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Plenary Talks

Abstract

Although not as common as osteoarthritis of the hip and knee, osteoarthritis of the ankle can cause considerable disability for those who suffer from it; since it usually produces pain when walking and significant loss of joint mobility. Posttraumatic arthritis is the main cause of osteoarthritis in the tibiofibular joint, which is why it is common to find it in young patients. The surgical alternatives classically are: - Arthroscopy. It is a minimally invasive technique that is performed in cases not very severe. It tries to regularize the joint surface by removing some osteophytes, being able to associate a synovectomy. It usually provides improvement, but rarely complete resolution. - Osteotomies of alignment. They try to recover the normal alignment of the deformed ankle to relieve pain. - Ankle arthrodesis. Fixation of the joint. The improvement of pain is very important, being able to be definitive. An important range of mobility is lost, although numerous physical activities can be performed. - Total ankle prosthesis. It has more complications than arthrodesis, but it also produces a very important improvement in pain while retaining a much greater range of mobility. They usually require replacement in about 10-15 years. However, at present, certain techniques that seem to achieve a considerable improvement in pain while preserving joint mobility are in the process of being analyzed. One of them is joint distraction or arthrodiastasis. Arthrodiastasis is used as an alternative to total prosthesis or arthrodesis in young patients. It consists on the placement of a circular ring fixator for 8-12 weeks during which a partial cyclic load is allowed. There are several theories that try to explain the beneficial effects of this technique, both mechanical and biochemical. However, in what seems to coincide all the literature is that the distraction of the joints favors mechanisms of fibrocartilage generation. Therefore, arthrodiastasis provides the advantages of being a closed technique that achieves clinical improvement, with few complications and without limiting joint mobility.

Biography

Dr. Jorge de las Heras Romero is a recognized expert in the area of Orthopaedics and Trauma Surgery, specialized in knee, foot and ankle reconstruction at University General Reina Sofía in Murcia, Spain. He finished a Master’s Degree in Clinical Medicine Research at Elche Miguel Hernández University and a Master’s Degree in Bioethics at the University of Murcia Medical School, where he finally received his Orthopaedic and Trauma Medicine PhD. He worked in the NHS England for 4 years after his MD, finalizing a basic training surgical rotation. Afterwards, he completed his surgical residency in Orthopaedics and Trauma Surgery (MIR) at the University Clinical Hospital of Valencia. Fellow member of the Trauma & Orthopaedic Surgery Spanish Society (SECOT), Foot and Ankle Spanish Society (SEMCPT), Orthopaedic Sport Surgery Spanish Society, European Society of Sport Traumatology, Knee Surgery & Arthroscopy (ESSKA) and European Foot and Ankle Society (EFAS). Dr. Jorge de las Heras Romero have authored several articles and book chapters in his field and he is the Director of Foot & Ankle Surgery Update Conference held annually in Murcia. His researches Interest are: knee sport injuries and foot and ankle surgery. He is also Editor of Orthopaedics, Traumatology and Sports Medicine International Journal (OTSMIJ), MOJ Orthopaedics & Rheumatology and EC Orthopaedics Journal.

Speaker
Jorge de las Heras Romero / University General Reina Sofía in Murcia, Spain

Abstract

OBJECTIVES: There is a drought of effective treatments of knee osteoarthritis (OA) and new therapies are needed. The present study has been conducted to establish an initial estimate of effectiveness of intra-articular (IA) injection of a proprietary 2.5% cross-linked polyacrylamide hydrogel (PAAG) for the treatment of knee OA symptoms and signs. METHODS: Patients with knee OA were invited into a prospective open-label cohort study. The patients received up to two IA injections of 3 ml of PAAG 1 month apart. The WOMAC questionnaire was used to estimate effectiveness, and was collected at baseline and after 4, 7 and 13 months. Primary outcome was change from baseline for the WOMAC pain subscale after 4 months (Normalised to 0-100 points; 100 worst). Data was analysed using a mixed-effect model without imputation of missing data. RESULTS: 84 patients (48 females) received IA PAAG. Of these WOMAC data were available from 62 after 4 months, 59 after 7 months, and 56 after 13 months. There were statistically and clinically significant reductions in WOMAC pain after 4 months (mean change -14.6 points [95% CI: -18.9 to -10.2]; p<.0001). Similar results were found in WOMAC stiffness, physical function, and WOMAC total. The improvement was sustained throughout the observation period. CONCLUSIONS: These results suggest beneficial effects of IA injection of PAAG on knee OA symptoms, even in the long term (1 year). This initial estimation of effectiveness is promising but needs to be confirmed in a randomised study with adequate measures taken to reduce risk of bias.

Biography

Henning Bliddal became a doctor in 1978, MD. in 1986 and specialist in 1987. In 1991 he became chief physician in rheumatology at the Copenhagen Municipal Hospital, and from 1997 the chief physician and research professor at Frederiksberg Hospital, where he and Bente Danneskiold-Samsøe have built the Parker Institute. HB was the principal teacher and course leader for 15 years as the specialist specialist in rheumatology and is expert in the Legal Counsel. HB has assessed professorships at home and abroad, PhD and theses. At the Parker Institute, HB is the supervisor of PhD students and generally initiates research projects. In addition to chapters for textbooks in rheumatology, HB has co-authored over 200 articles with peer-review and has lectured at congresses and professional meetings nationally and internationally. HB has been chairman of the National Board of Health's committee for the preparation of a national program for the treatment of knee arthrosis, and from 2010 has been appointed professor of rheumatology with osteoarthritis as a special field of research at the University of Copenhagen. HB is appointed head of the Parker Institute from March 1, 2011.

Speaker
Henning Bliddal / The Parker Institute, Denmark

Abstract

It is not practice that makes perfect, it is “perfect practice” that is important. Research has demonstrated specific movement patterns related to upper and lower extremity sports injuries. These include dynamic medial knee valgus and its relation to lower extremity sports injury, and sub optimal throwing technique and its relation to upper extremity injury in throwing athletes. Sub optimal movement patterns can predispose to injury, and correction of these patterns is essential for both injury prevention and appropriate rehabilitation. This lecture will discuss some of the means of analysis employed to identify sub optimal movement patterns, what the research tells us about optimal movement and sports technique, and the methods of incorporating optimal technique and movement patterns in sports injury rehabilitation and prevention.

Biography

Dr. Laskowski is Co-director of Mayo Clinic Sports Medicine and a Professor in the Department of Physical Medicine and Rehabilitation. Nationally and internationally recognized for his expertise in fitness and sports medicine, Dr. Laskowski studies and promotes best practices for general fitness, injury prevention and injury rehabilitation, strength training, and stability training. Collectively, Dr. Laskowski’ s work has produced several hundred publication credits, including scientific papers, abstracts, books, book reviews, book chapters, and popular media and multimedia. His articles have appeared in The Wall Street Journal, The New York Times, The Washington Post, The Chicago Tribune, Golf Digest, Prevention, Time, Men’s Health, Esquire, and GQ Magazine. He has appeared on the NBC Nightly News, ABC World News Now, and Good Morning America as a trusted voice in sports medicine and fitness. He has been recognized for exceptional contributions to his field, and has been annually acknowledged as one of the “Best Doctors in America" for the last 21 years. His teaching expertise has been recognized by his election to the Mayo Clinic Teacher of the Year Hall of Fame, and he also has been selected as Outstanding Faculty Member and as Co-Director of the Most Outstanding Course in the Mayo School of Continuous Professional Development. Dr. Laskowski has provided medical services at sports events ranging from high school football to the 2002 Winter Olympics and the Chicago Marathon. From 2006 to 2010, he was appointed by President George W. Bush to serve as a member of the President's Council on Physical Fitness and Sports; he served under Presidents Bush and Obama, and he received a special commendation from the Department of Health and Human Services for his contributions to the Council. He also received the American Academy of Physical Medicine and Rehabilitation’s Distinguished Public Service Award in 2016. Dr. Laskowski is a Fellow in the American College of Sports Medicine, and he was one of the first physiatrists to receive Subspecialty Certification in Sports Medicine

Speaker
Edward Laskowski / MAYO Clinic Sports Medicine Clinic, USA

Keynote Talks

Abstract

In our group we explore a new generation of smart living implants combining not only active therapeutics but also stem cells, as a novel strategy to regenerate stabilized cartilage and avoid prosthesis, by achieving regeneration of its subchondral bone foundation, requirement which is failing today in the clinic. In our group, a unique nanotechnology strategy is used to entrap, protect, and stabilize therapeutic agents into polymer coatings: nanoreservoirs, covering nanofibres of implantable nanofibrous membranes for bone and cartilage regeneration. Upon contact with cells, therapeutic agents become available through enzymatic degradation of the nanoreservoirs. As cells grow, divide, and infiltrate deeper into the porous membrane, they trigger slow and progressive release of therapeutic agents that, in turn, stimulate further cell proliferation. The nanoreservoirs technology enables to reduce the quantities of required therapeutic agent (compared to soaked membranes for instance) thereby reducing costs.

