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1.
Medicine (Baltimore) ; 99(15): e19735, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282732

RESUMO

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.


Assuntos
Candida albicans/isolamento & purificação , Prótese Articular/microbiologia , Osteoartrite/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/cirurgia , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Fluconazol/uso terapêutico , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/cirurgia , Osteoartrite/complicações , Prevalência , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Rev Med Suisse ; 16(685): 500-502, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167252

RESUMO

Osteoarthritis (OA) remains a prevalent and difficult to treat entity, mostly due to its different phenotypes. Varying constellations of mechanic, metabolic and extrinsic factors such as trauma are main drivers of OA. Anti-inflammatory therapy by anti-interleukin 1 did not show a clear effect neither in hand or knee OA whilst it seem to reduce joint replacement at least in a certain patient populations. Corticosteroids did reduce pain and methotrexate reduced structural progression in recent hand OA trials. More promising for mechanical knee OA are growth factors such as sprifermin or kartogenin which foster the differentiation of chondrocytes. New data are available on joint safety of the subcutaneously administered anti-nerve growth factor (NGF) molecule tanezumab. In OA treatment, pain, structure, and biomechanic impairment need to be addressed.


Assuntos
Osteoartrite , Artroplastia de Substituição , Progressão da Doença , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Osteoartrite/cirurgia , Osteoartrite do Joelho/tratamento farmacológico , Dor/complicações , Dor/tratamento farmacológico
3.
PLoS One ; 15(2): e0228779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040493

RESUMO

OBJECTIVES: To estimate the prevalence and associated factors of rotator cuff tear (RCT) in patients with hand osteoarthritis (HOA). METHODS: Between June 2013 and December 2015, we recruited 1150 participants in rural area of South Korea. Of the 1150 participants, 307 participants with HOA were analyzed. Plain radiography of both hands, magnetic resonance imaging of both shoulders, and serum levels of high-sensitive C-reactive protein (hsCRP) and high-density lipoprotein (HDL) were obtained for all patients. HOA and RCT were diagnosed by clinical and radiologic findings. RESULTS: The prevalence of RCT in patients with HOA (192/307, 62.5%) was higher than that in those without HOA (410/827, 49.5%, p<0.001). Among the 307 patients with HOA, the patients with RCT were older, and had higher hsCRP and lower HDL levels than the patients without RCT. Multiple logistic regression analysis confirmed significant associations of age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.11), serum hsCRP levels ≥0.6mg/L (OR, 1.68; CI, 1.00-2.80), and low HDL levels (male, <50 mg/dL; female, <40 mg/dL) (OR, 1.93; CI, 1.05-3.56) with RCT in patients with HOA. For patients below 60 years old, the prevalence of RCT was 2.8-fold higher in the low HDL group than normal HDL group (p = 0.048). Finally, the prevalence of RCT was 2.6-fold higher in patients with HOA with both elevated hsCRP and low HDL levels compared with those with neither (p<0.05). CONCLUSIONS: Our findings suggest inflammation and metabolic factors were associated with the prevalence of RCT in HOA patients.


Assuntos
Articulação da Mão , Osteoartrite/complicações , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/metabolismo , Estudos Transversais , Feminino , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Prevalência
5.
J Surg Orthop Adv ; 28(3): 196-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675296

RESUMO

Pisiform pathology may be a source of ulnar-sided wrist pain. This study reviews the long-term outcomes of patients treated with pisiformectomy. A retrospective study approved by the institutional review board was performed over a 27-year period of patients undergoing pisiformectomy. Range of motion, grip strength, complications, and need for revision surgery were recorded. The series includes 61 wrists (60 patients) with an average age at surgery of 46 years. Two complications were noted (3%): a postoperative ulnar nerve palsy and symptomatic retained suture. At final follow-up, average flexion-extension arc was 81% (expressed as percent of contralateral), radioulnar deviation arc was 88%, and average grip strength was 89%. Pisiformectomy is a reliable, motion-preserving procedure with low complication rates for patients with chronic ulnar-sided wrist pain. In this series, 93% of patients did not require further procedures at an average of 8.2 years follow-up. (Journal of Surgical Orthopaedic Advances 28(3):196-200, 2019).


