Assessment of clinical significance of ultrasonographic detection ofhyperechogenic deposits in hyaline cartilage in patients with knee osteoarthritis

The aimof the study was to assess the relationship between the detection of hyperechogenic deposits (HD) in the hyaline cartilage of the knee joints (KJ) at ultrasonography in patients with osteoarthritis (OA), clinical manifestations and structural changes according to KJ ultrasonography and radiography.Material and methods.A prospective analysis of clinical, radiological and ultrasonographic data of 114 patients with knee OA was conducted. The patients were divided into two groups: 32 patients with HD detected in at least one of the KJ, and 82 patients without HD; 32 patients of the 1st group and 34 patients of the 2nd group were observed for 2 years. A comparative assessment of initial clinical manifestations (WOMAC index), x-ray data and ultrasonographic parameters of the subchondral bone, hyaline cartilage and the degree of synovial inflammation in the groups of patients at the beginning of the study and after 2 years was carried out. The exclusion criteria were other joint diseases; paroxysmal course of the inflammatory process in KJ; trauma and history of operations on KJ; ESR >20 mm/h, uric acid level >360 μmol/l and C-reactive protein >5 mg/l.Results and discussion.HD in hyaline cartilage was found in 28.1% of patients with knee OA. After 2 years HD remained in all patients having them at inclusion, and in 5.6% of the patients they were found for the first time. In 13 patients with HD in hyaline cartilage, synovial fluid was studied and in all cases calcium pyrophosphate crystals were identified by phase-contrast microscopy. The presence of HD in the hyaline cartilage of patients with knee OA was accompanied by more pronounced ultrasonographic signs of synovitis and was associated with a higher rate of osteophytes growth in the absence of the changes of the hyaline cartilage thickness according to the ultrasonography and the width of the joint space according to x-ray.Conclusion.The presence of HD in the hyaline cartilage of patients with knee OA according to ultrasound examination may be associated with the deposition of calcium pyrophosphate crystals and is associated with persistent synovitis and accelerated growth of osteophytes.

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Phospholipase A2 inhibitor–loaded micellar nanoparticles attenuate inflammation and mitigate osteoarthritis progression

Science Advances ◽

10.1126/sciadv.abe6374 ◽

2021 ◽

Vol 7 (15) ◽

pp. eabe6374

Author(s):

Yulong Wei ◽

Lesan Yan ◽

Lijun Luo ◽

Tao Gui ◽

Biang Jang ◽

...

Keyword(s):

Clinical Success ◽

Joint Space ◽

Therapeutic Agents ◽

Knee Joints ◽

Phospholipid Membrane ◽

Drug Discovery And Development ◽

Knee Oa ◽

Clinical Challenge ◽

Osteoarthritis Progression ◽

Human And Mouse

Treating osteoarthritis (OA) remains a major clinical challenge. Despite recent advances in drug discovery and development, no disease-modifying drug for knee OA has emerged with any notable clinical success, in part, due to the lack of valid and responsive therapeutic targets and poor drug delivery within knee joints. In this work, we show that the amount of secretory phospholipase A2 (sPLA2) enzyme increases in the articular cartilage in human and mouse OA cartilage tissues. We hypothesize that the inhibition of sPLA2 activity may be an effective treatment strategy for OA. To develop an sPLA2-responsive and nanoparticle (NP)–based interventional platform for OA management, we incorporated an sPLA2 inhibitor (sPLA2i) into the phospholipid membrane of micelles. The engineered sPLA2i-loaded micellar NPs (sPLA2i-NPs) were able to penetrate deep into the cartilage matrix, prolong retention in the joint space, and mitigate OA progression. These findings suggest that sPLA2i-NPs can be promising therapeutic agents for OA treatment.

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Joint-specific twin and familial aggregation of recalled physician diagnosed osteoarthritis

Twin Research ◽

10.1375/twin.2.3.196 ◽

1999 ◽

Vol 2 (3) ◽

pp. 196-202 ◽

Cited By ~ 2

Author(s):

Urho M Kujala ◽

Jenni Leppävuori ◽

Jaakko Kaprio ◽

Jaakko Kinnunen ◽

Leena Peltonen ◽

...

Keyword(s):

Environmental Effects ◽

Twin Pair ◽

Familial Aggregation ◽

Knee Joints ◽

Questionnaire Study ◽

Gene Effects ◽

Specific Data ◽

Knee Oa ◽

History Of ◽

Additive Gene

AbstractIn our three-stage questionnaire study we investigated patterns of twin and familial aggregation of osteoarthritis (OA) for commonly affected joints. The baseline questionnaire study of the Finnish Twin Cohort was performed in 1975. In 1990, 4095 twin pairs of the same gender born 1930–1957 responded to a questionnaire and reported whether they had OA diagnosed by a physician. In 1996 both twins of 266 pairs of which at least one had reported OA in 1990 responded to a detailed questionnaire on joint-specific OA, including family history of OA. In male pairs shared (non-genetic) familial effects accounted for 37% of the total variance in liability to OA and unshared environmental effects for 63%. In female pairs additive gene effects explained 44% of the variance in liability to OA, and unshared environmental effects for 36%. Familial aggregation of finger and knee OA was clearly higher than that of hip OA. Twin-pair discordance for OA was, to some extent, associated with body-mass index, occupational loading and trauma. Our results indicate that genetic effects may be modulated by sex or by environmental factors distributed differently between men and women. Based on our joint-specific data finger and knee joints are the most optimal targets for studies of genetic factors predisposing to the development of OA.