Biography

Dr. Nadia Benkirane is Research director and head of the “Regenerative Nanomedicine” laboratory, at INSERM (French National Institute for Health and Medical Research). She was leader of “Active Biomaterials and Tissue Engineering” team INSERM 977. She received her Ph.D. from University Louis Pasteur, ULP, and Strasbourg, France for the work on Development of pseudo peptides as synthetic vaccines. Dr. Jessel (Benkirane) then held a postdoctoral position in collaboration with the Institute Pasteur, Paris, France, working on Immunotherapy HIV, and another postdoctoral position on the application of modified peptides as vaccines against FMDV (Plum Island Animal Disease Centre, ARS, USDA, Greenport, NY 11944-0848, USA). She joined the INSERM U595 in 2002 as a post-doc, and received the diploma to direct the research (HDR) in 2004. Dr. Jessel got the permanent position (CR1) in the INSERM 595 laboratory in 2004 and Research Director (DR2) position in the INSERM 977 and head of “active Biomaterials and Tissue Engineering team from 2009 until 2012). Currently Research Director (DR1) and head of the INSERM UMR 1260 (Regenerative Nanomedicine". Dr. Jessel possesses expertise in diverse fields of molecular and cellular biology, immunochemistry, tissue engineering and biomedical engineering. In the last 10 years, she focused her research on the bio-fictionalization of multilayered polyelectrolyte architectures with emphasis on the use of these architectures to induce specific cellular responses and gain control over cell proliferation and differentiation. Dr. Benkirane has more than 138 publications (h index: 36) with peer-reviewed publications in high impact factor journals (Proc. Nat. Acad. Sci. USA; Adv. Mater.; Adv. Funct. Mater. Small; Nanoletters, Biomaterials, ACS Nano), 5 chapter’s reviews and 5 international patents, she is a regular referee for a number of scientific journals (Nature nanotechnology, Nature Materials, ACS Nano, Biomaterials, Nanoletters…). She was under the contract (Interface INSERM/Clinic 2008-2013) and she got also “Prime d ‘Excellence Scientifique” from the INSERM, 2010-2014 and the PEDR from the INSERM on 2016 for 4 years.

Speaker
Nadia Benkirane / French National Institute of Health and Medical Research, France

Sessions:

Ocular Manifestations of Rheumatologic Disorders

Session Chair:

C. Stephen Foster
Harvard Medical School

Abstract

Systemic Lupus Erythematosus has many ocular manifestations, including Discoid Lupus associated blepharitis, conjunctivitis and episcleritis, Lupus scleritis, keratitis, uveitis and retinal vasculitis. And while the latter three can be sight threatening, none is commonly considered to be life threatening. In my 40 years on the Harvard faculty I have collaborated in the care of many patients with SLE, two of whom died of CNS complications of the disease. Other ophthalmologists have witnessed this too. The patients' rheumatologists felt that our recommendations for more aggressive therapy when retinal vasculitis emerged were too aggressive, since the patients' other SLE manifestations appeared to be under good control. I wish to emphasize to each of you how sensitive the eye is as a barometer for potentially lethal occult vasculitis. One of my cases, co-managed with rheumatologists at the Massachusetts General Hospital is highly illustrative. This 34 year old woman was hospitalized by her MGH rheumatologist no because of renal failure or any other non-ocular problem, but because she abruptly developed bilateral vision loss. Fluorescein angiography disclosed bilateral widespread retinal vasculitis. The patient had already received intravenous SoluMedrol (she had been on prednisone and hydroxychloroquin as an outpatient). What might be the most appropriate strategy now?

Biography

Dr. Foster was born and raised in West Virginia, received his Bachelor of Science Degree in Chemistry at Duke University, with Distinction and Phi Beta Kappa in 1965, and received his Doctor of Medicine Degree at Duke University Medical Center, in 1969, being elected to Alpha Omega Alpha. He trained in Internal Medicine at Duke University Hospital from 1969-1970, and at the National Heart and Lung Institute, at the National Institutes of Health in Bethesda, Maryland, from 1970 to 1972, during which time he also taught Internal Medicine, with an appointment as Instructor in Medicine at the George Washington University Hospital in Washington, DC. In 1972, Dr. Foster entered his Ophthalmology Residency training program at Washington University (Barnes Hospital), in St. Louis, Missouri, and having completed that in 1975, traveled to Boston to do two additional Fellowship trainings in Cornea and External Diseases, and in Ocular Immunology. He completed this training in 1977 and was invited to join the full-time faculty of the Department of Ophthalmology of Harvard Medical School, where he was a member of the Cornea Service and Director of the Residency Training Program at the Massachusetts Eye and Ear Infirmary. He began his independent research in 1977 and has since been continuously funded by grants from the National Institutes of Health.

Speaker
C. Stephen Foster / Harvard Medical School

Abstract

JIA associated uveitis is the leading cause of uveitis in children. It accounts for only 10% of all uveitis; yet it accounts for 33% of all legal blindess in developed societies. Why? Because of delayed diagnosis and because of inadequate systemic therapy. Incidence = 7-21 cases per 100,000 persons per year. Risk factors: FEMALE OLIGOARTICULAR ANA POSITIVE AGE 2-5 AT ONSET HLA-DR 1 LACK OF STEROID SPARING SYSTEMIC IMMUNOMODULATORY THERAPY DELAYED REFERRAL TO AN OCULAR IMMUNOLOGIST Ocular complications - 0.33 eye-year, i.e., slow, progressive accumulation of damage. IT DOES NOT BURN OUT! Cataract, glaucoma, macular edema, band keratopathy and macular pathology are the most common vision robbing complications over time. Early use of IMT reduces the risk of ocular complications and of blindness.

Biography

Speaker
Frances B. Foster / Massachusetts Eye Research And Surgery Institution, USA

Abstract

Behcet’s disease (BD) is a systemic relapsing obliterative vasculitis, affecting arteries, veins and mainly capillaries. Even though almost all organs can eventually be involved, uveitis makes the disease’s prognosis guarded and usually urges to start proper treatment. There’s no specific test to diagnose Behcet’s disease. Acute bilateral panuveitis is the most common clinical presentation of the disease with dense vitritis, severe retinal vasculitis, areas of retinal necrosis and hemorrhages. The main differential diagnosis includes toxoplasmic retinochoroiditis, ocular tuberculosis, acute retinal necrosis syndrome and primary vitreoretinal lymphoma. Imaging techniques such as fluorescein angiography and optic coherence tomography are important to evaluate disease severity and complications. It is important to exclude ocular findings such as papilledema, which may be associated with neuroBD. Therapeutic management is very rapidly initiated, requiring a close collaboration between ophthalmologists, internists or rheumatologists. It follows the revised EULAR recommendations. Any patient with BD and inflammatory eye disease affecting the posterior segment should be on a treatment regimen such as azathioprine, cyclosporine-A, interferon-alpha or monoclonal TNF-alpha antagonists. Systemic glucocorticoids should be used only in combination with azathioprine or other systemic immunosupressants. Patients presenting with an initial or recurrent episode of acute sight threatening uveitis should be treated with high dose glucocorticoids, infliximab or interferon-alpha. Intravitreal glucocorticoid injection is an option in patients with unilateral exacerbation as an adjunct to systemic treatment. For patients with isolated anterior uveitis, systemic immunosuppressants could be considered for those with poor prognostic factors such as young age, male sex and early disease onset. The use of biologic agents has dramatically improved the visual outcome of patients with BD.

Biography

Bahram Bodaghi, MD, PHD, FEBO is Professor of Ophthalmology at Sorbonne University in Paris, France. He is a Board member of the FOReSIGHT Hospital University Institute and serves as Vice President of the French Society of Ophthalmology. He chairs the national University Council of Ophthalmology since 2013 and is actively involved in undergraduate and postgraduate teaching programs at the University of Paris. He has been elected President of the International Ocular Inflammation Society. During the last decade, he mainly focused his efforts in the understanding of infectious agents associated with different forms of intraocular inflammation but also new therapeutic strategies in autoimmune uveitis.

Speaker
Bahram Bodaghi / University in Paris, France.

Sessions:

Modern Rheumatology and Orthopedidcs

Abstract

Background: Hepatitis after the reactivation of hepatitis B virus (HBV) has been recognized serious in the patients with rheumatoid arthritis (RA) treated with biologics. Objectives: The objective of the present study was to search some common background which might be relevant to the host factors that provoke such a serious hepatitis. Methods: We retrospectively collected and analyzed all data of serum alanine aminotransferase (ALT) levels in selected patients with RA at random. Results: A significant association (P < 0.001) between methotrexate (MTX) therapy and elevated serum ALT level was found only in the anti-HBcAb-negative RA group. The mean serum ALT level was significantly higher (P < 0.001) in patients with than without MTX therapy in the anti-HBcAb-negative RA group, although no significant difference was found (P = 0.73) in the anti-HBcAb-positive RA group. In addition, the anti-HBcAb-positive RA patients showed significantly lower mean serum level of ALT (P < 0.01) than anti-HBcAb-negatives provided they are naïve with biologics. But no significant difference between anti-HBcAb-positives and -negatives in the mean serum level of ALT was found among patients experienced with biologics (P < 0.8). Conclusions: The anti-HBcAb-positive RA group showed the suppression of MTX-induced elevations in serum ALT level. However, this suppression was not found in patients experienced in the treatment with biologics, although it was preserved in those who had not experienced biologics. Failure of this suppressive mechanism of ALT in anti-HBcAb-positive RA patients treated with biologics could be possibly associated with serious hepatitis after the reactivation of HBV infection.