Assuntos
Osteoartrite , Punho , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Punho/cirurgia , Articulação do Punho
6.
Acta Clin Croat ; 58(Suppl 1): 82-89, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741564

RESUMO

The concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.


Assuntos
Dor Facial/terapia , Osteoartrite/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Neuralgia do Trigêmeo/terapia , Terapia por Acupuntura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Criança , Dor Facial/etiologia , Dor Facial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/diagnóstico , Medição da Dor , Modalidades de Fisioterapia , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico , Adulto Jovem
7.
Life Sci ; 238: 116920, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610189

RESUMO

AIMS: Dendritic cells (DCs) and Toll-like receptor (TLR) participate in mediating inflammation process. However, the functional role of TLR expressed on DCs in osteoarthritis (OA) development has not been defined yet. The purpose of this study was to investigate the role and mechanism of TLR and DCs in the progression of experimental osteoarthritis (OA). MATERIALS AND METHODS: Experimental OA model was induced by iodoacetate injection. Expressions of toll-like receptors in DCs of OA mice were detected by qRT-PCR and flow cytometry. TLR agonists lipopolysaccharide (LPS) and R848 or TLR antagonist FP7 were used, and the levels of TLRs and inflammatory cytokines were examined by qRT-PCR and ELISA. KEY FINDINGS: The expression levels of TLR family members were increased in DCs derived from synovial fluid of OA mice compared with the sham mice. In vitro, OA mice-derived DCs had increased production of inflammatory cytokine after TLR agonists LPS and R848 challenge, while TLR challenges did not affect DCs maturation. Inhibition of TLR by TLR antagonist FP7 blocked TLR challenges-induced increased inflammation in DCs. In mice, administration of FP7 attenuated LPS-induced inflammatory response and OA condition. SIGNIFICANCE: Increased TLR expression in OA-derived DCs contributes to the inflammation condition and potentially acts as a therapeutic target for osteoarthritis.


Assuntos
Artrite Reumatoide/complicações , Células Dendríticas/imunologia , Inflamação/etiologia , Osteoartrite/complicações , Receptores Toll-Like/metabolismo , Animais , Citocinas/metabolismo , Células Dendríticas/metabolismo , Inflamação/metabolismo , Inflamação/patologia , Lipopolissacarídeos/toxicidade , Camundongos , Camundongos Endogâmicos C57BL
8.
BMC Vet Res ; 15(1): 349, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623621

RESUMO

BACKGROUND: NSAIDs are accepted as the most predictably efficacious medical treatment of the clinical signs of osteoarthritis (OA). The marine-based fatty-acid compound PCSO-524 has been proposed as an adjunctive treatment for canine OA, however benefits of this agent is still controversial. The purpose of this study was to evaluate and compare the effectiveness of PCSO-524 combined with the NSAID firocoxib using force plate gait analysis, orthopedic assessment score (OAS) and canine brief pain inventory score (CBPI) in dogs with OA. A prospective, randomized, double-blinded study was conducted. Seventy-nine dogs that had hip and/or stifle OA were assigned randomly into three treatment groups: firocoxib, PCSO-524 and combination of firocoxib and PCSO-524, orally for 4 weeks. Peak vertical force (PVF, expressed as a percentage of bodyweight), OAS, CBPI, serum prostaglandin E2 concentration, hematology and blood chemistry values were evaluated before treatment (Day0), as well as at the second (Day14) and fourth week (Day28) during treatment. RESULTS: Within group analysis revealed significant increases in PVF over the 4-week treatment period for firocoxib, PCSO-524 and the combination (p < 0.05). Mean increases in PVF were 3.25 ± 4.13, 2.01 ± 3.86, 4.11 ± 4.69%BW (mean ± SD) respectively. The OAS showed non-significant change in all treatment groups. There were significant decreases in CBPI pain severity score (PSS) and CBPI pain interference scores (PIS) within some groups over time, however no significant differences were found between the groups. Significantly decreased serum PGE2 concentration (p < 0.05) was found in the combination group. Significant increases in BUN and creatinine (p < 0.05) compared to pre-treatment values were found in the firocoxib and combination groups but not in the PCSO-524 group at day28, but all values in all dogs remained within the normal ranges. CONCLUSIONS: The results of this study suggested combination of both PCSO-524 and firocoxib is more effective in alleviation of inflammation and improvement of weight bearing ability when compared to the uses of either PCSO-524 or firocoxib alone. Further clinical studies are needed to confirm this, and to determine if there is any benefit of PCSO-524 over placebo.


