Search Results (63)

Introduction/Objectives: Osteoarthritis (OA) is a chronic systemic disease that affects the entire array of joint structures. It is one of the most common chronic, socially significant diseases, associated with a decline in the quality of life of patients and constantly increasing the cost of treatment. Clinical trial outcomes are largely inconclusive, and OA remains one of the few musculoskeletal diseases without an established disease-modifying therapy. One potential explanation is the use of ineffective tools for OA classification, patient stratification, and the assessment of disease progression. There is growing interest in musculoskeletal ultrasonography (MSK US), as it enables the dynamic visualization of the examined structures and gives information about both inflammatory and structural changes that have occurred. Determining the leading ultrasound phenotype, which depends on the most damaged tissue at a given time (bone, cartilage, synovial membrane, joint capsule, ligaments, tendons, menisci, etc.), can rationalize therapy use by selecting patients more suitable for specific treatments. This article aims to evaluate and summarize the potential of MSK US in the process of determining the clinical phenotype of OA and to emphasize the importance of this imaging modality in evaluating further therapeutic strategies. Method: A single-center prospective study conducted in the period of September 2023–June 2024 enrolled 259 consecutive patients with proven OA. The statistical program Minitab version 22.2.1 (2025) was used to analyze the data. The predominant and secondary phenotypes were tabulated for each OA localization and were presented numerically and as relative proportions (%). The rate of the most frequently occurring phenotypes was compared against that of the less frequent ones through paired z-tests. The initially acceptable type I error was set at 5%; it was further adjusted for the number of comparisons (Bonferroni). Results: The most frequent and predominant US phenotype for patients with knee OA was intra-articular effusion (n = 47, 37.90%). It was significantly higher compared to the rest of the US phenotypes: synovial proliferation (n = 22, 17.70%; p < 0.001), cartilage destruction (n = 26, 21%; p = 0.001), altered subchondral bone (n = 8, 6.50%; p < 0.001), extra-articular soft tissue changes (n = 12, 9.70%; p < 0.001), crystal deposits (n = 6, 4.8%; p < 0.001), and post-traumatic (n = 3, 2.40%; p < 0.001). The most common US phenotype for hip OA was altered subchondral bone (n = 32, 47.1%), with significant differences from intra-articular effusion (n = 12, 17.60%; p = 0.001), synovial proliferation (n = 5, 7.40; p = 0.001), cartilage destruction (n = 12, 17.60%; p = 0.001), extra-articular soft tissue changes (n = 3, 4.40%; p = 0.001), crystal deposits (n = 3, 4.40%; p = 0.001), and post-traumatic (n = 0). Altered subchondral bone was also the leading US phenotype for hand OA (n = 31, 55.40%), with significant differences compared to intra-articular effusion (n = 1, 1.80%; p < 0.001), synovial proliferation (n = 7, 12.50%; p < 0.001), cartilage destruction (n = 11, 19.60%; p < 0.001), extra-articular soft tissue changes (n = 2, 3.60%; p < 0.001), crystal deposits (n = 3, 5.40%; p < 0.001), and post-traumatic (n = 1, 1.80%, p < 0.001). For shoulder OA, extra-articular soft tissue changes were the most frequent (n = 8, 46.20%), followed by post-traumatic (n = 4, 30.70%), as the rate of both phenotypes was significantly higher compared to that of intra-articular effusion (n = 0), synovial proliferation (n = 0), cartilage destruction (n = 1, 7.70%; p = 0.003), and crystal deposits (n = 0). Conclusions: The therapeutic approach for OA is a dynamic and intricate process, for which the type of affected joint and the underlying pathogenetic mechanism at a specific stage of the disease’s evolution is essential. MSK US is one of the options for the clinical phenotyping of OA. Some of the suggested ultrasound subtypes may serve as the rationale for selecting a particular treatment. Full article

