bluuebunny/crossref_metadata_2025 huggingface dataset:
Can isolated removal of osteophytes achieve correction of varus deformity and gap-balance in computer-assisted total knee arthroplasty?
Authors: Mullaji Arun
Published: May 2020

Aims

The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA).

Methods

A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other.

Results

Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case.

Conclusion

Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49–58.
Predicting implant size in total knee arthroplasty using demographic variables
Authors: Blevins Jason L. , Rao Vindhya , Chiu Yu-fen , Lyman Stephen , Westrich Geoffrey H.
Published: May 2020

Aims

The purpose of this investigation was to determine the relationship between height, weight, and sex with implant size in total knee arthroplasty (TKA) using a multivariate linear regression model and a Bayesian model.

Methods

A retrospective review of an institutional registry was performed of primary TKAs performed between January 2005 and December 2016. Patient demographics including patient age, sex, height, weight, and body mass index (BMI) were obtained from registry and medical record review. In total, 8,100 primary TKAs were included. The mean age was 67.3 years (SD 9.5) with a mean BMI of 30.4 kg/m2 (SD 6.3). The TKAs were randomly split into a training cohort (n = 4,022) and a testing cohort (n = 4,078). A multivariate linear regression model was created on the training cohort and then applied to the testing cohort . A Bayesian model was created based on the frequencies of implant sizes in the training cohort. The model was then applied to the testing cohort to determine the accuracy of the model at 1%, 5%, and 10% tolerance of inaccuracy.

Results

Height had a relatively strong correlation with implant size (femoral component anteroposterior (AP) Pearson correlation coefficient (ρ) = 0.73, p < 0.001; tibial component mediolateral (ML) ρ = 0.77, p < 0.001). Weight had a moderately strong correlation with implant size, (femoral component AP ρ = 0.46, p < 0.001; tibial ML ρ = 0.48, p < 0.001). There was a significant linear correlation with height, weight, and sex with implant size (femoral component R2 = 0.607, p < 0.001; tibial R2 = 0.695, p < 0.001). The Bayesian model showed high accuracy in predicting the range of required implant sizes (94.4% for the femur and 96.6% for the tibia) accepting a 5% risk of inaccuracy.

Conclusion

Implant size was correlated with basic demographic variables including height, weight, and sex. The linear regression and Bayesian models accurately predicted required implant sizes across multiple manufacturers based on height, weight, and sex alone. These types of predictive models may help improve operating room and implant supply chain efficiency. Level of Evidence: Level IV Cite this article: Bone Joint J 2020;102-B(6 Supple A):85–90.
Does the sequential addition of accelerometer-based navigation and sensor-guided ligament balancing improve outcomes in TKA?
Authors: Livermore Andrew T. , Erickson Jill A. , Blackburn Brenna , Peters Christopher L.
Published: May 2020

Aims

A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation.

Methods

This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially. A historical control group, with the use of intramedullary guides for distal femoral resection and surgeon-guided ligament balancing, was compared with a group using accelerometer-based navigation for distal femoral resection and surgeon-guided balancing (group 1), and one using navigated femoral resection and sensor-guided balancing (group 2). Primary outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) and Knee injury and Osteoarthritis Outcome (KOOS) scores measured preoperatively and at six weeks and 12 months postoperatively. The position of the components and the mechanical axis of the limb were measured postoperatively. The postoperative range of motion (ROM), haematocrit change, and complications were also recorded.

Results

There were 194 patients in the control group, 103 in group 1, and 74 in group 2. There were no significant differences in baseline demographics between the groups. Patients in group 2 had significantly higher baseline mental health subscores than control and group 1 patients (53.2 vs 50.2 vs 50.2, p = 0.041). There were no significant differences in any PROMs at six weeks or 12 months postoperatively (p > 0.05). There was no difference in the rate of manipulation under anaesthesia (MUA), complication rates, postoperative ROM, or blood loss. There were fewer mechanical axis outliers in groups 1 and 2 (25.2%, 14.9% respectively) versus control (28.4%), but this was not statistically significant (p = 0.10).

Conclusion

The sequential addition of navigation of the distal femoral cut and sensor-guided ligament balancing did not improve short-term PROMs, radiological outcomes, or complication rates compared with conventional techniques. The costs of these added technologies may not be justified. Cite this article: Bone Joint J 2020;102-B(6 Supple A):24–30.
Antimicrobial properties of antibiotic-loaded implants
Authors: Griseti Quentin , Jacquet Christophe , Sautet Pierre , Abdel Matthew P. , Parratte Sébastien , Ollivier Matthieu , Argenson Jean-Noel
Published: May 2020

Aims

The aim of this study was to compare the ability of tantalum, 3D porous titanium, antibiotic-loaded bone cement, and smooth titanium alloy to inhibit staphylococci in an in vitro environment, based on the evaluation of the zone of inhibition (ZOI). The hypothesis was that there would be no significant difference in the inhibition of methicillin-sensitive or methicillin-resistant Staphylococcus aureus (MSSA/MRSA) between the two groups.