Assuntos
4-Butirolactona/análogos & derivados , Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças do Cão/tratamento farmacológico , Ácidos Graxos Insaturados/uso terapêutico , Osteoartrite/veterinária , Sulfonas/uso terapêutico , 4-Butirolactona/uso terapêutico , Animais , Dinoprostona/sangue , Cães , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Marcha/efeitos dos fármacos , Masculino , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Dor/tratamento farmacológico , Dor/etiologia , Dor/veterinária , Medição da Dor/veterinária , Estudos Prospectivos
9.
Artigo em Russo | MEDLINE | ID: mdl-31626166

RESUMO

AIM: To evaluate the possibility of using symptomatic slow acting drugs for osteoarthritis (SYSADOA) in patients with nonspecific lower back pain and high cardiovascular risk. MATERIAL AND METHODS: The study registered as the observational program 'Possibilities of SYSADOA-therapy in patients with nonspecific lower back pain and high cardiovascular risk' was organized in outpatient clinics with sequential inclusion of patients (n=315) with lower back pain. All patients randomized into 5 main groups by method of envelopes were treated with different SYSADOA. The control group (group 6) included 63 patients without lower back pain syndrome. The duration of follow-up was 9 months. The results of the first 3 months of observation of group 1 treated with chondroitin sulfate (chondroguard) compared to the control group are presented. RESULTS: On the 21st day of therapy, the pain level decreased by more than 62% in group 1. There were no changes in the plasma hemostasis parameters (thrombin time, prothrombin index, activated partial thromboplastin time) and glomerular filtration rate, which was comparable with the control group. CONCLUSION: Chondroguard is safe for patients with comorbid osteoarthritis and high cardiovascular risk both in short and repeated long-term treatment.


Assuntos
Doenças Cardiovasculares , Dor Lombar , Osteoartrite , Doenças Cardiovasculares/complicações , Humanos , Dor Lombar/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Osteoartrite/complicações , Fatores de Risco , Resultado do Tratamento
10.
Artigo em Russo | MEDLINE | ID: mdl-31626227

RESUMO

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.


Assuntos
Sulfatos de Condroitina , Glucosamina , Osteoartrite , Manejo da Dor , Idoso , Sulfatos de Condroitina/uso terapêutico , Medicina Baseada em Evidências , Glucosamina/uso terapêutico , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Dor/etiologia
11.
Medicine (Baltimore) ; 98(39): e17204, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574829

RESUMO

Adhesive capsulitis (AC) is a common chronic disorder for adult patients; however, whether a history of pre-existing shoulder diseases may affect the development of AC is still not fully understood. We aimed to investigate the incidence and prevalence of AC and to assess the association of pre-existing shoulder diseases and traumatic injuries of the shoulder with the development of AC in adults.This retrospective population-based cohort and nested case-control study used data from the National Health Institute Research Database of Taiwan. A total of 24,414 patients aged 20 years or older and with a diagnosis of AC were identified between 2000 and 2013. We calculated the incidence of AC for each year during the study period. In addition, these AC patients were matched with controls (n = 97,656) in a ratio of 1:4 based on age, gender, and index date. Univariate and multivariate logistic regression models were performed to identify variables associated with AC.Females and patients aged 50 to 69 years had higher age-gender standardized incidence and prevalence of AC than their counterparts. Multivariate analyses showed that after adjusting for relevant covariates, pre-existing shoulder diseases of calcific tendinitis (odds ratio [OR] = 8.74, 95% confidence interval [CI] = 5.66-13.5), biceps tendinitis (OR = 7.93, 95% CI = 5.33-11.79), rotator cuff syndrome (OR = 6, 95% CI = 5.26-6.85), osteoarthritis (OR = 4.27, 95% CI = 3.44-5.3), and impingement syndrome (OR = 3.13, 95% CI = 2.64-3.71), as well as fracture (OR = 4.51, 95% CI = 3.82-5.34) and dislocation (OR = 3.57, 95% CI = 2.35-5.45) of the shoulder were significantly associated with AC risk.Higher odds of AC were observed among patients with pre-existing shoulder conditions. This study highlights the need to consider differences in AC risk among patients with various types of shoulder diseases and traumatic injuries of the shoulder.