Biography

Dr. Noguchi, Osamu graduated Nippon Medical College in 1975 and move to Musashino Red Cross Hospital (Tokyo), and studied practical Internal Medicine, Pediatrics, Surgery and Anesthesiology under the position of medical intern for three years. After that, he completed the postgraduate course of Keio University with specialty of Rheumatology in 1980, while he worked at Murayama Byouin National Sanatorium as the head physician of the third branch of Internal Medicine. I also studied Nephrology, Tuberculosis and Thermo logy during this era. He took the post of Director at Takato-Machi Osafuji Clinic in Nagano Prefecture, Japan in 1989. And he opened Gennoki Clinic with the specialty of Rheumatology in the area of Ina City in 1997.

Speaker
Osamu Noguchi / Gennoki Clinic, Japan

Sessions:

Rheumatic Disease

Abstract

The acute phase response is an ancient, evolutionarily conserved defense system of vertebrates regulating homeostatic disturbances caused by infections, injuries, traumas, cancer and/or immunologic disorders, ultimately leading to resolution of inflammation and healing. One of the major acute phase proteins in humans is serum amyloid A (SAA), levels of which can dramatically increase during the acute phase. Persistently elevated levels of SAA in patients with chronic inflammatory diseases (e.g. rheumatoid arthritis) can cause tissue damage and may lead to amyloidosis. The resolution of the acute phase and SAA reduction following the acute phase are well-documented, however the exact mechanism remains elusive. Antibodies against SAA have been identified in sera of healthy blood donors, intravenous immunoglobulin (IVIg), as well as in patients. A novel bead-based Luminex assay has recently been developed for quantitative detection of autoantibodies against SAA1, which could be combined with simultaneous detection of antibodies against other acute phase proteins. Furthermore, enriched fractions of anti-SAA1 antibodies have been isolated from IVIg and were shown to decrease interleukin-6 protein levels released from SAA1-treated peripheral blood mononuclear cells from healthy blood donors. In conclusion, naturally occurring antibodies against SAA1 could play a physiological role in down-regulating their antigen, as well as other proinflammatory cytokines, leading to the resolution of the acute phase. These natural autoantibodies could be endogenous immune-regulators of the acute phase response and may also represent a potential and attractive therapeutic option in patients with chronic inflammatory diseases.

Biography

Prof. Snezna Sodin-Semrl completed her PhD at the University of Illinois at Chicago, USA and postdoctoral studies at the same institution, with an Arthritis Foundation Fellowship. She received a Marie Curie-International Reintegration Grant, with which she returned to the University Medical Center in Ljubljana, Slovenia, where she is currently leader of the National Research Programme “Systemic Autoimmune Diseases”. She has published more than 60 original and review scientific articles and book chapters and is regularly called upon, as an expert to evaluate Horizon 2020 grant proposals.

Speaker
SNEZNA SODIN-SEMRL / UNIVERSITY MEDICAL CENTER LJUBLJANA, Slovenia

Sessions:

Arthritis

Abstract

Objective: Increasing studies indicate that Cucurbitacin E (CuE), a derivative isolated from Cucurbitaceae plants may exert anti-inflammatory effect. In this study we explore the effect of CuE on TNF-α-induced inflammatory cytokines production in human synoviocytes MH7A cells, and further explore the detailed molecular mechanism involved in its anti-inflammatory effect. Materials and method: MH7A cells were stimulated with TNF-α in the presence or absence of CuE, The expression of pro-inflammatory cytokines was determined by quantitative real-time PCR and enzyme-linked immunosorbent assay (ELISA). Signal-transduction protein expression was determined by Western blot. Nuclear translocation of NF-κB p65 was determined by a confocal fluorescence microscopy. Result: CuE suppresses TNF-α-induced interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-8 (IL-8) mRNA and protein expression in MH7A cells in a dose-dependent manner with no apparent cytotoxicity. CuE also suppressed TNF-α-induced phosphorylation of NF-κB p65, IKKα/β, IκBα as well as NF-κB p65 nuclear translocation in a dose-and time-dependent manner. Furthermore, CuE suppresses the TNF-α-induced activiation of PI3K/Akt similarly as the PI3K inhibitor LY294002,which also decreases the activation of NF-κB as well as mRNA and protein expression of IL-1β, IL-6, and IL-8 in TNF-α-induced MH7A cells. Conclusion: These findings demonstrate that Cucurbitacin E as a potential therapeutic agent for Rheumatoid arthritis can inhibits TNF-α-induced inflammatory cytokine production in human synoviocyte MH7A cells via modulation of PI3K/Akt/NF- κB pathway.

Biography

Dr. Zhang Peng had degree of Clinical Medicine of Bone and studied from well-known orthopedic experts Dai Kerong academicians, mainly engaged in the experimental study of the pathogenesis and treatment of rheumatoid arthritis; During his postdoctoral research in Zhejiang university, he received the first class aid of postdoctoral fellowship; Then, he entered the Chinese University of Hong Kong Department of bone trauma continue to engage in bone and joint Study on mechanism of inflammation and its transformation and application.

Speaker
Peng Zhang / Shenzhen Institutes of Advanced Technology,Chinese Academy of Sciences,China

Sessions:

Physical Medicine and Rehabilitation

Abstract

The aim of this study was to define the efficacy and outcome value of an innovative procedure tool (TRIA-MF protocol) in the treatment of lower limb amputees before and after prosthesis use with the purpose to quantify the quality of the procedure and its economic impact on the clinical patients’ recovery. 12 patients (4 women and 8 males) subjected to lower limb amputation and admitted according to the principles of inclusion criteria of the TRIA-MF protocol at the Rehabilitation Department of the Clinical Institute Città di Brescia were recruited in this study. All patients were included in an integrated and task-specific management protocol of the amputee, which allowed to follow the rehabilitation process from amputation to the final restoration, for a period of 6 months for each patient. Patients were evaluated 5 times during the study, collecting their degree of pain (VAS), their independence profile (Barthel Index) and the cirtometry of their amputation stump. Data on the duration of their admission to the rehabilitation unit, the inter-time between the amputation and acquisition of the temporary prosthesis, and between temporary prosthesis acquisition and the final prosthesis acquisition were also reported. Patients of our sample, at the end of their hospitalization, highlight a significant modification of the temporal data at 1 month and 6 months from their hospital discharge. A statistical significant increase of the Barthel Index value was observed in all patients recruited in this study proceeding from time T0 to time T4; in the same way, a statistical significant decrease of the VAS scale was observed in all patients recruited proceeding from time T0 to time T4; the cirtometry of the amputation stump (expressed in cm) showed a statistical significant decrease in all patients recruited proceeding from time T0 to time T4. We haven’t observed a statistical significant correlation between the duration of the rehabilitative hospitalization and our clinical data; no statistical significant correlation was observed between the amputation stump cirtometry time-related modification and our intertime data.

Biography

Dr Falso MV received his degree in Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation in 2004 from the University of Medicine of Verona (Italy). This was followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona (Italy), by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia (Italy) and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity. In his career he also promoted the use of innovative dynamic carbon-kevlar custom made AFO (DAFONS), innovative postural devices in patients affected by neurological complex postural needs, the device treatment of idiopathic scoliosis by using an innovative dynamic spine brace called “BRIXIA” and the device treatment of gait disorders by using an innovative dynamic carbon Kevlar foot insole called “PRODYNAMIC”

Speaker
Falso Maurizio / Middle Cares Rehabilitation Unit – Fondazione Madonna del Corlo - Lonato (Bs), Italy.

Sessions:

Orthopedics Medical Devices

Abstract

The number of revision total hip arthroplasty (THA) procedures is on the rise, which is a problem since these surgeries are more technically demanding and increase the risk of infection and additional bone degeneration. We are therefore aiming to reduce the need for revision surgery with better implants. Our current focus is on the polyethylene (PE) socket. The non-cross-linked PE initially used by surgeons had high fracture toughness, but a softness that led to an increased wear rate. To improve this, gamma irradiation was applied to cross link the PE molecules and produce stronger materials with lower wear patterns. However, the harder sockets were also more brittle and prone to breaking. We are at the threshold of developing the first biomedical application of carbon nanotubes (CNTs). Abrasion tests are currently being planned to simulate long-term wear and tear on the new CNT-PE sockets. There remains speculation on the safety of CNTs, especially regarding inhaled particles, which may behave similarly to asbestos in terms of pathogenicity. In this regard, it will be imperative to establish that the safety or danger of inhaled CNTs is completely different from that of implanted CNTs. We believe the new artificial joints will be safe for patients, and envision a bright future for CNT-based biomedical materials for THA and other prosthetic applications.

Biography

Naoto Saito has completed his PhD from Shinshu University, Japan. He is the director of Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University.

