to investigate the relationship between joint attention and toddler's race, sex and SES. Eighty-four dyads of diverse race, sex and SES were videotaped playing, and joint attention and initiating matemal bid sequences were coded. Joint attention related to a “persisting” mother, whether or not the toddler accepted the initial maternal bid. No race differences were found; however, females engaged in more frequent bouts of joint attention and had more frequent nonpersistent maternal responses after the bid was accepted. Finally, SES was generally unrelated to joint attention. The manner in which bids for joint attention transpired and the amount of joint attention that occurred was largely independent of the dyad's SES as measured here.     

The role of PGE2 in the sensitization of mechanoreceptors in normal and inflamed ankle joints of the rat

Summary The role of PGE₂ in the sensitization of highthreshold tarsal joint mechanoreceptors (putative nociceptors) has been investigated in 11 arthritic and 16 normal rats. Injections of a low dose of Freund's complete adjuvant at multiple sites into the tissues surrounding the ankle joint induced a chronic unilateral monoarthritis in the injected limb. Measurements of both spontaneous activity and responses of tarsal joint mechanoreceptors to repeated graded mechanical stimuli were made. All of the mechanoreceptors examined had afferent fibres with conduction velocities in the C or A- range. Using this new model of joint inflammation we have shown that lysine acetylsalicylate reduces the mechanical sensitivity of these joint mechanoreceptors and reduces the spontaneous activity in afferent nerve fibres. Prostaglandin E₂ is unable to restore either the spontaneous activity in the afferent axon or the mechanical sensitivity of tarsal joint mechanoreceptors after lysine acetylsalicylate in the arthritic rat. Similarly, PGE₂ does not sensitize or excite tarsal joint mechanoreceptors in the normal rat. In the normal rat, however, PGE₂ potentiates the excitatory action of bradykinin and enhances the sensitizing effect of bradykinin on the responses of joint mechanoreceptors to mechanical stimulation when both substances are injected simultaneously. These results indicate that PGE₂ is not important in the sensitization of these joint mechanoreceptors in this model of chronic joint inflammation but that in other circumstances PGE₂ may be able to contribute to a sensitization of joint mechanoreceptors by enhancing the action of bradykinin.     

Observation on therapeutic effect of cold moxibustion on rheumatoid interphalangeal arthritis

目的:观察冷灸对类风湿性指间关节炎的临床疗效.方法:将576例类风湿性指间关节炎随机分为冷灸组290例和对照组286例,治疗时间为2个月.结果:两者总有效率差异不明显,但在第2个疗程末前者完全缓解率达77.2%,后者仅23.4%,两者差异有显著意义(P＜0.005).结论:冷灸治疗类风湿性指间关节炎效果优于西药抗炎剂.     

Clinical analysis of knee osteoarthritis treated mainly by acupuncture

目的:了解不同治疗方法对膝关节骨关节炎的临床治疗效果.方法:对148例患膝随机分为4组进行针灸、中药频谱照射法、综合法、西药内服治疗,观察其疗效.结果:4组总有效率分别为78.9%,72.7%,92.3%和78.9%,各组之间无差异(P＞0.05).综合组显效率优于其他各组(P＜0.05).结论:针灸、中药频谱照射对膝骨关节炎有一定疗效,综合法能协同两者作用,使疗效提高.     

Clinical observation on scapulohumeral periarthritis treated by Tuina and SSP meridian therapeutic apparatus

目的:观察推拿结合经脉治疗仪治疗肩周炎的疗效.方法:观察组采用推拿结合日本产SSP经脉治疗仪治疗肩周炎患者35例.对照组单纯用经脉治疗仪治疗肩周炎患者30例.结果:观察组与对照组对肩周炎的治疗都有一定效果.但观察组的治愈率与对照组相比有明显差距(P＜0.01),观察组对肩周炎的治愈率明显高于对照组.结论:经脉治疗仪结合推拿是治疗肩周炎的一种有效方法.