Methods

A total of 30 beads made of three different materials (tantalum/3D porous titanium and smooth titanium alloy) were bathed for one hour in a solution of 1 g vancomycin in 20 ml of sterile water for injection (bath concentration: 50 mg/mL). Ten 1 cm3 cylinders of antibiotic-loaded cement were also created by mixing standard surgical cement with 1 g of vancomycin in standardized sterile moulds. The cylinders were then placed on agar plates inoculated with MSSA and MRSA. The ZOIs were measured each day and the cylinders were transferred onto a new inoculated plate.

Results

For MSSA and MRSA, no inhibitory effect was found in the control group, and antibiotic-loaded smooth titanium alloy beads showed a short inhibitory effect until day 2. For MSSA, both tantalum and 3D porous titanium beads showed significantly larger mean ZOIs than cement beads (all p < 0.01) each day until day 7 for tantalum and until day 3 for 3D porous titanium. After six days, antibiotic-loaded cement had significantly larger mean ZOIs than the 3D porous titanium (p = 0.027), but no significant difference was found with tantalum (p = 0.082). For MRSA, both tantalum and 3D porous titanium beads had significantly larger mean ZOIs than antibiotic-loaded cement each day until day 6 for tantalum (all p < 0.01) and until day 3 for 3D porous titanium (all p < 0.04). Antibiotic-loaded cement had significantly larger mean ZOIs than tantalum and 3D porous titanium from day 7 to 9 (all p < 0.042).

Conclusion

These results show that porous metal implants can deliver local antibiotics over slightly varying time frames based on in vitro analysis. Cite this article: Bone Joint J 2020;102-B(6 Supple A):158–162.
Microvascular free flap coverage for salvage of the infected total knee arthroplasty
Authors: Lee Gwo-Chin , Colen David L. , Levin L. S. , Kovach Stephen J.
Published: May 2020

Aims

The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA.

Methods

We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function.

Results

In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation.

Conclusion

Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176–180.
Modern full-component aseptic revision total knee arthroplasties have similar recoveries compared with primary total knee arthroplasty patients when applying an enhanced recovery anaesthetic and analgesic protocol
Authors: Costales Timothy , Chapman Danielle M. , Miller Michael J. , Dalury David F.
Published: May 2020

Aims

Enhanced perioperative protocols have significantly improved patient recovery following primary total knee arthroplasty (TKA). Little has been investigated the effectiveness of these protocols for revision TKA (RTKA). We report on a matched group of aseptic revision and primary TKA patients treated with an identical pain and rehabilitation programmes.

Methods

Overall, 40 aseptic full-component RTKA patients were matched (surgical date, age, sex, and body mass index (BMI)) to a group of primary cemented TKA patients. All RTKAs had new uncemented stemmed femoral and tibial components with metaphyseal sleeves. Both groups were treated with an identical postoperative pain protocol. Patients were followed for at least two years. Knee Society Scores (KSS) at six weeks and at final follow-up were recorded for both groups.

Results

There was no difference in mean length of stay between the primary TKA (1.2 days (0.83 to 2.08)) and RTKA patients (1.4 days (0.91 to 2.08). Mean oral morphine milligram (mg) equivalent dosing (MED) during the hospitalization was 42 mg/day for the primary TKA and 38 mg/day for the RTKA groups. There were two readmissions: gastrointestinal disturbance (RTKA) and urinary retention (primary TKA). There no were reoperations, wound problems, thromboembolic events or manipulations in either group. Mean overall KSS for the RTKA group was 87.3 (45 to 99) at six-week follow-up and 89.1 (52 to 100) at final follow-up (mean 3.9 years, (3.9 to 9.0)). Mean overall KSS for the primary group was 89.9 (71 to 100) at six-week follow-up and 93.42 (73 to 100) at final follow-up (mean 3.5 years (2.5 to 9.2)).

Conclusion

An identical pain and rehabilitation protocol used for primary TKA patients can enable certain full-component aseptic RTKA patients to have a similar early functional outcome. Cite this article: Bone Joint J 2020;102-B(6 Supple A):96–100.
Long-term outcome of iliosacral resection without reconstruction for primary bone tumours
Authors: Gupta Sanjay , Griffin Anthony M. , Gundle Kenneth , Kafchinski Lisa , Zarnett Oren , Ferguson Peter C. , Wunder Jay
Published: May 2020

Aims

Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction.

Methods

Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS).