Speaker
Naoto Saito / Shinshu University, Japan

Sessions:

Shoulder & Elbow Surgery

Abstract

Purpose: To present our outcome analysis of 46 consecutive shoulders (44 patients) presenting with massive, retracted rotator cuff tears that we treated with arthroscopic rotator cuff repair with concomitant superior capsular reconstruction utilizing an acellular dermal allograft. We report our experience that this technique theoretically restores superior capsular integrity and decreases superior capsular distance therefore decreasing tension on the repair. The use of concomitant superior capsular reconstruction with repair has allowed repair of seemingly irreparable tears to the native footprint possible. We also present the concept of superior capsular distance to quantitatively measure the decreased distance present with restoration of superior capsular integrity, which we believe facilitates repair in these tears. We believe this technique also provides biologic augmentation in these large tears with poor tissue quality. Methods: Forty-six shoulders in forty-four consecutive patients (mean age 58.8) presented with massive rotator cuff tear (Cofield Classification, >5cm), retraction (>5 cm, and atrophy (Goutalier Grade 3 or 4). The tears involved the supraspinatus or both the supraspinatus and infraspinatus tendons. All tears, upon initial arthroscopic evaluation, appeared to be massive retracted rotator cuff tears with poor tissue quality that upon arthroscopic mobilization and attempted repair we were unable to re-approximate the native rotator cuff or superior capsule to the native footprint. While performing superior capsular reconstruction with an acellular dermal allograft in these patients, it was noted that the rotator cuff was able to then be re-approximated under very little tension over the native footprint to the greater tuberosity of the humerus over the superior capsular reconstruction graft. All patients in this outcome analysis underwent an arthroscopic superior capsular reconstruction with concomitant rotator cuff repair. Outcome analysis was performed via an internet based outcome-tracking system to evaluate visual analog score, ASES score, and simple shoulder test scores. These scores were obtained preoperatively as well as intervals of 2 weeks, 3 months, 6 months, 1 year, and 2 year postoperatively. Radiographic analysis of standard AP radiographs were analyzed to assess acromio-humeral interval, displacement of the geometric center of the humeral head from the geometric center of the glenoid, and superior capsular distance preoperatively as well as 1 week, 6 months, and 1 year postoperatively. These radiographic measurements were obtained utilizing the digital radiographic calibration software inherent to our digital radiographic system. Digital dynamometric strength analysis and functional range of motion assessments were obtained in the preoperatively as well as 6 months and 1 year post-operatively. All data obtained was analyzed statistically to evaluate for significance. Results: Forty-four patients (46 shoulders) received surgical treatment with functional biological augmentation. A 4% failure rate has been observed and 86% of patients are satisfied with the surgical results. Outcome data analysis demonstrated significant (p<0.05) improvements in pain (VAS preop 2.80 – VAS 1 year 0.8) strength (FF/ABD preop 4.5 lb/3.7 lb – FF/ABD 1 year 9.7 lb /12.4 lb), and range of motion (FF/ABD preop 127.3°/112.0° – FF/ABD 1 year 163.0°/163.8°). There was no statistical difference (P<0.05) at 1 year between strength and range of motion in the operative and non-operative extremity. Radiographic analysis showed significance (P<0.05) at the 1-week, 6-month, and 1-year time points for an increase in the acromio-humeral interval (mean 7.6mm preop – mean 8.7mm 1 year) and superior capsular distance (mean 52.8mm preop – mean 45.2mm 1 year). Outcome data analysis demonstrated improved scores in visual analog scores (4.0 to 0.9), simple shoulder test (45.4 to 54.2), SANE scores (35.0 to 49.3), ASES function score (14.8 to 20.7), and ASES index scores (54.8 to 80.0) at one year follow-up. Conclusions: Functional biologic augmentation with superior capsular reconstruction and concomitant rotator cuff repair in massive rotator cuff tears with associated advanced muscular atrophy has demonstrated promising early results in treating this problematic patient population. The use of the acellular dermal allograft intraoperatively as a graft to reconstruct the superior capsule allows for easier approximation of retracted rotator cuff tears to the native rotator cuff attachment site at the greater tuberosity of the humerus and a reduction of superior capsular distance. This technique also provides a biologic scaffold that allows host cell infiltration and enhances the healing process. Utilization of this technique in large retracted tears with poor tissue quality has the theoretic benefit of providing a repair with less tension and restoration of superior stability. While the short-term results have been promising in this outcome analysis and long-term benefit needs to be confirmed. Author Biography:

Biography

Dr. Pennington is a board certified Orthopedic Surgeon with sub- specialty certification in sports medicine. He completed medical school and orthopedic residency training at the Medical College of Wisconsin. His fellowship training in shoulder and knee reconstruction was completed at the California Pacific Medical Center in San Francisco, CA. He is a partner in The Orthopedic Institute of Wisconsin and a founding member of Midwest Orthopedic Specialty Hospital. His primary scope of practice is all aspects of shoulder reconstruction via arthroscopic and open reconstruction methods. He has numerous publications and presentations pertaining to shoulder reconstruction.

Speaker
William T. Pennington / The Orthopedic Institute of Wisconsin, USA

Plenary Talks

Abstract

Medical science greatly developing day by day, every day we wake up on new technology, innovations and procedures, Spine and brain, had high chance of this development and advance technology. Most of the surgeon nowadays, seeking patients safety and satisfaction, that why Minimum Invasive Surgery become the first goal to be achieved from most of surgeon Minimum Invasive surgery, including Microscopic spine and brain surgery, Endoscopic Brain and spine surgeries, in addition to all of that ,navigation system started to play role in helping surgeon to obtain best possible results. More or less introduction of Robotics to be part of new modulates of treatment in all surgeries, including Brain and spine. The development of endoscopy techniques in the treatment of the brain and spine disorders have followed to significantly improve outcome, moreover, endoscopic procedures a less invasive technique consequently minimizes a possibilities of intra and post-operative complications. In addition a neuro endoscopic can replace, in many cases, traditional neurosurgical procedures in brain and spine, with less complication and good outcomes. In this presentation we will discuss the outcome of given sample for patients who undergoes minimally invasive spine surgeries, the patients evaluates by using VAS and SF- MPQ scaling.

Biography

Dr. Munaf A Hatem studied and practice in Republic of Iraq. He graduated from Medical school at 1998, and then he joined orthopedic programs in different Iraq hospitals. Since 2006 he decided to travel and live in Sultanate of Oman, then he started my practice their since 2010. He decided to pursue his ambition, he joined fellowship and PhD program in Medical University of Lodz, Republic of Poland, now he practice his specialization in both of Sultanate of Oman and Poland. He is member and follow of many orthopedic organizations and committees, most of them are global, e.g. AAOS, ESSKA, SICOT, he is member in scientific committee of some of this organization; recently he is participated in first Rheumatology and orthopedic congress in Spain as keynote speakers and chairman for some sessions. He is proud to be member in scientific committee of this congress. He had published some papers in Iraq, Oman, and republic of Poland, he presented paper in last ESKA meeting in London, right now am interested doing some research and work in some papers, in addition to my practice as an Orthopedic doctor.

Speaker
Munaf A Hatem / Hepavita Medical Center/Poland, Peace land Medical services/Oman

Abstract

The sacroiliac joint (SIJ) is organized by articular surfaces between the sacral and iliac bones. The SIJ include different functions, among which to connect the spine to the pelvic bone, which permits for a better transmission of vertical forces from the spine to the pelvis and lower extremities. The first purpose of the SIJ is to provide stability, which is promoted partly by the muscles attached to the SIJ, and is provided by a multiple mechanism, embracing the complex of ligaments fixed to the SIJ. The range of motion of SIJ is estimated around 2 to 4 degrees. Additionally, there are 35 muscles attaching to the sacrum or innominate, which work in combined effort with the fascial and ligaments, thus to ensure movement and simultaneously stability of the trunk and lower extremities. The SIJ also is an important generator for pelvic and low back pain (LBP)in the differential diagnosis of referred map pain in the lower extremities, and should be considered in the differential diagnosis of pelvic and LBP. There is an underestimation of the prevalence of SIJ pain, because there is a lack of research done on the SIJ posterior ligaments. In the United States and rest of the world, there is an augmented prevalence of LBP and its related costs. In Europe, the increase of adult patients with LBP is associated to the sedentary activities as working with a computer behind a desk. Marcucci, Alexander, and Matthews observed in a pilot study composed of a sample with 20 patients having LBP or pelvic, and or lower extremities pain, after applying two different osteopathic release techniques on the posterior SIJ ligaments, a reduction of the pain in 18 patients, from which 12 had no pain anymore, 6 had only a reduction of the intensity of their pain. In two cases, the techniques did not provide any effect on the pain intensity. There is a necessity to assess the potential function of the SIJ posterior ligaments in producing LBP and referred map pain in the lower extremities.

Biography

Sergio Marcucci has completed his Doctorate in Health Sciences (DHSc) at the age of 47 years from A. T. Still University, College of Graduate Health Studies, Mesa, USA. He received his MSc from A. T. Still University of Kirksville USA and his D.O. from Sutherland College of Osteopathic Medicine, Belgium. He is practicing osteopathic medicine since 15 years. He had 10 oral presentations and one poster presentation. He has published 2 papers in reputed journals and has been serving as a reviewer board member of three repute journals.