This study focuses on how rocks respond mechanically and how to keep them stable when soft rock roadways are under deep tectonic stress. It does this through a combination of theoretical analysis, numerical simulations, and field applications. We created a mechanical model of roof strata to calculate how much they would bend under both horizontal tectonic stress and their weight. This modeling helped us determine the critical yield limits. A systematic study of the angle θ between the direction of tectonic stress and the axis of the roadway showed that the concentration of horizontal stress on the roof gets stronger as θ increases, while the vertical stress on the sidewalls slowly gets weaker. The main sign of surrounding rock failure is shear damage that is most severe at the roof, floor, and shoulder angles. The maximum plastic zone depth occurs at θ = 90°. Studies that looked at both gob-side and along-roadway stages found that the two types of failure were very different, characterized by severe roof damage during roadway advancement and pronounced coal pillar instability in gob-side conditions. Based on these results, targeted support strategies were successfully used in field engineering to control deformations and provide both theoretical foundations and practical solutions for stabilizing deep soft rock roadways under tectonic stress. Full article

The service status of rail, fasteners and track slabs is the key determinant of whether the ballastless track is ready for traffic after a fire. The track slab rail support bolt anchoring performance and the shoulder service performance damaged by fire were tested. Experiments of ballastless track slab concrete burned at different high temperatures were carried out to compare macro- and microstructural properties of the concrete under high-temperature burning to study the microstructure of hydration products after high-temperature burning and reveal the damage mechanism of the track slab concrete after a fire. The results show that the fire damage to the rail and fastener is mainly deformations, fractures and strength reduction. The degree of the fire damage of the mortar layer and base slab is much lower than that of the track slab. The main fire damage to the concrete is track and base slab cracks, spalling and gaps. The degree of the fire damage to the mortar layer and base slab is much lower than that of the track slab. The fire damage of the track slab concrete is mainly bursts, and the concrete cracks, spalling and deterioration occur layer by layer from the outside to inside. The shoulder injury is the most serious, the shear resistance is greatly reduced, the rail support is protected by the rail and fastener, the impact of the fire damage is small and the bolt anchoring performance was not decreased. The position of the track slab’s inside damage corresponds to the surface damage position. The steel bar inside the track slab is in good condition, and there is no obvious damage. The bulk expansion of the ballastless track concrete was caused by the expansion of aggregates under fire. When the expansion of aggregates is constrained by the shrinkage of hydration products, greater internal stress is generated, which is the main reason for the cracking or bursting of the ballastless track slab concrete under high temperatures. Full article

Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O₂-O₃ therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O₂-O₃ reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials’ protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields. Full article

Metabolic syndrome (MetS) associated with Osteoarthritis (OA) is an increasingly recognised entity. Whilst the degenerative pattern in cuff-tear arthropathy (CTA) has been well documented, the biological processes behind primary shoulder OA and CTA remain less understood. This study investigates transcriptomic differences in these conditions, alongside the impact of MetS in patients undergoing total shoulder replacement. In a multi-centre study, 20 OA patients undergoing total shoulder replacement were included based on specific treatment indications for OA and cuff-tear arthropathy as well as 25 patients undergoing rotator cuff repair (RCR) as a comparator group. Tissues from subchondral bone, capsule (OA and RCR), and synovium were biopsied, and RNA sequencing was performed using Illumina platforms. Differential gene expression was conducted using DESeq2, adjusting for demographic factors, followed by pathway enrichment using the mitch package. Gene expressions in CTA and primary OA was differentially affected. CTA showed mitochondrial dysfunction, GATD3A downregulation, and increased cartilage degradation, while primary OA was marked by upregulated inflammatory and catabolic pathways. The effect of MetS on these pathologies was further shown. MetS further disrupted WNT/β-catenin signalling in CTA, and in OA. Genes such as ACAN, PANX3, CLU, and VAT1L were upregulated, highlighting potential biomarkers for early OA detection. This transcriptomic analysis reveals key differences between end-stage CTA and primary glenohumeral OA. CTA shows heightened metabolic/protein synthesis activity with less immune-driven inflammation. Under MetS, mitochondrial dysfunction (including GATD3A downregulation) and altered Wnt/β-catenin signalling intensify cartilage and bone damage. In contrast, primary OA features strong complement activation, inflammatory gene expression, and collagen remodelling. MetS worsens both conditions via oxidative stress, advanced glycation end products, and ECM disruption—particularly, increased CS/DS degradation. These distinctions support targeted treatments, from antioxidants and Wnt modulators to aggrecanase inhibitors or clusterin augmentation. Addressing specific molecular disruptions, especially those amplified by MetS, may preserve shoulder function, delay surgical intervention, and improve long-term patient outcomes. Full article