Results

At a mean follow-up of 159 months (1 to 207), 23 patients were alive without disease, one was alive with lung metastases, one was alive following local recurrence, four were dead of disease, and three had died from other causes. The overall ten-year survival was 77%. There was only one (3%) local recurrence, which occurred at 26 months. There were 18 complications in 17 patients; 13 wound healing complications/infections, three fractures, one pulmonary embolism, and one dislocation of the hip. Most complications occurred early. The mean functional scores were 21.1 (SD 8.1) for MSTS-87, 67.3 (SD 23.9) for MSTS-93 and 76.2 (SD 20.6) for TESS.

Conclusion

Patients requiring Type I or Type I/IV pelvic resections can expect a good oncological outcome and a high rate of local control. Complications are generally acute in nature and are easily manageable. These patients achieved a good functional outcome without the need for bony reconstruction. Cite this article: Bone Joint J 2020;102-B(6):779–787.
A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome
Authors: Katzouraki Galateia , Zubairi Akbar Jaleel , Hershkovich Oded , Grevitt Michael P.
Published: May 2020

Aims

Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES.

Methods

A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI.

Results

The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed ‘low-risk’ of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy.

Conclusion

This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677–682.
Sport after total hip arthroplasty: undoubted progress but still some unknowns
Authors: Meek R. M. Dominic , Treacy Ronan , Manktelow Andrew , Timperley John A. , Haddad Fares S.
Published: May 2020

In this review, we discuss the evidence for patients returning to sport after hip arthroplasty. This includes the choices regarding level of sporting activity and revision or complications, the type of implant, fixation and techniques of implantation, and how these choices relate to health economics. It is apparent that despite its success over six decades, hip arthroplasty has now evolved to accommodate and support ever-increasing patient demands and may therefore face new challenges.

Cite this article: Bone Joint J 2020;102-B(6):661–663.
Optical properties of PlatSil SiliGlass tissue-mimicking phantoms
Authors: Naglič Peter , Zelinskyi Yevhen , Rogelj Luka , Stergar Jošt , Milanič Matija , Novak Jure , Kumperščak Borut , Bürmen Miran
Published: June 2020

In this work, we revise the preparation procedure and conduct an in depth characterization of optical properties for the recently proposed silicone-based tissue-mimicking optical phantoms in the spectral range from 475 to 925 nm. The optical properties are characterized in terms of refractive index and its temperature dependence, absorption and reduced scattering coefficients and scattering phase function related quantifiers. The scattering phase function and related quantifiers of the optical phantoms are first assessed within the framework of the Mie theory by using the measured refractive index of SiliGlass and size distribution of the hollow silica spherical particles that serve as scatterers. A set of purely absorbing optical phantoms in cuvettes is used to evaluate the linearity of the absorption coefficient with respect to the concentration of black pigment that serves as the absorber. Finally, the optical properties in terms of the absorption and reduced scattering coefficients and the subdiffusive scattering phase function quantifier γ are estimated for a subset of phantoms from spatially resolved reflectance using deep learning aided inverse models. To this end, an optical fiber probe with six linearly arranged optical fibers is used to collect the backscattered light at small and large distances from the source fiber. The underlying light propagation modeling is based on the stochastic Monte Carlo method that accounts for all the details of the optical fiber probe.
Tuning of reflection spectrum of a monolithic high-contrast grating by variation of its spatial dimensions
Authors: Marciniak Magdalena , Broda Artur , Gębski Marcin , Dems Maciej , Muszalski Jan , Czerwinski Andrzej , Ratajczak Jacek , Marona Łucja , Nakwaski Włodzimierz , Lott James A. , Czyszanowski Tomasz
Published: May 2020

We report the first experimental parametric analysis of subwavelength monolithic high-contrast grating (MHCG) mirrors. To date, subwavelength grating mirrors have been fabricated by suspending a thin grating membrane in the air or placing it on a low refractive index material – a scheme that requires sophisticated processing and makes the gratings sensitive to mechanical stress, impeding current injection, and heat dissipation if used in active devices. Inherently MHCGs are well suited for optoelectronic devices because they can be fabricated in all possible material systems. Here we demonstrate above 90% optical power reflectance, strong polarization discrimination. Based on experimental analysis aided by numerical simulations, we demonstrate the possibility of tuning the spectral characteristics of MHCGs reflectance for more than 200 nm via modification of the duty cycle of the MHCG stripes. We show our MHCG tuning method is convenient to define the properties of MHCG devices during the device processing.
Seroprevalence of African horse sickness in selected donkey populations in Namibia
Authors: Molini Umberto , Zaccaria Guendalina , Kandiwa Erick , Mushonga Borden , Khaiseb Siegfried , Ntahonshikira Charles , Chiwome Bernard , Baines Ian , Madzingira Oscar , Savini Giovanni , D'Alterio Nicola
Published: May 2020