Speaker
Sergio Marcucci / A. T. Still University, USA

Abstract

Granulomatosis with Polyangiitis (GPA) and Relapsing Polychondritis and both life threatening rheumatologic disorders, and both can affect the eye. About 60% of patients with GPA will develop an inflammatory eye problem, and 25% of those cases have the eye inflammation as the first manifestation of the disease. bringing them into the medical system. Control of the dacryocystitis or scleritis or peripheral ulcerative keratitis or retinal vasculitis depends entirely upon control of the underlying GPA. Thus, the ophthalmologist is dependent upon the rheumatologist to do whatever it takes to induce remission, whether that be with rituximab or with cyclophosphamide. But it is to be emphasized that the eye involvement is a powerful signal that any therapy less than one of those two immunomodulatory agents is doomed to fail. Induction of remission of the eye inflammation will be a very strong indicator of therapy success. The same may be said of relapsing polychondritis. Further, the RP patient who appears to be in remission with systemic prednisone and a non-steroidal anti-inflammatory agent and Dapsone who develops de novo ocular inflammation (scleritis or PUK) is destined to develop other more serious non-ocular manifestations of the disease if the vigor of therapy is not increased significantly. Just as in all of the other acquired connective tissue disorders, so too in RP the eye is an exquisitely sensitive barometer of subclinical vasculitis which may be lethal if not addressed before vital organ involvement occurs.

Biography

Dr. Foster was born and raised in West Virginia, received his Bachelor of Science Degree in Chemistry at Duke University, with Distinction and Phi Beta Kappa in 1965, and received his Doctor of Medicine Degree at Duke University Medical Center, in 1969, being elected to Alpha Omega Alpha. He trained in Internal Medicine at Duke University Hospital from 1969-1970, and at the National Heart and Lung Institute, at the National Institutes of Health in Bethesda, Maryland, from 1970 to 1972, during which time he also taught Internal Medicine, with an appointment as Instructor in Medicine at the George Washington University Hospital in Washington, DC. In 1972, Dr. Foster entered his Ophthalmology Residency training program at Washington University (Barnes Hospital), in St. Louis, Missouri, and having completed that in 1975, traveled to Boston to do two additional Fellowship trainings in Cornea and External Diseases, and in Ocular Immunology. He completed this training in 1977 and was invited to join the full-time faculty of the Department of Ophthalmology of Harvard Medical School, where he was a member of the Cornea Service and Director of the Residency Training Program at the Massachusetts Eye and Ear Infirmary. He began his independent research in 1977 and has since been continuously funded by grants from the National Institutes of Health.

Speaker
C. Stephen Foster / Uveitis Foundation, USA

Keynote Talks

Abstract

Despite the availability of different pharmacological entities for the management of osteoarthritis (OA), joint health remains an unmet need across generations ranging from active millennials to older adults. The American College of Rheumatology recommends a healthy life style (e. g. exercise and weight loss) before moving to drug treatment. Dietary supplements have been used with more or less success either alone or in conjunction with pharmacological treatments. The undenatured type II collagen (UC-II) contained in chicken sternum cartilage has been shown in human clinical trials to mitigate joint pain in osteoarthritic subjects and also to increase flexibility in healthy subjects at risk of developing OA. Further, in a OA animal model, UC-II has been shown to improve cartilage and bone structure at the level of joint deterioration. This presentation will focus on discussing the benefits of UC-II supplementation as a measure to maintain joint health in both healthy subjects and osteoarthritic patients. In addition, because of its unique mechanism of action, the oral tolerance, the UC-II dose of 40 mg can be given once daily, which may improve consumer compliance.

Biography

Dr. Aouatef Bellamine earned her Ph.D. in life science with honors from the University of Sorbonne in France. She is a pioneer in the field of lipid metabolism where she was the first to purify and characterize enzymes involved in cholesterol synthesis in Mycobacterium tuberculosis. Her research brought her from academia (Vanderbilt University) to industry where she led a program at Bristol-Myers Squibb looking at lipodystrophy resulting from the use of protease inhibitors and anti-psychotic drugs. Later on at BMS, she joined the metabolic disease team where she contributed to the launch of several diabetic drugs. She also led a work stream looking at the attributes of DPP-4 inhibitors and their beneficial effects on cardiovascular outcomes, as part of the SAVOR trial. Currently at Lonza, Dr. Bellamine is a leading member of the R&D organization in the Consumer Health and Nutrition Business Unit, where she is involved in the research and clinical development of the Nutrition portfolio. She has a proven track record and has authored over 25 peer reviewed articles and book chapters in the fields of lipid metabolism, endocrinology and Nutrition. She also authored several patents both in the US and Europe. She has been invited as a lecturer in many scientific conferences and has been involved in several advisory boards as a spokesperson. Dr. Bellamine is a member of the American Association for the Advancement of Science, the American Society of Nutrition, the Council for Responsible Nutrition as a senior member, the American Diabetes Association and the Society of Toxicology.

Speaker
Aouatef Bellamine / Lonza Inc.
USA

Abstract

In rehabilitation, treatment is focused primarily on the functional consequences of the disease, with the accent on non-pharmacological treatment interventions. Both physicians and a variety of health professionals may be involved in rehabilitative treatment programs. Comprehensive multidisciplinary team care programs are aimed at improving disease activity, physical and psychosocial functioning, with the ultimate goal of assisting patients to achieve and maintain maximum personal independence. Treatment modalities may consist of optimization of antirheumatic drug therapy and intra-articular injections with corticosteroids, general rest, local immobilization of inflamed joints, the application of local heat or cold, exercise and occupational therapy, education and psychosocial support. Within the framework of rehabilitation, the goal of education and psychosocial support programs for patients with Rheumatoid Arthritis (RA) is to give patients the strategies and tools necessary to make daily decisions to cope with the disease. The education of patients may consist of information only, counselling, or a behavioral approach. In a recent systematic review on the education of RA patients, a positive effect on disability, joint counts, patients' global assessment, psychological status and depression was found. The benefits were, however, modest and short-lived. The literature indicated a possible superiority of behavioral treatment. These positive effects were confirmed in another review that focused merely on behavioral interventions for RA, and included trials on interventions such as relaxation, biofeedback, stress management and cognitive-behavioral therapy. It remains unclear whether the results of educational and psychological interventions can be improved by ‘booster sessions’, the involvement of spouses or other family members, or a more explicit tailoring of the timing and contents of the program to the individual's needs and motivation.

Biography

Zehra Gok Metin has completed her PhD from Hacettepe University Faculty of Nursing, Turkey and postdoctoral studies from University of Alabama, USA. Gok Metin is currently working an assistant professor in Medical Nursing Department at Faculty of Nursing of Hacettepe University. Her research interests include Rheumatoid Arthritis, symptom management, and complementary and alternative approaches. Gok Metin has conducted several high quality clinical trials, has published more than 20 papers in reputed journals, and has been serving as an editorial board member of reputed journals.

Speaker
Zehra Gok Metin / Hacettepe University, Turkey

Abstract

Objective: The objective was to assess the safety and efficacy of a single intra-articular administration of JTA-004, a novel viscosupplement, in patients suffering from symptomatic knee osteoarthritis (OA) at 6 months. Design and methods: In this prospective, multicenter, double-blind phase II/III trial (NCT02740231), 164 patients with primary OA knee pain were randomly assigned to one of the three JTA-004 strengths or the comparator treatment (Hylan G-F 20) in a 1:1:1:1 ratio. Safety was assessed by monitoring and reporting vital signs, physical examination, adverse events and concomitant medications. The primary efficacy endpoint was the change from baseline at 6 months in WOMAC® VA3.1 pain subscale. Results: JTA-004 was shown to be well tolerated at all strengths evaluated. At 6 months, patients in the three JTA-004 groups showed a better improvement in pain compared to patients in the comparator group although statistical significance was not achieved. As the three JTA-004 strengths had a similar efficacy, a post hoc analysis was subsequently performed between the pooled JTA-004 treated patients and the comparator group. The exploratory analysis showed a 26.1±2.4 (adjusted mean±SE) mm improvement in pain in the pooled JTA-004 group vs. 15.6±4.1 mm in the comparator group at 6 months, demonstrating a statistically significant superiority of JTA-004 over the comparator (p = 0.030). Conclusions: This study provides first evidences of safety and efficacy of JTA-004 in the treatment of symptomatic knee OA. Efficacy will be further confirmed in a subsequent pivotal Phase III study.