Assuntos
Bursite/epidemiologia , Lesões do Ombro/complicações , Adulto , Idoso , Bursite/etiologia , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Osteoartrite/complicações , Prevalência , Estudos Retrospectivos , Ombro/patologia , Taiwan/epidemiologia , Tendinopatia/complicações
12.
Medicine (Baltimore) ; 98(40): e17336, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577728

RESUMO

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem , Articulação Zigapofisária/patologia
13.
Clin Exp Rheumatol ; 37 Suppl 120(5): 31-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621558

RESUMO

Osteoarthritis (OA) is a painful joint disease affecting more than 32.5 million adults in the US and over 350 million adults worldwide. The prevalence is expected to rise continually over the next several decades with significant impacts to societal health and economic costs as well as individuals' daily activities and quality of life. In 2008, the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) led a collaborative effort to address approaches to reduce the burden of OA via public health interventions, policies (systems and environmental), and communication strategies. This collaboration resulted in the National Public Health Agenda for OA (OA Agenda), which was vetted by more than 75 stakeholder organisations and released in 2010. The OA Agenda listed ten recommendations focused on public health interventions for OA including weight management, physical activity, self-management education, and injury prevention, and policies, systems, communication, research and evaluation. In 2011, the CDC and AF mobilised the OA Action Alliance (OAAA), a national coalition of organisations concerned with mitigating the public health impact of OA, to operationalise the recommendations set forth in the OA Agenda. Since then, the OAAA has grown to include more than 110 organisations that work collectively to increase awareness about the prevention and management of OA, provide educational resources, and expand access to evidence-based programmes for target audiences including individuals with OA, community-based organisations, healthcare systems and providers, and policymakers. This review highlights the OAAA's progress to date in addressing the OA Agenda recommendations; successes and challenges in delivery of effective communication, programmes, and resources; and future implications.


Assuntos
Exercício Físico/fisiologia , Obesidade/complicações , Osteoartrite/complicações , Saúde Pública , Artralgia , Humanos , Qualidade de Vida , Programas de Redução de Peso
14.
J Orthop Surg Res ; 14(1): 314, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533754

RESUMO

BACKGROUND: The objective of this study was to assess the efficacy of intra-articular injections of hyaluronic acid (HA) and a novel, on-site conjugate of HA with autologous fibrinogen in platelet-rich plasma (HA-PRP) in a canine model of osteoarthritis (OA) METHODS: Twelve beagle dogs underwent a unilateral resection of the cranial cruciate ligament (CrCL) of the stifle joint. Clinical and radiographic signs of OA were confirmed in all dogs 8 weeks following CrCL resection and prior to treatment. The dogs were randomized into three groups: saline (n = 4), HA (n = 4), and HA-PRP (n = 4). Each dog received intra-articular injections of the respective substance into the affected joint at pre-determined time points. The dogs were assessed for adverse effects for 3 days after each injection and for lameness, pain, range of motion, kinetics, and radiographic OA severity prior to treatment and 3 months after injection. OA severity as determined by radiographic examination was not significantly different among the groups at any time point. The dogs were then humanely euthanatized and the stifle joint assessed by gross and histological examinations. RESULTS: Dogs treated with four weekly injections of HA or two biweekly injections of HA-PRP were significantly (p < 0.05) better than dogs treated with four weekly injections of saline at 2-, 4-, and 12-week time points based on a comfortable range of motion (CROM) and clinical lameness score. Gait analysis measuring symmetry and weight distribution on pressure sensor walkway showed significantly (p < 0.05) improved limb function for dogs treated with HA and HA-PRP compared with dogs treated with saline yet with better clinical outcome for the HA-PRP-treated group at 12 and 20 weeks follow-up. Gross and histological analysis of synovium and articular cartilage demonstrated significant (p < 0.05) improvement by both treatments groups compared to controls. There was however significantly (p < 0.05) less damage to the cartilage in the HA-PRP group compared to the HA-treated group. CONCLUSIONS: These data suggest that while injection of HA and HA-PRP may be sufficient for short-term amelioration of the symptoms associated with OA, treatment with HA-PRP conjugates may be superior, providing significantly better long-term cartilage preservation.