Background and Aim: African horse sickness (AHS) is a non-contagious viral disease of horses and other equids caused by an arbovirus belonging to the Reoviridae family and genus Orbivirus. AHS is an endemic disease that is responsible for the death of a high number of horses every year in Namibia. At present, there is no information on the prevalence and distribution of AHS virus (AHSV) serotypes in the different regions of Namibia. Therefore, this survey aimed to fill this knowledge gap by investigating the AHSV seroprevalence in Namibian donkeys. Materials and Methods: A total of 260 blood samples (20 samples for each region) were randomly collected from donkeys aged between 3 and 5 years. Sera were screened for AHSV-specific immunoglobulin G antibodies using a commercial competitive enzyme-linked immunosorbent assay kit and samples positive to AHSV antibodies were further tested by serum neutralization (SN) assay to evaluate the AHSV serotype-specific immune response. Results: Seroprevalence of antibodies against AHSV in Namibian donkeys was 63.5%. The AHSV prevalence was significantly higher in the northern region (64%) than in the southern region (36%). A significantly (p<0.05) higher number of donkeys had antibodies against AHSV-6 (37.8%) and AHSV-9 (37.8%). The AHSV-2, AHSV-6, and AHSV-9 prevalence were higher (p<0.05) in the northern regions compared to the southern regions. None of the donkeys in this study, however, tested positive for AHSV-8. Conclusion: Results of the current study indicate that all AHSV serotypes have either circulated previously or are circulating in Namibia except for AHSV-8. In particular, AHSV-1, -2, -3, -4, -5, -6, and -9 serotypes have circulated or are circulating in the northern region of Namibia, while AHSV-1, -4, -5, -6, -7, and -9 have infected donkeys in the south. AHSV-9 and AHSV-6 were the most prevalent serotypes detected in donkeys in this study. SN results showed that several donkeys from Kavango East, Kavango West, and Ohangwena regions had been exposed to multiple serotypes, indicating the possibility of cocirculation of several strains in Namibia.
Effect of pre-supplementation with Pleurotus sajor-caju crude extracts on body weight and consequence responses of leukocytes and immune organs in fancy carp following inoculation with Aeromonas veronii
Authors: Rattanachan Sitthichon , Bunnajirakul Sumrarn , Punyadarsaniya Darsaniya
Published: May 2020

Aim: The present study aimed at highlighting the effects of oyster mushroom (Pleurotus sajor-caju), as a dietary supplement on growth performance, differential leukocytes population, and histological changes of melanomacrophage centers (MMCs) in spleen and kidney of fancy carp on bacterial infection.

Materials and Methods: A total of 60 fancy carp were allocated into four groups according to feed formulations including; (1) basal diet with 2% crude extract of P. sajor-caju, (2) basal diet with 2% β-glucan, whereas Group 3, and Group 4 were positive and negative control, which were fed only basal diet. Diets were provided for 30 days, thereafter, fish of Group 1 to Group 3 were intraperitoneally injected with Aeromonas veronii (1.8×109 CFU), whereas Group 4 was injected with normal saline. At day 7 post-bacterial inoculation, all fish were weighed, whole blood was collected for differential white blood cell count, and two visceral organs, posterior kidney and spleen, were collected from euthanized fish to observe histological changes, particularly MMCs.

Results: No significant differences in body weight were found (p>0.05) at 1st week of the experiment; however, fish body weight was significantly increased from week 2 to week 4 of the experiment. Increased monocyte number was found in carp fish fed with the P. sajor-caju or β-glucan supplemented diets compared to the control groups (p<0.05). The proliferation of monocyte in fish was consistent with increased number and size of MMCs in hemotopoietic organs, posterior kidney and spleen, especially in fancy carp fed with of P. sajor-caju crude extract and commercially available β-glucan before bacterial inoculation in fish.

Conclusion: These findings indicate that crude polysaccharide from P. sajor-caju can be potentially used as a feed additive that might promote innate immune function in fish.
The interchangeability of original tumor necrosis factor- α inhibitors and biosimilars in rheumatology: experience in replacing original infliximab with Flammagis for ankylosing spondylitis
Authors: Muravyev Yu. V. , Lebedeva V. V. , Starkova A. S. , Rumyantseva D. G. , Urumova M. M. , Erdes Sh.
Published: May 2020

The paper discusses prospects for prescribing tumor necrosis factor-α (TNF-α) inhibitor biosimilars, their interchangeability with original drugs for inflammatory joint diseases. It describes clinical cases when original infliximab is replaced with its biosimilar Flammagis for ankylosing spondylitis. The authors emphasize that it is difficult to predict the interchangeability of original TNF-α inhibitors and biosimilars in rheumatology, and this is confirmed by the above clinical cases. They also indicate that the optimal use of biosimilars requires a constant cooperation of rheumatologists, pharmacologists, and regulatory authorities, which is aimed at protecting the rights of a patient in order to ensure safe, effective and high-quality care. It is concluded that it is advisable to conduct further investigations to develop a special pharmacovigilance system in this area.
COVID-19: the new challenge for rheumatologists
Authors: Belov B. S. , Karateev A. E.
Published: May 2020