Biography

Dr. Olivier Godeaux is a seasoned biopharmaceutical industry executive with a proven track record in advancing drug candidates through all phases of development to regulatory approval and commercial launch. Dr. Godeaux held various senior positions in clinical development at fast-growing biotechnology companies, clinical research organisations and global pharmaceutical companies such as Johnson & Johnson, GSK and UCB, where he led several complex, large-scale Phase III clinical studies involving 1,000+ patients in Europe, US and Japan. Olivier Godeaux received both his Doctor of Medicine and his Master in Public Health degrees from the Université Catholique de Louvain (UCLouvain), Belgium. As Chief Medical Officer of Bone Therapeutics S.A., Olivier Godeaux is responsible for the development and execution of the Company’s clinical development strategy, advancing its late-stage products through clinical development towards commercialisation, while playing a crucial role in the interactions with regulatory authorities, clinical experts and key opinion leaders

Speaker
Olivier Godeaux / Bone Therapeutics, Belgium

Sessions:

Modern Orthopedics and Rheumatology

Session Chair:

Munaf A Hatem
Lodz Medical University, Poland

Abstract

Objective: To discover the possibility of using microRNA155 (miRNA155) expression level as a biomarker of Behçet's Disease (BD) activity or remission. Methods: Thirty BD patients’ white blood cells (WBCs) miRNA155 expression was measured and compared to WBCs miRNA155 expression in 15 healthy subjects. Assessment of disease activity was done using Behçet's Disease Current Activity Form (BDCAF). Results: MiRNA155 expression significantly decreases with the increase of BD activity scored by BDCAF. Conclusion: Increased miRNA155 may be used as a biomarker of BD remission and thus in the disease follow up. There could be a prospect of treating the disease via microRNA 155 effect enhancement. Keywords: Behçet's disease, MicroRNA155, BDCAF, Egyptian patients.

Biography

Speaker
Sally Saad Hassouna / Alexandria University, Egypt

Sessions:

Musculoskeletal System

Abstract

Load and joint kinematics change with differences in running surface. Running regularly on trails compared to road might influence the load on the Achilles tendon and its adaptations along with other factors such as balance, strength and proprioception. The aim of ths study was to investigate Achilles tendon structure and functional tests in road and trail runners. The study included 26 road and17 trail runners. All running at least 3 times per week with a minimum of 20km per week and had participated in running competitions over 2 years. Each participant was examined for Achilles tendon structure (via ultrasound tissue characterization (UTC) imaging) and functional tests in addition to demographical questionnaire. Main Outcome Measure included: The percentages of Echo types I, II, III and IV within the tendon, tendon length and width, tendon cross sectional area (via UTC imaging); ankle inversion movement discrimination ability (via AMEDA device); dynamic postural balance (via Y balance test); jumping performance (by triple hop distance test) and hip muscle abduction muscle strength (by hand held dynamometry). Significant difference in the distributions of the four echo-types in the UTC examination was found between groups. Percentage of echo-types I was significantly lower while echo-types II was higher in the road group compared with trail group (67.3%, 28.9% and 74.15%,22.1%, respectively)(p<0.001). No significant differences between groups was found for other tests. We concluded that tendon integrity as examined with UTC is different between road and trail runners. This suggest an influence of running surface on Achilles tendon structure.

Biography

Dr. Gail Dar has completed her PhD from the Department of Anatomy, Tel-Aviv University, Israel. She is a physiotherapist in her Bachler degree (B.PT). She is working as a physiotherapist in "Wingate Institute" which is the national institute for physical education and sport in Israel. She is a full member in the Physical Therapy Department in Haifa University, Israel. Her research focuses on the musculoskeletal system in order to better understand function, injuries and treatment. Her research deals with the basic anatomy of the structure in addition to physical therapy and rehabilitation. She has published more than 50 papers in reputed journals.

Speaker
Gali Dar / Haifa University, Israel

Sessions:

Physical Medicine and Rehabilitation

Abstract

To assess knowledge and practice levels in asymptomatic hyperuricemia (AH) and investigate predictors of urate-lowering therapy (ULT) misprescribing among primary health care (PHC) physicians. Articles Methods: A cross-sectional study was conducted among 201 PHC physicians from December 2017 to May 2018. A based clinical guidelines for hyperuricemia management from American Professional Organizations, a semi-structured questionnaire was administered to collect demographic and professional data; knowledge and practice levels in management of AH; and barriers to the management of hyperuricemia and gout, with focus of the misprescribing of ULT in AH. A 2-stage stratified sampling technique was used to select 4 PHC centers were from each of the 5 advisory sectors in Jeddah, Kingdom of Saudi Arabia; and to recruit a minimum of 10 eligible participants per primary health care center (PHCC). Binary logistic regression was used to analyze predictors of ULT misuse in AH. Results: Only 32.8% participating physicians had adequate knowledge about AH. Regarding practice, while majority (88.1%) correctly recommended a lowpurine diet and lifestyle changes to patients, almost half misprescribed ULT and 10.9% misprescribed nonsteroid anti-inflammatory drugs. Lack of knowledge and awareness about guidelines were the most frequently selfreported barriers to adequate practice. Predictors of ULT misuse included the percentage of patients having gout (110%: OR=5.40, p=0.047) or receiving ULT (>10-20%: OR=20.02, p=0.001)among patients seen in clinic, attendance of rheumatology conferences (OR=2.55, p=0.017), and having a close relative with hyperuricemia or gout (OR=2.45, p=0.026). Conclusion: There are inadequate levels of knowledge regarding AH among Saudi PHC physicians increasing risk of malpractice including misprescription of ULT and anti-inflammatory medications.

Biography

Speaker
Norah A. Alqarni / King Fahad Armed Forces Hospital, Kingdom of Saudi Arabia

Abstract

Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). A statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test; a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off; a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2; a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4; a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4; in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses.

Biography

Dr Falso MV received his degree in Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation in 2004 from the University of Medicine of Verona (Italy). This was followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona (Italy), by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia (Italy) and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity. In his career he also promoted the use of innovative dynamic carbon-kevlar custom made AFO (DAFONS), innovative postural devices in patients affected by neurological complex postural needs, the device treatment of idiopathic scoliosis by using an innovative dynamic spine brace called “BRIXIA” and the device treatment of gait disorders by using an innovative dynamic carbon Kevlar foot insole called “PRODYNAMIC”

Speaker
Falso Maurizio / Middle Cares Rehabilitation Unit - Madonna del Corlo Foundation - Lonato (Bs), Italy.

Sessions:

Orthopedic Surgery

Abstract

Introduction: PRP was used firstly in treatment of osteoarthritic joints and have very nice effect in it, but actually I found that some patient whom got some problem of instability due to injury to ACL got benefit from injection so I try to use it in ACL partial injury. Methods: we carried out an audit on ACL partial injury diagnosed by MRI and Arthroscopies between April 2014 – April 2018 . we inject 3-5 ml PRP in the different type of injured ACL. Fellow up for 3-6 month clinically the ability to return to playing football. Result: 178 patients admit to Orthopeadic Department Aldiwaniya Teaching Hospital 67% returned to play football, 6% missing in fellow up , 2% got infection , 4% got restriction of movement , 21% they got no benefit from injection . Conclusions: In this study we found that PRP play a good role in patients got a sport injury of the knee in general and as well as Partial injury of ACL. Keywords: Anterior Cruciate Ligament (ACL), Arthroscopy, Plasma Rich Platelets ( PRP), injection, return to play, football

Biography

Speaker
Yahia Falih Mohammad / AlDiwaniya Teaching Hospital Diwaniya, Iraq

Abstract

1. Knee dislocation is a rare orthopedic emergency that requires special care. The incidence of knee dislocation is estimated to be low, accounting for less than 0.02% of the total number of annual trauma. The majority of knee dislocation injuries occur in high­energy trauma that causes stress in the anteroposterior direction in the sagittal plane of the knee and varus­valgus angulation in the frontal plane, inducing a rotational dislocation of the tibia in relation to the femoral condyles. Kennedy’s classification of knee dislocations is based on the direction of tibial dislocation in relation to the femur, such as anteromedial, posteromedial, anterolateral, and posterolateral. Posterolateral rotatory dislocation occurs infrequently and most of the cases are considered irreducible by closed reduction because of incarceration of soft tissues, such as the medial capsule, retinaculum, vastus medialis muscle, and medial meniscus. The ‘Pucker sign’ or ‘Dimple sign’ is a physical characteristic of irreducible knee dislocation, which is caused by invagination of the skin and soft tissues into the medial joint space Key Words: Knee, Dislocation, Vastus medialis, Interposition

Biography

Bandar Ahmed, male, Orthopedic surgeon, graduated from college of medicine , king Saud University in 2012. Associate Consultant Orthopedic Surgeon at King Saud Medical City Department of Orthopedic Surgery, Riyadh, Saudi Arabia.Saudi Board in Orthopedic Surgery (2014-2018) Resident of The Year (2016-2017) in Orthopedic Training Program, Ministry of National Guard- Health Affairs, Riyadh , Kingdom of Saudi Arabia Chapter leader for sport medicine and upper extremity in Saudi Orthopedic Surgery Program Residents Educational Activity 2017 Chapter leader for sport medicine in Saudi Orthopedic Surgery Program Residents Educational Activity 2018 Speaker in the 1st Arthroscopy and Sport Medicine meeting of Saudi Orthopedic Association in Riyadh , KSA , February 2018 Speaker in the 2nd Sport Surgery meeting of Saudi Orthopedic Association in Riyadh , KSA , April 2019

Speaker
Bandar Ahmed / King Saud Medical City, Saudi Arabia

Sessions:

Pediatric Rheumatology and Orthopedics

Abstract

Objective: Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterized by articular inflammation and joint destruction. Although the mechanism of RA pathogenesis is not fully understood, humeral and cellular immunity are known to be involved. In particular, CD4+ T lymphocytes and their cytokines played an important role in the initiation of inflammation in (RA) disease. The aim of this study is to asses TH17 / T-reg ratio in adult and juvenile RA patients and correlate their relations to disease activity Methods: A prospective study was carried out on 40 RA patients, 20 adults mean age (36.4±11.1) and 20 juvenile (12.7±2.2) and 40 healthy controls. All patients and control were subjected to history taking and measuring of CBC, ESR, CRP, RF, Anti-CCP , ANA and. assessment t of Th17 cells and T-reg cells by flowcytometry. Results:There was statistically significant increased in TH17/T-reg ratio in both active adult and juvenile RA when compared with inactive adult and juvenile RA and control groups. however there was no significant difference between inactive adult and juvenile RA and control groups Also there was significant positive correlation between TH17/ T - reg ratio in active adult and juvenile RA and DAS , CRP, ,ANT-CCP and ANA Conclusion:Th17/T- reg ratio is increased in active adult and juvenile RA when compared with inactive RA and control and thus this ratio may be used as a marker of diseased activity Key word: Th17, T – reg, Rheumatoid Arthritis, diseased activity.