Assuntos
Artrite Experimental/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Osteoartrite/tratamento farmacológico , Viscossuplementação/métodos , Viscossuplementos/uso terapêutico , Animais , Artrite Experimental/complicações , Artrite Experimental/diagnóstico por imagem , Artrite Experimental/patologia , Cartilagem Articular/patologia , Cães , Fibrinogênio/administração & dosagem , Fibrinogênio/efeitos adversos , Fibrinogênio/uso terapêutico , Marcha , Análise da Marcha/métodos , Ácido Hialurônico/efeitos adversos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Coxeadura Animal/etiologia , Osteoartrite/complicações , Osteoartrite/diagnóstico por imagem , Osteoartrite/patologia , Plasma Rico em Plaquetas , Radiografia , Distribuição Aleatória , Índice de Gravidade de Doença , Joelho de Quadrúpedes/diagnóstico por imagem , Membrana Sinovial/patologia , Viscossuplementação/efeitos adversos
15.
Life Sci ; 236: 116861, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31513815

RESUMO

Osteoarthritis is a prevalent worldwide joint disease, which demonstrates a remarkable adverse effect on the patients' life modality. Medicinal agents, exclusively nonsteroidal anti-inflammatory drugs (NSAIDs), have been routinely applied in the clinic. But, their effects are restricted to pain control with insignificant effects on cartilage renovation, which would finally lead to cartilage destruction. In the field of regenerative medicine, many researchers have tried to use stem cells to repair tissues and other human organs. However, in recent years, with the discovery of extracellular microvesicles, especially exosomes, researchers have been able to offer more exciting alternatives on the subject. Exosomes and microvesicles are derived from different types of bone cells such as mesenchymal stem cells, osteoblasts, and osteoclasts. They are also recognized to play substantial roles in bone remodeling processes including osteogenesis, osteoclastogenesis, and angiogenesis. Specifically, exosomes derived from a mesenchymal stem cell have shown a great potential for the desired purpose. Exosomal products include miRNA, DNA, proteins, and other factors. At present, if it is possible to extract exosomes from various stem cells effectively and load certain products or drugs into them, they can be used in diseases, such as rheumatoid arthritis, osteoarthritis, bone fractures, and other diseases. Of course, to achieve proper clinical use, advances have to be made to establish a promising regenerative ability for microvesicles for treatment purposes in the orthopedic disorders. In this review, we describe the exosomes biogenesis and bone cell derived exosomes in the regenerate process of bone and cartilage remodeling.


Assuntos
Cartilagem Articular/citologia , Exossomos/transplante , Osteoartrite/terapia , Osteogênese , Células-Tronco/citologia , Humanos , Osteoartrite/complicações , Osteoartrite/patologia , Medicina Regenerativa
16.
J Shoulder Elbow Surg ; 28(10): 2023-2030, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31405717

RESUMO

BACKGROUND: Results of anatomic shoulder arthroplasty for glenohumeral osteoarthritis with severe glenoid retroversion are unpredictable with a high rate of glenoid loosening. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, with good early results. We sought to confirm this at longer follow-up (minimum 5 years). The study hypothesis was that early results would endure over time. METHODS: We retrospectively reviewed all RSAs performed in 7 centers from 1998 to 2010. The inclusion criteria were primary glenohumeral osteoarthritis with B1, B2, B3, or C glenoid. Forty-nine shoulders in 45 patients fulfilled the criteria. Bone grafting was performed in 16 cases. Clinical outcomes were evaluated with the Constant score (CS) and shoulder range of motion. RESULTS: The mean total CS increased from 30 preoperatively to 68 points (P < .001) with significant improvements in all the subsections of the CS and range of motion. Scapular notching was observed in 20 shoulders (43%), grade 1 in 5 (11%), grade 2 in 7 (15%), grade 3 in 5 (11%), and grade 4 in 3 (6%). The glenoid bone graft healed in all the shoulders. Partial inferior lysis of the bone graft was present in 8 cases (50%). Scapular notching and glenoid bone graft resorption had no influence on the CS (P = .147 and P = .798). CONCLUSION: RSA for the treatment of primary glenohumeral osteoarthritis in patients with posterior glenoid deficiency and humeral subluxation without rotator cuff insufficiency resulted in excellent clinical outcomes at a minimum of 5 years of follow-up.