Fresh pecans are increasingly popular for their sweet taste and high nutritional value. To facilitate their commercialization, it is crucial to screen the proper moisture content for efficient mechanical shelling while retaining nutritional quality and finding a reasonable packaging method for storage. This study compared the mechanical shelling efficiencies of fresh pecans with different moisture contents via a standardized evaluation system used by the U.S. Department of Agriculture for over 70 years. The results indicated that pecans dried for 24 h (17.51% moisture, wet basis) achieved the highest mechanical shelling efficiency with the lowest kernel shoulders damaged (DSh%, 31.7%), shortest separation time (10.67 min·kg⁻¹), and highest rate of complete halves (CH, 91.6%). Compared with dried pecans, fresh pecans had a lighter testa color (L*, 55.05), higher 2,2-Diphenyl-1-picrylhydrazyl (DPPH, 18.88 μg TE·g⁻¹) and 2,2′-Azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) diammonium salt (ABTS, 87.15 μmol TE·g⁻¹), free-radical scavenging activity, and lower acid values (AV, 0.21 mg·g⁻¹) and peroxide values (PV, 0.003 mg·g⁻¹). Aluminum film packaging with vacuum (ALV) best preserved the quality of fresh pecans during 9 months of storage, as indicated by the acid and peroxide values. The results of this study provided a first report for the industrialization of fresh pecans. Full article

Background/Objectives: Subpectoral biceps tenodesis using a bicortical button has been associated with the risk of damage to the axillary nerve. The purpose of this study is to describe the anatomical relationships between the long head of the biceps tendon tenodesis location, the bicortical tenodesis button, the pectoralis major tendon, and the axillary nerve to help clarify the safety of using bicortical button fixation. Methods: Subpectoral biceps tenodesis with a bicortical button was performed on ten cadaveric shoulders. The specimens were dissected to identify the tenodesis button, the pectoralis major tendon, and the axillary nerve. Distances were measured between the anterior cortical drill hole and the proximal border of the pectoralis major tendon and between the tenodesis button and the axillary nerve. Results: The distance between the tenodesis button and the axillary nerve demonstrated a very high positive and statistically significant correlation with the distance between the anterior cortical drill hole and the proximal border of the pectoralis major tendon (R = 0.9586, p = 1.22 × 10 ⁻⁵). Conclusions: The proximal border of the pectoralis major tendon correlates with the level of the anterior branch of the axillary nerve. Subpectoral biceps tenodesis using a bicortical button is a safe procedure with regard to the axillary nerve given it is performed well below the proximal border of the pectoralis major tendon. The inferior border of the pectoralis major tendon is a useful intraoperative landmark. Full article

Shoulder and elbow injuries are prevalent among baseball players, particularly pitchers, who experience repetitive eccentric loading of the shoulder, leading to muscle damage and increased injury risk. Nearly 40% of shoulder injuries in baseball occur in pitchers, with many facing low rates of return to sport. The rotator cuff (RC) muscles—supraspinatus (SSP), infraspinatus (ISP), subscapularis (SSC), and teres minor (TMin)—are crucial for shoulder stability, movement, and force generation, particularly in overhead sports. Each RC muscle comprises subregions with distinct biomechanical properties, such as strength, moment arm behavior, and activation patterns. These differences allow for a finely tuned balance between joint stability and mobility. For example, the superior subregion of the ISP significantly contributes to external rotation, a function critical in sports like baseball that require precision and power. During pitching, the SSP, ISP, and SSC stabilize the glenohumeral joint through high activation during explosive phases, such as stride, arm cocking, and arm acceleration. Understanding these functional subregional differences is vital for diagnosing and managing shoulder pathologies like RC tears. Despite advancements, clinicians face challenges in predicting re-injury risks and determining return-to-play readiness for athletes with shoulder injuries. Integrating insights into subregional biomechanics with patient care could enhance outcomes. Tailored interventions—whether surgical or rehabilitative—targeting specific subregions could improve recovery times, reduce re-injury risks, and enable more personalized treatment plans. Such approaches are especially beneficial for athletes, older individuals, and those prone to RC injuries, promoting better long-term shoulder health and performance. The present work aims to highlight some of the research on these subregions and their differences, providing insights to enhance treatment approaches for shoulder injuries. Full article