Biography

Dr Sheren Esam Maher has completed his PhD fromMinia university, Egypt She is professor of pediatrics And head of pediatric rheumatology clinic , Minia university hospital. She has published more than 25 papers in reputed journals . Many national and international conferences . Awards The most popular and accessed abstract at Who'sWho's in the world 2014 Abstract title : Sexual maturation in Egyptian boys and girls with juvenile rheumatoid arthritis .

Speaker
Sheren Esam Maher / Minia University,Egypt

Sessions:

Biomechanics & Kinesiology

Abstract

The data of biomechanical examination of 60 people before and after arthroscopic reconstruction of ACL were analyzed. This was a prospective controlled study. The analysis of loads in the support circuit of the feet was carried out on the balance charts obtained by the method of in-Shoe baroplantography on the diagnostic software and hardware complex "Diasled" with matrix pressure sensors in the form of insoles. Data recording was carried out in static-in the usual orthostatic position standing with simultaneous support on both feet. It has been revealed that patients with ACL injury are characterized by an imbalance in the load distribution in the support loop of the feet in the form of a shift in the total center of pressure towards the injured limb, in contrast to the vast majority of pathologies in which there is a preference for the contralateral limb rather than the affected one. In addition, there is a diagonal skew of the support from the heel of the healthy foot to the toe of the foot of the limb with a damaged joint. As the function of the knee joint is restored, these disorders decrease. Reduction of bilateral asymmetry of load distribution in the sagittal plane of the reference contour is an objective indicator of the effectiveness of treatment of damage to the ACL, especially in the long term.

Biography

T. V. Serebryak defended his thesis at the research Institute of traumatology and orthopedics named after R. R. Vreden, the doctor the traumatologist-orthopedist, researcher at the Department of biomechanical research of the Federal state budgetary institution "Federal scientific center of rehabilitation of the disabled named after G. A. Albrecht" of the Ministry of labour and social protection of the Russian Federation

Speaker
Tatiana Serebryak / Federal State Budgetary Institution, Russian Federation

Sessions:

Shoulder & Elbow Surgery

Abstract

Purpose: To present our outcome analysis of 88 consecutive shoulders (86 patients) presenting with massive, retracted, irreparable rotator cuff tears that we treated with arthroscopic superior capsular reconstruction utilizing an acellular dermal allograft. We also present the concept of superior capsular distance to quantitatively measure the decreased distance present upon restoration of superior capsular integrity. We believe this radiographic analytical tool, in addition to acromiohumeral distance, can be utilized to demonstrate restoration and maintenance of superior stability. Methods: Eighty-eight shoulders in eighty-six consecutive patients presented with massive rotator cuff tears (Cofield classification, >5cm), retraction (>5cm), and atrophy (Goutalier Grade 3 or 4). The tears involved the supraspinatus or both the supraspinatus and infraspinatus tendons. All failed previous treatments including surgical (n=34) and non-surgical modalities (n=54). The patients in this series were considered too young and active (ages 27-79, mean age 59.4) for treatment with reverse total shoulder arthroplasty. All patients were treated by a single surgeon and underwent arthroscopic superior capsular reconstruction with an acellular dermal allograft. Outcome analysis was performed via an internet based outcome-tracking system to evaluate visual analog score, ASES score, and simple shoulder test scores. These scores were obtained preoperatively and at intervals of 2 weeks, 3 months, 6 months, one year, and two years postoperatively. Radiographic analysis of standard AP radiographs were analyzed to assess acromiohumeral interval and superior capsular distance preoperatively as well as 1 week, 6 months, and one year postoperatively. These radiographic measurements were obtained utilizing the digital radiographic calibration software inherent to our digital radiographic system. Digital dynamometric strength analysis and functional range of motion assessments were obtained preoperatively as well as 6 months and one year postoperatively. All data obtained was analyzed statistically to evaluate for significance. Results: Eighty-six patients (88 shoulders) received surgical treatment with superior capsular reconstruction. Upon follow-up, 90% of patients report satisfaction with the surgical results. Outcome data analysis demonstrated significant (p<0.05) improvements in pain (VAS preop 4.0 – VAS 1 year 1.2), strength (FF/ABD/EXR preop 4.8 lb/4.1 lb/7.7 lb – FF/ABD/EXR 1 year 9.8 lb/9.2 lb/12.3 lb), and range of motion (FF/ABD preop 120°/103° - FF/ABD 1 year 160°/159°). At one year, there was no statistical difference in strength and range of motion between the operative and non-operative extremity. Radiographic analysis showed significance (p<0.05) at the 1 week, 6 month, and one year time points for an increase in the acromiohumeral interval (mean 7.1mm preop – mean 9.7mm 1 year) and the superior capsular distance (mean 52.9mm preop – mean 46.2mm 1 year). Outcome data analysis also demonstrated improved scores in visual analog scores (4.0 to 1.2), simple shoulder test (52 to 79), SANE Scores (32 to 70), ASES Function scores (13 to 21), and ASES Index scores (52 to 79) at one year follow-up. A 4.5% failure rate has been observed, three radiographically and one clinically, with the single clinical failure being revised to a reverse total shoulder arthroplasty. Conclusion: Younger, active patients with massive irreparable rotator cuff tears and pseudoparalysis have been historically difficult to predictably treat with arthroscopic methods. Our outcome analysis demonstrates that arthroscopic superior capsular reconstruction with acellular dermal allograft has been a successful procedure in this patient population, leading to decreasing pain and improving function with promising early results. Radiographic analysis in these patients has also demonstrated a consistent and lasting decrease in superior capsular distance as well as an increase in the acromiohumeral interval, indicative of maintenance of superior capsular stability. As it is generally accepted that reverse total shoulder arthroplasty should be avoided in this patient population, this procedure “burns no bridges” for future reconstructive procedures. Arthroscopic superior capsular reconstruction appears to be a reproducible alternative that may delay or prevent the need for future reverse total shoulder arthroplasty in this patient population. Longer-term follow-up will be required to demonstrate the sustainability of these promising short-term results.

Biography

Dr. Pennington is a board certified Orthopedic Surgeon with sub- specialty certification in sports medicine. He completed medical school and orthopedic residency training at the Medical College of Wisconsin. His fellowship training in shoulder and knee reconstruction was completed at the California Pacific Medical Center in San Francisco, CA. He is a partner in The Orthopedic Institute of Wisconsin and a founding member of Midwest Orthopedic Specialty Hospital. His primary scope of practice is all aspects of shoulder reconstruction via arthroscopic and open reconstruction methods. He has numerous publications and presentations pertaining to shoulder reconstruction.

Speaker
William T. Pennington / The Orthopedic Institute of Wisconsin, USA

Sessions:

Physiotherapy

Abstract

Objective: to analyze aspects related to the functional capacity, quality of life (QoL) and the health conditions of women with rheumatoid arthritis (AR). Methods: prospective study performed with 44 women diagnosed with RA. Functional capacity was performed using the Modified Health Assessment Questionnaire (MHAQ) and the Functional Status (FS), the ability to perform activities of daily living distance covered in the (6MWT), physical fitness status by the Duke Activity Status Questionnaire (DASI), the hand grip strength (HGS) by dynamometry, pain by Visual Analog Scale for Pain (VAS-P), and QoL by the questionnaire the World Health Organization Quality of Life (WHOQoL-BREF). The statistical analysis was performed using descriptive statistics with absolute (N) and relative (%) frequencies, mean ± standard deviation (SD). Fisher's exact test to test the dependence of two nominal categorical variables, Variance-One-Way analysis model (ANOVA) to analyze the influence of normal continuous response variables with nominal categorical independent variables and the Pearson correlation coefficient to evaluate the degree of relationship between two quantitative variables (p<0.05). Results: The studied women had a mean of 48 ± 7.98 years, sedentary, with low level of physical fitness, overweight and moderate level of pain. Most women were classified with normal functional status, the 6MWT was 486.50 ± 65.7 m, the HGS was 16.15 ± 8.02 kg on the right hand. The overall QoL was on average 60.91 ± 13.05. MHAQ and FS were correlated and correlated with QoL. Conclusion: RA affected the functional capacity of the women studied in a multidimensional manner.