Currently, the infection caused by the new coronavirus COVID-19 is considered by the global community as an emergency of international concern. Rheumatologists are particularly concerned about this problem, since patients with immune-mediated inflammatory rheumatic diseases (IMIRDs) are at higher risk for infectious diseases and receive immunosuppressive treatment. The use of disease-modifying antirheumatic drugs and biological agents increases the incidence of serious infections, but insufficient/no monitoring of IMIRD activity is an even greater risk factor for infectious complications. In addition, the role of vaccination mainly against influenza and pneumococcal infection is substantially increasing in modern conditions, since the risk of death from respiratory tract infections is quite high in patients with IMIRDs, which is very important in the context of the current COVID-19 pandemic.The paper presents an update on the incidence of viral infections in patients with IMIRDs and also discusses whether antirheumatic drugs can be used to treat COVID-19.
Differential diagnosis in joint and spine damages
Authors: Chichasova N. V.
Published: May 2020

The lecture covers main approaches to differential diagnosis in rheumatic diseases. It highlights the key questions that should be answered at the primary examination of the patient. The most important signs that can identify severe, sometimes urgent nonrheumatic diseases are presented. The author describes pain of different patterns and intensity and the most common variants of acute or chronic onset of mono-, oligo-, or polyarthritis. The 2016 European League Against Rheumatism (EULAR) definition of arthralgia suspicious for the development of rheumatoid arthritis is given. The lecture presents the signs indicating the inflammatory nature of back pain in cases of suspected spondyloarthritis (SpA), as well as a two-step diagnostic strategy for axial SpA. Attention is paid to the semiotics of joint damage and extra-articular manifestations in various rheumatic diseases. A brief algorithm for a differential diagnostic search for joint pain is given.
Dynamics of lymphocyte subpopulations, CD4+CD25+CD127- T regulatory cells in patients with rheumatoid arthritis during therapy with the rituximab biosimilar Acellbia
Authors: Avdeeva A. S. , Rubtsov Yu. P. , Cherkasova M. V. , Nasonov E. L.
Published: May 2020

Objective: to evaluate the effect of the rituximab (RTM) biosimilar Acellbia on the peripheral blood levels of CD3+, CD3+CD4+, CD3+CD8+, CD16+CD56+, CD19+, and CD4+CD25+CD127- lymphocytes in patients with rheumatoid arthritis (RA).Patients and methods. Examinations were made in 20 RA patients who received 2 RTM infusions at a total dose of 1200 mg. The levels of C-reactive protein, IgM rheumatoid factor, IgG, IgM, and IgA were measured by a nephelometric method. The relative and absolute contents of CD3+, CD3+CD4+, CD3+CD8+, CD16+CD56+, CD19+, CD4+CD25+CD127- T regulatory cells (Tregs) were estimated by multicolor flow cytofluorometry.Results and discussion. At week 24 of RTM therapy, there was a good/satisfactory effect according to EULAR criteria in 17 (85%) patients; DAS28 remission in 4 (20%), and SDAI remission in 2 (10%). The use of RTM was accompanied by a significant increase in the relative content of CD4+CD25+CD127- T lymphocytes, the median of which at weeks 12 and 24 after therapy initiation increased from 6.8 [5.2; 7.6]% to 7.3 [6.1; 8.3] and 6.97 [6.4; 8.2]%, respectively (p<0.05). The absolute peripheral blood count of Tregs tended to increase at weeks 12 after the first infusion of the drug (up to 0.05 [0.04; 0.075] ⋅ 109 /l; p=0.05). At week 24 follow-up, the patients who achieved SDAI remission/low disease activity had significantly higher baseline relative Tregs levels (7.35 [6.8; 7.97]% than those with the moderate activity of the pathological process (5.8 [4.3; 7.22] %; p<0.05).Conclusion. The use of the RTM biosimilar is accompanied by the development of complete depletion of CD19+ lymphocytes and by an increase in CD3+ and CD3+CD4+ lymphocytes and Tregs. The larger baseline number of CD4+CD25+CD127- lymphocytes is associated with the higher efficiency of RTM therapy.
Indicators of rheumatoid arthritis disease activity. An association with a patient’s psychological status
Authors: Rybakova V. V. , Olyunin Yu. A. , Likhacheva E. V. , Nasonov E. L.
Published: May 2020