Assuntos
Artroplastia do Ombro/métodos , Cavidade Glenoide/cirurgia , Osteoartrite/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Artroplastia do Ombro/efeitos adversos , Transplante Ósseo , Feminino , Seguimentos , Cavidade Glenoide/patologia , Humanos , Masculino , Osteoartrite/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Luxação do Ombro/complicações , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
17.
Med Arch ; 73(3): 144-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31402800

RESUMO

Introduction: Previous research found that diabetes mellitus capable to aggravate osteoarthritis disease. In brief, the hyperglycemia condition in diabetes mellitus has an impact on protein glycation of all joint components, including molecule, such as perlecan. The protein expression of perlecan reflects the presence amount of perlecan in the matrix of articular cartilage. However, the impact of hyperglycemia on articular perlecan has not been explained. Moreover, the role of perlecan as a mechanotransducer for chondrocytes in type 1 Diabetes mellitus remains unclear. Aim: This research aims to analyze the effect of hyperglycemia in type 1 Diabetes mellitus to the mRNA level and protein expression of perlecan. Methods: Thirty-five adult male rats were divided into seven groups, such as three groups of rat model with anterior cruciate ligament transection (ACLT) at right knee (ACLT1, ACLT2, ACLT3); three groups of rats with ACLT at right knee which followed by Streptozotocin injection for diabetic mice model (DM1, DM2, DM3); and control group (N). Rat sacrificed at the third week, fourth week, and sixth week after two months of maintenance. The mRNA level and protein expression were analyzed by using PCR and Western blot. All of data was analyzed by ANOVA. Results: Protein expression of perlecan in ACLT mice with diabetes mellitus (DM1, DM2, DM3 group) was gradually decreased according to the increased hyperglycemia duration. Whilst, protein expression of perlecan within ACLT mice without diabetes mellitus (ACLT1, ACLT2, ACLT3 group) was increased. The similar result also demonstrated by the mRNA level of perlecan. Group of DM1, DM2, DM3 exhibited decreased mRNA level of perlecan over the hyperglycemia duration. While, ACLT1, ACLT2, and ACLT3 group had a gradually increased of perlecan mRNA level. Conclusion: Hyperglycemia on osteoarthritic condition decreased mRNA level and protein expression of perlecan which increased the severity of osteoarthritis disease.


Assuntos
Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Tipo 1/sangue , Proteoglicanas de Heparan Sulfato/genética , Proteoglicanas de Heparan Sulfato/metabolismo , Hiperglicemia/sangue , Osteoartrite/metabolismo , Animais , Glicemia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 1/complicações , Modelos Animais de Doenças , Hiperglicemia/etiologia , Masculino , Osteoartrite/complicações , Osteoartrite/genética , RNA Mensageiro/metabolismo , Ratos
18.
Am J Health Syst Pharm ; 76(8): 554-559, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361866