Biography

Pablo Costa Cortêz has completed his MSc, from Federal University of Amazonas (UFAM)/ Brazil, PhD student from Program of Basic and Applied Immunology of the UFAM. He is a physiotherapist and professor of Northern University Center, is specialized in physiotherapy orthopedic trauma and intensive care units, works as a research in the lines of evaluation of the functionality, quality of life and lung function of individuals with Rheumatoid Arthritis and Parkinson

Speaker
Pablo. Costa Cortez / Federal University of Amazonas, Brazil

Abstract

Chronic neck pain is associated with proprioceptive deficit and deep muscles morphological changes. It is believed that deep neck muscles have extremely high density of muscle spindles. This characteristic may make them play an essential role in neck proprioception. However, it is not clear if therapeutic exercises targeting deep neck muscles have superiority in improving proprioceptive deficit or general exercises which is frequently recommended to patients. In this preliminary randomized clinical trial 20 patient with chronic non-specific neck pain were recruited and allocated into two groups. One group received specific exercises including deep neck muscles strengthening and the other group received neck general exercise including neck and shoulder free active range of motions (ROM). Absolute repositioning error in neck rotation was measured. Repeated measures ANOVA was used to analyze data. The level of significance was set at 0.05.The main effect of time was found significant (F=4.42, p=0.04) indicating both general and specific exercises improved neck proprioception significantly, although the main effect of group was not significant (F=1.101, p=.32). Furthermore, the group by time interaction was not significant (F=0.67, p=0.42) demonstrating similar effects of both specific and general exercise on neck proprioception. Results of the present study indicate that both deep neck muscles strengthening and general ROM exercises improved neck proprioception challenging the belief of more essential role of deep neck muscles in proper neck proprioception compared to superficial muscles.

Biography

Manizheh has completed her doctor of Physiotherapy (DPT) from National University of Medical Sciences, Spain. She has been working as the representative of physiotherapists and physicians in Iranian Medical Council for ten years. She is currently managing her own Physiotherapy clinic and has evaluated, examined and managed thousands of rheumatologic and orthopedic patients. Her area of interest is on orthopedic conditions. She has been awarded as the best physiotherapist in Iran in 2016.

Speaker
Manizheh Saberi / Shiraz University of Medical Sciences, Iran

Sessions:

Orthopedic Implants

Abstract

Total knee replacement is the most effective treatment to relief pain and restore normal function in a diseased knee joint. The aim of this research was to develop a patient-specific knee implant which can be fabricated using 3D Printing also called as additive manufacturing techniques. 3D printing is an emerging technology and its use in orthopaedics is slowly gaining acceptance. This technique makes it easy to manufacture patient specific devices/guides and instrumentation of any shape and size. The patient-specific technology improves on conventional of the shelf process by allowing to consider each patients anatomical structure, shape and size. In this study patient specific knee implant design , simulation and 3D print is discussed. In particular we want to highlight the role of computer simulations in testing and optimising patient specific device. Patient knee CT scan data was modeled in ImageSim software and 3D model was generated. This model was used as the base model to capture the outer shape of distal femur and proximal tibia. Full set of J curves of condyles were captured and then exported. These set of J curves along with other landmarks were imported in Solidworks and full implant for femur , tibia components and insert were designed. A detailed total knee-joint FE model was created in order to predict stress and strain at various flexion angles. Results from these simulations highlighted some initial stress riser sites especially in femur component. The design was accordingly changed and simulations were run again to make sure that design changes were correctly done. Finally, the patient-specific knee implant was successfully built using additive manufacturing techniques

Biography

Ash Harkara is a founder director of VOLMO LTD. Ash completed his PhD from University Pune and Postdoctoral Studies from school of EE, University of Leeds, UK. Ash has twenty years of experience in industry and academics. He has written number of papers in reputed journals and also presented papers in number of international conferences. Since last ten years Ash has been working in medical image processing and patient specific implants

Speaker
Ash Harkara / VOLMO LTD , United Kingdom

Sessions:

Orthopedics physical therapy

Abstract

Chronic neck pain is associated with proprioceptive deficit and deep muscles morphological changes. It is believed that deep neck muscles have extremely high density of muscle spindles. This characteristic may make them play an essential role in neck proprioception. However, it is not clear if therapeutic exercises targeting deep neck muscles have superiority in improving proprioceptive deficit or general exercises which is frequently recommended to patients. In this preliminary randomized clinical trial 20 patient with chronic non-specific neck pain were recruited and allocated into two groups. One group received specific exercises including deep neck muscles strengthening and the other group received neck general exercise including neck and shoulder free active range of motions (ROM). Absolute repositioning error in neck rotation was measured. Repeated measures ANOVA was used to analyze data. The level of significance was set at 0.05.The main effect of time was found significant (F=4.42, p=0.04) indicating both general and specific exercises improved neck proprioception significantly, although the main effect of group was not significant (F=1.101, p=.32). Furthermore, the group by time interaction was not significant (F=0.67, p=0.42) demonstrating similar effects of both specific and general exercise on neck proprioception. Results of the present study indicate that both deep neck muscles strengthening and general ROM exercises improved neck proprioception challenging the belief of more essential role of deep neck muscles in proper neck proprioception compared to superficial muscles.

Biography

Manizheh has completed her doctor of Physiotherapy (DPT) from National University of Medical Sciences, Spain. She has been working as the representative of physiotherapists and physicians in Iranian Medical Council for ten years. She is currently managing her own Physiotherapy clinic and has evaluated, examined and managed thousands of rheumatologic and orthopedic patients. Her area of interest is on orthopedic conditions. She has been awarded as the best physiotherapist in Iran in 2016.

Speaker
Manizheh Saberi / Shiraz University of Medical Sciences, Iran

Sessions:

Trauma and Fractures

Abstract

Tibial plateau represent one of the most critical weight-bearing surfaces in human body; fractures of impact the stability, mobility and knee joint line. Proper treatment of these fractures are crucial for decrease disability and risc of documented complications, specialy posttraumatic osteoarthritis. Tibial plateau fractures (Schatzker type V and VI) are complex fractures caused by high energy, often associated with soft tissue damage and are at the high risk for wound comlications after open reduction and internal fixation (ORIF). Another dificulty is to estabilsh stable fixation of comminuted fractures.Clasical operative technique with two plates is related with potentional complications such as failed fixation, malunion, nonunion, joint stifness, posttraumatic arthritis, infection, and most of all soft tissue complications tha range from 23%-87,5%. Veri and.all compared internal and external fixation in double cohort studies, and recorder high degree of wound complications and reoperations in ORIF group through single incision and two plates. Also, their resutls suggested efficasy and safety, with low degree of wound complications and early functional recovery in external hybrid fixation group. Ilizarov method for treatment of such a fractures at our Clinic is used since 2005. This paper presents operative technique and results of treatment of comminuted tibial plateau fractures by Ilizarov method.

Biography

Vaso Kecojević has completed his residency of orthopaedic surgery and traumatology in 2002. at Medical Faculty, University of Novi Sad, Serbia. He is the president of ASTAS (Association for Sports Traumatology and Artroscopy of Serbia), member of EBOT Writing Committee, member of ESSKA Education Commity 2010.-2014., member of ESSKA Arthroscopy Committee 2014.-2016., rewiewer in Journal of Clinical Orthopaedics and Trauma. He has published chapters in 7 books, and more than 10 papers in journals and has several oral presentations at national and international meetings

Speaker
Vaso Kecojevic / University of Novi Sad, Serbia

Sessions:

Orthopedic Rehabilitation

Abstract

Humanoid robots try mimicking humanlike moves. Scientists design joints, links and actuators in such a way that robots move like humans. In Estella robot, a 165 centimeter height humanoid robot, we designed and developed a mechanical structure similar to human anatomy with flexible spine. The Estella’s spine including five vertebral joints (including neck) to shape the human spine configuration which, each of vertebrae joints are an 3-▁R SS actuation redundant parallel robot with three orientation-based degrees of freedom. The clavicle of the Estella connects cervical and thoracic spine to each other from up and down and also it connected to scapula using a spherical joint in both sides. This spherical joint is restricted by two actuators to imitate elevation/depression motions and protraction/retraction motions. The glenoid joint is designed with three actuators to support flexion/extension, adduction/abduction and longitudinal rotation motions. The design of lower arm of Estella supports pronation/supination motions in elbow joint which is constructed in a way to mimic the rotation of ulna and radius bones around each other. The elbow and wrist joints have all motions in sagittal and frontal planes including flexion/extension and radial/ulnar abduction. Considering anatomical position, the lower arm in frontal plane have 7 degrees angle deviation with longitudinal axis which is the result of the ratio of hip width to waist width in human anatomy. Estella’s hand is the scale-down 3D printed Youbionic hand. Each hand is controlled by 11 micro actuators and it can imitate all the motions of a human hand. In the future, we wish to develop Estella’s lower limbs mechanisms and also its face to become a complete humanoid robot.

Biography

Speaker
Behnam Rahnama / USWR, Tehran, Iran

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