Objective: to study of the relationship between psychological factors and indicators of rheumatoid arthritis (RA) disease activity in patients who have been followed up for a long time after initiation of treat-to-target therapy.Patients and methods. The investigation enrolled 38 RA patients (29 women and 9 men) aged 33 to 80 years (mean age, 56.5±12.5 years) with a mean disease duration of 6.0±0.9 years. All the patients underwent clinical examination; the following parameters were recorded: patient global assessment; physician’s global assessment; pain visual analogue scale (VAS), by measuring in millimeters; number of painful joints (NPJ), and number of swollen joints (NSJ). The investigators determined functional status with the Health Assessment Questionnaire (HAQ), quality of life with the 36-Item Short Form Health Survey questionnaire (SF-36), the nature of pain by the painDETECT questionnaire (PDQ), and the presence of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). The patients also filled out the Resilience (Res) Questionnaire (RQ) and the General Self-Efficacy ((GSE) Scale. Disease activity was evaluated by DAS28, CDAI, and RAPID3 scores. Results and discussion. RA disease activity was high in 4 patients, moderate in 21, and low in 9, and 4 patients had DAS28 remission. The average scores of RQ, its individual components, and GSE scale were comparable with the corresponding population scores for this age group. The patients who had RQ scores below the average group ones were noted to have significantly higher scores of patient global assessment; physician’s global assessment, NPJ, NSJ, CDAI, and RAPID3 than in those who had moderate and higher RQ scores. The similar trend was traced for individual Res components, such as involvement (INV), control (CONT), and risk acceptance (RA). However, the revealed differences in these indicators failed to reach statistical significance. There was no correlation between the measures of inflammatory activity and the result of GSE. The patients with subclinical and clinical anxiety and depression had significantly lower RQ, INV, and CONT scores than those who did not have anxiety or depression, whereas RA and GSE did not differ significantly in these groups. There was a significant positive correlation of Res, INV, and CONT with the quality of life, as assessed by SF-36. The findings suggest that low RQ scores can decrease the efficiency of the therapy performed (due to the patient’s poor compliance), on the one hand, and can corrupt the result of inflammatory activity assessment (due to the impact on a patient’s perception of his/her illness), on the other hand.Conclusion. The findings may suggest that there is a need to assess the psychological status of a patient when determining the level of RA disease activity.
Clinical symptoms of joint damage in Lö fgren's syndrome
Authors: Egorova O. N. , Belov B. S. , Romanova K. G.
Published: May 2020

Objective: to investigate joint damage and laboratory and instrumental features in Löfgren's syndrome (LS) in patients referred to the Rheumatology Center.Patients and methods. The five-year investigation enrolled 142 patients of both sexes (31 men and 111 women; mean age, 39.3±11.1 years) with erythema nodosum (EN) accompanied by polyarthralgias or arthritis. All the patients underwent comprehensive clinical, laboratory and instrumental examinations, including joint ultrasound and chest computed tomography.Results and discussion. Disseminated EN that was correlated with the level of CRP was detected in 96% of cases (p=0.006; r=0.38). The signs of joint damage with predominantly periarticular changes in the ankle joints were observed in 124 (87%) patients. There was a relationship of the duration of the articular syndrome to that of inflammatory changes in subcutaneous tissue and to the number of nodules (p=0.02; r=0.45). The level of CRP had a significant direct correlation with the number of nodules (p=0.008; r=0.29) and the severity of the articular syndrome (p=0.003; r=0.29). Elevated levels of angiotensin-converting enzyme were found in 97 (78%) patients. Joint damage was significantly more frequently combined with X-ray Stage I sarcoidosis (Sr) (p=0.03). The Stage II Sr showed a male preponderance (p=0.04) and a 4.8-fold increase in the merging of subcutaneous nodes into conglomerates (p=0.002).Conclusion. Joint damage may be one of the first signs of LS, which requires that physicians of various specialties should coordinate their actions to timely diagnose, assess activity, and choose an adequate therapeutic approach.
On the diagnosis and coding of reactive arthropathies
Authors: Balabanova R. M.
Published: May 2020

According to statistics from the Ministry of Health of Russia, the incidence of reactive arthropathies varies significantly by region and year. In ICD-10, reactive arthropathies include reactive urogenic arthritis (M02.3), other reactive arthropathies (M02.8), and reactive arthropathies, unspecified (M02.9). Information on reactive arthritis (ReA) cannot be extracted from these data.Objective: to specify the number of patients with ReA among inpatients with reactive arthropathies.Patients and methods. A retrospective analysis of 224 case histories was made in the patients treated at the V.A. Nasonova Research Institute of Rheumatology Clinic in 2009–2018 and discharged with Codes M02.3, M02.8, and M02.9.Results and discussion. Nineteen out of the 224 patients were diagnosed with reactive urogenic arthritis (M02.3), 128 had reactive arthropathies (M02.8), and 77 had reactive arthropathies, unspecified (M02.9). All the 19 patients with this diagnosis met the criteria for reactive urogenic arthritis. Among the 128 patients with reactive arthropathies, 77 met the ReA criteria, 8 of them were found to have reactive urogenic arthritis, since the clinical picture had a triad consisting of arthritis, urogenic or enterocolitic infection, and conjunctivitis. Twenty-five out of the 77 patients discharged with Code M02.9 met the criteria for certain ReA and 6 did those for possible ReA. Thus, the diagnosis fitted the criteria for ReA in only half (56.7%) of the patients with reactive arthropathies.Conclusion. The performed investigation revealed that clinicians paid insufficient attention to the diagnosis of ReA and that statisticians did this to the coding of reactive arthropathies.
The types of left ventricular remodeling in patients with rheumatoid arthritis
Authors: Krivotulova I. A. , Korochina K. V. , Chernysheva T. V. , Kuznetsov G. E. , Tenchurina L. R.
Published: May 2020