Background: Damage to the upper trunk of the brachial plexus, often caused by high-energy trauma, leads to significant functional impairment of the upper limb. This injury primarily affects the C5 and C6 roots, resulting in paralysis of muscles critical for shoulder and elbow function. If spontaneous nerve regeneration does not occur within 3–6 months post-injury, surgical intervention, including nerve transfers, is recommended to restore function. Methods: This study evaluates long-term outcomes of nerve transfer surgeries performed between 2013 and 2023 on 16 adult patients with post-traumatic brachial plexus injuries. The most common cause of injury was motorcycle accidents. Nerve transfers targeted shoulder and elbow function restoration, including transfer of the accessory nerve to the suprascapular nerve, the radial nerve branch to the long or medial head of the triceps brachii to the axillary nerve, or the transfer of motor fascicles of the ulnar and median nerves (double Oberlin) to the brachialis and biceps brachii motor nerves. Results: Postoperative results showed varying degrees of functional recovery. In the shoulder, most patients achieved stabilization and partial restoration of active movement, with average flexion up to 92° and abduction up to 78°. In the elbow, full flexion with M4 strength was achieved in 64% of patients. In both the shoulder and the elbow, double nerve transfers yield better long-term outcomes than single transfers. Secondary procedures, such as tendon transfers, were required in some cases to improve limb strength. Conclusions: The study concludes that nerve transfers offer reliable outcomes in restoring upper limb function, although additional surgeries may be necessary in certain cases. Full article

To investigate corrosion and resulting changes in the sealing performance of premium connections in corrosive CO₂ environments, we carried out a simulation analysis of their secondary current distribution and structural mechanics based on multi-physics field coupling. A finite element calculation model of Ф88.9 mm × 6.45 mm taper–taper premium connections (steel grade P110) was established using COMSOL6.0 general software. By analyzing corrosion laws under different environmental parameters, five internal pressures and tensile displacements were set. We simulated premium connections under different operating conditions using a secondary current distribution module. To investigate the distribution of the corrosion current density in premium connections under different operating conditions, the sealing performance before and after corrosion was quantitatively evaluated using a seal strength index. The results show that the current density is higher at the torque shoulder of the premium connections, which is more susceptible to damage. As the internal pressure increases, the current density in the inner wall of the column increases, and on the threads, the current density is highest at the rounded corners of the root of the thread, which is also more likely to be damaged. Under different internal pressures, although the sealing strength of the premium connections meets the sealing criterion, the corroded ones show a significant reduction in sealing performance. The results of this study provide a reliable theoretical basis for research on sealing premium connections in corrosive environments. Full article

Rotator cuff tears (RCT) are the most common cause of shoulder pain among adults. “Rotator cuff” refers to the four muscles that cover the shoulder joint: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles help maintain the rotational movement and stability of the shoulder joint. RCT is a condition in which one or more of these four muscles become ruptured or damaged, causing pain in the arms and shoulders. RCT results from degenerative changes caused by chronic inflammation of the tendons and consequent tendon tissue defects. This phenomenon occurs because of the exhaustion of endogenous tendon stem cells. Tendon regeneration requires rejuvenation of these endogenous tendon stem/progenitor cells (TSPCs) prior to their growth phase. TSPCs exhibit clonogenicity, multipotency, and self-renewal properties; they express classical stem cell markers and genes associated with the tendon lineage. However, specific markers for TSPC are yet to be identified. In this review, we introduce novel TSPC markers and discuss various strategies for TSPC reprogramming. With further research, TSPC reprogramming technology could be adapted to treat age-related degenerative diseases, providing a new strategy for regenerative medicine. Full article