RESUMO

PURPOSE: Implementation of the SAFE PAIN algorithm for reducing opioid use for chronic pain in older adults is described. SUMMARY: A multidisciplinary team at Sheppard Pratt Health System, the largest private provider of psychiatric care in Maryland, used lean methodology to identify the root causes for noncompliance to evidence-based practices for patients in the geropsychiatry unit treated for osteoarthritis or chronic back pain. The team collaborated to develop a facility-specific treatment algorithm, called SAFE PAIN (Sheppard Pratt Health System Algorithm For Elderly Patient Centered Analgesia Interdisciplinary Nagara), was based on the Center for Disease Control and Prevention's evidence-based recommendations that included nonpharmacologic interventions as a first-line therapy for patients with osteoarthritis or chronic back pain. Rates of prescribing new opioids and prescribing evidence-based alternative medications via the SAFE PAIN algorithm were evaluated from March 1 to September 30, 2017 and compared with baseline (2012-2016). The lean methodology interventions led to zero new opioid orders during the study period, a significant decrease compared with previous years (p < 0.01). The rates of prescribing evidence-based alternative medications increased significantly from the baseline period to postimplementation (p < 0.01). Lean methodology interventions also decreased waste in several processes. CONCLUSION: The prescribing rate of new opioids for osteoarthritis and chronic back pain decreased and the prescribing rate for evidence-based medications increased after implementation of the SAFE PAIN algorithm in a geropsychiatry unit.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Procedimentos Clínicos , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/reabilitação , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Feminino , Geriatria/organização & administração , Geriatria/normas , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Humanos , Masculino , Maryland , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Osteoartrite/complicações , Osteoartrite/reabilitação , Manejo da Dor/normas , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psiquiatria/organização & administração , Psiquiatria/normas
19.
Bone Joint J ; 101-B(7_Supple_C): 28-32, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256642

RESUMO

AIMS: The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients. PATIENTS AND METHODS: A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit. RESULTS: The median body mass index (BMI) at initial visit was 46.9 kg/m2 (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m2 (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m2 (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had bariatric surgery. A total of 58 patients (20.1%) underwent TJA. For those 58, BMI at initial visit was 45.3 kg/m2 (IQR 43.7 to 47.2), and at surgery was 42.3 kg/m2 (IQR 38.1 to 46.5). Only 23 patients (39.7%) of those who had TJA successfully achieved BMI < 40 kg/m2 at surgery. CONCLUSION: Restricting TJA for morbidly obese patients does not incentivize weight loss prior to arthroplasty. Only 20.1% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and coordinated care are required to optimize patients prior to surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):28-32.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Obesidade Mórbida/complicações , Osteoartrite/cirurgia , Perda de Peso/fisiologia , Suspensão de Tratamento , Adulto , Idoso , Cirurgia Bariátrica , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Obesidade Mórbida/cirurgia , Osteoartrite/complicações , Estudos Prospectivos
20.
Bone Joint J ; 101-B(7_Supple_C): 17-21, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256648

RESUMO

AIMS: To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery. PATIENTS AND METHODS: An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017. A total of 4733 patients underwent joint arthroplasty and had preoperative measurement of albumin levels: 2220 at four hospitals and 2513 at the study hospital. Albumin ≤ 3.4 g/l, designated as malnutrition, was found in 543 patients (11.5%). A nutritional intervention programme focusing on a high-protein, anti-inflammatory diet was initiated in January 2017 at one study hospital. Hospital LOS, re-admission rate, and 90-day charges were compared for differential change between patients in study and control hospitals for all elective hip and knee arthroplasty patients, and for malnourished patients over time as the nutrition intervention was implemented. RESULTS: Malnourished patients with nutritional intervention at the study hospital had shorter hospital LOS beginning in 2017 than malnourished patients at control hospitals during the same period (p = 0.04). Similarly, this cohort had significantly lower primary hospitalization charges, charges associated with hospital re-admissions, and 90-day total charges (p < 0.001). Inclusion of covariant potential confounders (age, anaemia, diabetes, and obesity) did not alter the conclusions of the primary statistical analysis. CONCLUSION: Joint arthroplasty outcomes were positively affected in study patients with low albumin when a high-protein, anti-inflammatory diet was encouraged. Elective surgery was neither cancelled nor delayed with a malnutrition designation. While the entire network population experienced improved postoperative outcomes, malnourished control patients did not experience this improvement. This study demonstrated that education on malnutrition can benefit patients. Cite this article: Bone Joint J 2019;101-B(7 Supple C):17-21.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Desnutrição/complicações , Estado Nutricional , Apoio Nutricional/métodos , Osteoartrite/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Osteoartrite/complicações , Alta do Paciente/tendências , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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