Studying the factors leading to a pathological change in the cardiac structure in patients with rheumatoid arthritis (RA) can contribute to improvement in early diagnosis and to prevention of premature mortality from cardiovascular events.Objective. To study the types of left ventricular (LV) remodeling in patients with RA, by taking into account traditional cardiovascular risk factors, and to assess the clinical and immunological features of RA and the impact of drug therapy.Patients and methods. The investigation enrolled 74 RA patients who underwent assessment of echocardiography findings, by determining the type of LV remodeling, traditional cardiovascular risk factors, clinical and immunological features of the disease, as well as the current drug therapy.Results and discussion. Eccentric LV hypertrophy (ELVH) (n=33 (44.59%)) and concentric LV hypertrophy (CLVH) (n=34 (45.95%)) occurred at almost the same frequency among the pathological types of LV remodeling in patients with RA. Higher DAS28 values (p<0.0001) were noted in ELVH than in CLVH. There were also positive correlations of EHLH with ESR and CRP level (r= 0.51, p<0.0001; r=0.48, p=0.0001, respectively). The higher values of systolic blood pressure (p=0.0002), body mass index (p=0.01), patient age (p=0.0001), and the incidence of dyslipidemia (p= 0.008) were established in CVLH than in ELVH. LV diastolic dysfunction (DD) was detected much more frequently in RA patients with CLVH than in those with ELVH (p=0.01). The DD parameters (peak A, E/A) correlated with the degree (r=0.5, p<0.0001; r=-0.5. p<0.0001) and stage of hypertension (r=0.54, p<0.0001; r=-0.48, p=0.0001, respectively), as well as with peak A and traditional risk factors, such as patient age (r=0.52, p<0.0001), and high-density lipoprotein cholesterol levels (r=-0.48, p=0.0001).Conclusion. Most patients with RA had signs of LV hypertrophy; moreover, ELVH was closely linked with disease activity, whereas CLVH was related to the traditional risk factors.
Model Pengelolaan Sampah di Kelompok Paguyuban Peduli Sampah Kalibeber Wonosobo
Authors: Subqi Imam , Albab Ulul
Published: May 2020

This article discusses two important studies. First, the way the Kalibeber Wonosobo community handles waste. Second, the model of waste management in the Kalibeber Wonosobo group. This research uses a Participatory Action Research approach. This approach involves the Kalibeber community as an object and subject as well as to deal with waste. The results of this study show two important scopes. First, the Kalibeber Wonosobo community has an initiative to deal with waste. The initiative emerged because the community felt the environment was dirty, the river water flow was obstructed, and many sufferers of itching. Second, the waste management model uses decentralization. Waste management is carried out in each sub-area to be able to reuse waste (recycling). This discourse is different from other studies. The most prominent differentiating side is the active role of the community by being able to separate organic and inorganic waste. The community operates independently with a voluntary financing mechanism.Artikel ini membahas dua kajian penting. Pertama, cara masyarakat Kalibeber Wonosobo menangani sampah. Kedua, model pengelolaan sampah kelompok paguyuban peduli sampah Kalibeber Wonosobo. Penelitian ini menggunakan pendekatan Participatory Action Research. Pendekatan ini melibatkan masyarakat kalibeber sebagai obyek dan subyek sekaligus untuk menangani sampah. Hasil penelitian ini menunjukan dua cakupan penting. Pertama, masyarakat Kalibeber Wonosobo memiliki inisiatif untuk menangani sampah. Inisiatif muncul karena masyarakat merasakan lingkungan kotor, aliran air sungai terhambat, dan banyak penderita penyakit gatal-gatal. Kedua, model pengelolaan sampah menggunakan desentralisasi. Pengelolahan sampah ini dilakukan pada setiap sub area untuk bisa memanfaatkan kembali sampah (daur ulang). Diskursus ini berbeda dengan kajian lain. Sisi pembeda yang paling menonjol, antara lain peran masyarakat yang aktif dengan mampu memisahkan sampah organik dan anorganik. Masyarakat bergerak mandiri dengan mekanisme pembiayaan secara sukarela.
Eksekusi Mati Javanese Al-Hallaj Dalam Suluk Jawa
Authors: Muzairi Muzairi
Published: May 2020