Tunnels traditionally regarded as resilient to seismic events have recently garnered significant attention from engineers owing to a rise in incidents of seismic damage. In this paper, the reflection characteristics of the elastic plane wave incident on the free surface are analyzed, and the matrix analysis method SWIM (Seismic Wave Input Method) for the calculation of equivalent nodal loads with artificial truncated boundary conditions for seismic wave oblique incidence is established by using coordinate transformation technology, according to the displacement velocity and stress characteristics of a plane wave. The results show that the oblique incidence method is more effective in reflecting the traveling wave effect, and the “rotational effect” induced by oblique incidence must be considered for P wave and SV wave incidence, including the associated stress and deformation. This effect exhibits markedly distinct rotational phenomenon. In particular, the P wave incidence should be focused on the vault and the inverted arch due to the expansion wave. With the increase of the oblique incidence angle, the structural stress and deformation are rotated to a certain extent, and the values are significantly increased. Simultaneously, the shear action of the SV wave may result in “ovaling” of the tunnel structure, thereby facilitating damage to the arch shoulder and the sidewall components. As the oblique incidence angle, the potentially damaging effects of the “rotational effect” to the vault and the inverted arch, but the numerical value does not change significantly. In addition, in comparison to a circular cross-section, the low-frequency amplification of seismic waves in the surrounding rock and the difference of frequency response function in different parts of the lining are more pronounced. In particular, the dominant frequency characteristics are significant at P wave incidence and the seismic wave signal attenuation tends to be obvious with increasing incidence angle. In contrast, SV waves exhibit more uniform characteristics. Full article

The deformation and damage to seasonal permafrost roadbeds, as seasons shift, stems from the intricate interplay of temperature, moisture, and stress fields. Fundamentally, the frost heave and thaw-induced settlement of soil represent a multi-physics coupling phenomenon, where various physical processes interact and influence each other. In this investigation, a comprehensive co-coupling numerical simulation of both the temperature and moisture fields was successfully executed, utilizing the secondary development module within the finite element software, COMSOL Multiphysics 6.0. This simulation inverted the classical freezing–thawing experiment involving a soil column under constant temperature conditions, yielding simulation results that were in excellent agreement with the experimental outcomes, with an error of no more than 10%. Accordingly, the temperature, ice content, and liquid water content distributions within the seasonal permafrost region were derived. These parameters were then incorporated into the stress field analysis to explore the intricate coupling between the moisture and temperature fields with the displacement field. Subsequently, the frost heave and thaw settlement deformations of the roadbed were calculated, accounting for seasonal variations, thereby gaining insights into their dynamic behavior. The research results show that during the process of freezing and thawing, water migrates from the frozen zone towards the unfrozen zone, with the maximum migration amount reaching 20% of the water content, culminating in its accumulation at the interface separating the two. Following multiple freeze–thaw cycles, this study reveals that the maximum extent of freezing within the roadbed reaches 2.5 m, while the road shoulder experiences a maximum freezing depth of 2 m. A continuous trend of heightened frost heave and thaw settlement deformation of the roadbed is observed in response to temperature fluctuations, leading to the uneven deformation of the road surface. Specifically, the maximum frost heave measured was 51 mm, while the maximum thaw settlement amounted to 13 mm. Full article

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies. Full article

Background: Managing osteochondral cartilage defects (OCDs) of the talus is a common daily challenge in orthopaedics as they predispose patients to further cartilage damage and progression to osteoarthritis. Therefore, the implementation of a reliable tool to quantify the amount of cartilage damage that is present is of the essence. Methods: We retrospectively identified 15 adult patients diagnosed with uncontained OCDs of the talus measuring <150 mm², which were treated arthroscopically with bone marrow stimulation. Five independent assessors evaluated the pre-operative MRI scans with the AMADEUS scoring system (i.e., MR-based pre-operative assessment system) and the intra-/inter-observer variability was then calculated by means of the intraclass correlation coefficients (ICC) and Kappa (κ) statistics, respectively. In addition, the correlation between the mean AMADEUS scores and pre-operative self-reported outcomes as measured by the Manchester–Oxford foot questionnaire (MOxFQ) was assessed. Results: The mean ICC and the κ statistic were 0.82 (95% CI [0.71, 0.94]) and 0.42 (95% CI [0.25, 0.59]). The Pearson correlation coefficient was found to be r = −0.618 (p = 0.014). Conclusions: The AMADEUS tool, which was originally designed to quantify knee osteochondral defect severity prior to cartilage repair surgery, demonstrated good reliability and moderate inter-observer variability for small OCDs of the talar shoulder. Given the strong negative correlation between the AMADEUS tool and pre-operative clinical scores, this tool could be implemented in clinical practise to reliably quantify the extent of the osteochondral defects of the talus. Full article