It is very striking how Javanese Al Hallaj in the text of Suluk Jawa here published, is described  as a mystic  who propagated  the “Science  of Reality”  to the uninitiated public imitating the conduct of Shaikh Siti Jenar, Sunan Panggung, Ki Bebeluk and Shaikh Amongraga. It is my intention here to discuss this common motif of conflict between traditional Javanese mysticism and orthodox, legalistic Islam, as reflected in these traditions, in order to gain some insight into the motif and significance of the Suluk Jawa.
Beragama Di Tengah Badai Kemanusiaan
Authors: Mutiullah Mutiullah
Published: May 2020

Religion is one requirement of human life. Since beginning of life, human needs religion as guide to appoint  the good conditions. It has many contributions to civilizations such as hopefully to save. Also, it gives solving to many human’s problems. Recently, religion has challenging that is to solve many social conflicts as poverty and fundamentalism thoughts. So, what should religion does? There are two answers. The first, religion has to reinterpret his dogma. The second is religion as future ideology must to solve many human problems.
Mobility and Competitive Action on Competitive Advantage of Indonesian Small Medium Enterprises in the Clothing Industries
Authors: ZULTAQAWA Zeis , ALEXANDRI Mohammad Benny , RIZAL Muhammad , KOSTINI Nenden , AULIA Muhammad Donie
Published: June 2020

The purpose of this study is to find out how mobility and competitive action affect the competitive advantage of SMEs business sector in the clothing industries in Indonesia. This research is based on a quantitative approach using a population of clothing industries in Bandung Regency. Samples are taken with random sampling techniques. Samples are 110 SMEs producing clothing. Data is processed using Descriptive Analysis and Path Analysis. The findings show that mobility has no impact on competitive advantaged but has high impact on competitive action also has a positive effect on competitive advantage in SMEs in Bandung Regency. This research shows that mobility and competitive action can create a competitive advantage in the clothing industries in Bandung Regency although in small impact.
The ‘Smart Region’ Concept: The Implementation of Digital Technology
Authors: LYSHCHIKOVA Julia V. , STRYABKOVA Elena A. , GLOTOVA Anastasia S. , DOBRODOMOVA Tatiana N.
Published: June 2020

The article is devoted to the identification and systematization of theoretical and methodological approaches to the formation of the concept ‘smart region’ in Russia and abroad. The objects of the research are the processes of the sustainable spatial development of a region as a geographically-localized ecosystem of the digital economy. The subject of the research is the organizational, economic and managerial relations that arise in the process of formation and institutionalization of the concept ‘smart region’ in the management of sustainable spatial development. The authors have found that the concept ‘smart region’ is an evolutionary idea. Its main content is the creation and development of the region as competitive in the national and global aspects economic system and safe and comfortable for a person socio-territorial community, determined by a set of economic, social and environmental factors based on the implementation of modern information and communications and other technologies.
Crenças sobre educação em prisões: Percepções de docentes
Authors: Sousa Evangelina da Silva , Albuquerque Larissa Cavalcante , Pinho Ana Paula Moreno , Fontenele Raimundo Eduardo Silveira
Published: May 2020

O objetivo desta pesquisa foi analisar as crenças normativas, comportamentais e de controle comportamental percebido relacionadas ao ensino no ambiente de cárcere, sob a perspectiva da Teoria do Comportamento Planejado (Ajzen, 1991). Trata-se de uma pesquisa exploratória, descritiva, com abordagem qualitativa. Foram realizadas oito entrevistas semiestruturadas com agentes de ensino que atuam na educação de jovens e adultos e em projetos relacionados à educação no cárcere na região metropolitana de Fortaleza – Ceará. O conteúdo das entrevistas foi analisado por meio da análise de conteúdo. Os resultados indicaram que o comportamento planejado de exercer a docência no ambiente de cárcere dos entrevistados é orientado pelos três tipos de crenças: comportamentais, normativas e de controle percebido. Os resultados acrescentam informações a respeito da docência no ambiente de cárcere, contribuindo para a área da educação, ao proporcionar a compreensão sobre a atuação de professores em um ambiente provido de estigmas e preconceitos; e da gestão, posto que as unidades prisionais são instituições públicas que lidam com projetos sociais, cuja dinâmica é movimentada pelas contingências intrínsecas a esse ambiente, pelo poder disciplinar e pelas normalizações. Ademais, reforça-se a importância da Teoria do Comportamento Planejado como modelo teórico adequado para predizer o comportamento humano.