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Retrospective analysis of clinical characteristics of 405 patients with COVID-19

Journal of International Medical Research ◽

10.1177/0300060520949039 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094903 ◽

Cited By ~ 1

Author(s):

Ting Zhan ◽

Meng Liu ◽

Yalin Tang ◽

Zheng Han ◽

Xueting Cheng ◽

...

Keyword(s):

Clinical Characteristics ◽

Severe Disease ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Circulatory System ◽

Respiratory Illnesses ◽

Reactive Protein ◽

Circulatory System Diseases ◽

History Of ◽

Abnormal Lymphocyte

Objective This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan. Results The patients’ median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels. Conclusion SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.

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Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

Scientific Reports ◽

10.1038/srep22365 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 31

Author(s):

Jana Podlipská ◽

Ali Guermazi ◽

Petri Lehenkari ◽

Jaakko Niinimäki ◽

Frank W. Roemer ◽

...

Keyword(s):

Articular Cartilage ◽

Knee Osteoarthritis ◽

Diagnostic Performance ◽

Structural Changes ◽

Morphological Changes ◽

Cost Effective ◽

Conventional Radiography ◽

Joint Space ◽

Meniscal Extrusion ◽

Knee Oa

Abstract Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.

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Hepatic angiosarcoma

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i6p578-580 ◽

2018 ◽

Vol 97 (6) ◽

pp. 578-580

Author(s):

Vivian Nunes Arruda ◽

Melissa De Andrade ◽

Rhafir Gonçalves

Keyword(s):

Clinical Manifestations ◽

Pulmonary Nodules ◽

Emergency Laparotomy ◽

Abdominal Ultrasonography ◽

Reactive Protein ◽

Hepatic Angiosarcoma ◽

History Of ◽

Rare Malignancy ◽

Pathology Reports ◽

The Right

Hepatic Angiosarcoma is a rare malignancy of endothelial cell origin that is generally idiopathic and presents non-specific clinical manifestations. Hemoperitoneum can occur in 17-27% of cases and is a result of tumor rupture, which has a devastating prognosis. We present a 79-year-old female patient with history of diffuse right upper quadrant abdominal pain associated with syncope episodes and unintentional weight loss. Physical examination was unremarkable except for painful palpation of the right upper quadrant. Laboratory exams indicated chronic disease anemia, a 2.7 INR, decreased albumin, increased C-Reactive Protein and GGT, and normal AST, ALT, Alkaline Phosphatase and Bilirubin. Viral hepatitis serologies were negative. Abdominal ultrasonography revealed hepatomegaly and solid liver lesions of heterogeneous echogenicity and imprecise limits. Three-phase abdominal CT showed multiple liver masses of heterogeneous pattern of enhancement suggestive of atypical hemangioma associated with ascites. Chest CT revealed bilateral pulmonary nodules suggestive of metastasis. During hospital stay, the patient developed a massive hemoperitoneum that required emergency laparotomy. In this circumstance, liver and omentum biopsies were performed and the pathology reports ultimately indicated the possibility of hepatic angiosarcoma. The patient developed refractory hemoperitoneum and hemorrhagic shock and ultimately passed away, 48 days after hospital admission. Definitive diagnosis was only available posteriorly, with immunohistochemistry positivity for ERG, CD34 and Factor VIII-related antigen on both omentum and lung samples. This case study provides valuable clinical discussion and emphasizes how a transdisciplinary approach is essential to correctly diagnose and manage such complex cases.

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Progression of sacroiliitis in men and women according to the cohort of early axial spondyloarthritis (CORSAR) over 3 years of follow-up

Rheumatology Science and Practice ◽

10.47360/1995-4484-2021-715-719 ◽

2021 ◽

Vol 59 (6) ◽

pp. 715-719

Author(s):

D. G. Timokhina ◽

T. V. Dubinina ◽

A. B. Demina ◽

O. A. Krichevskaya ◽

Sh. F. Erdes

Keyword(s):

Structural Damage ◽

Structural Changes ◽

Radiographic Progression ◽

Axial Spondyloarthritis ◽

Chronic Inflammatory Disease ◽

Men And Women ◽

X Ray ◽

Delay In Diagnosis ◽

Reactive Protein ◽

The Right

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease with predominant involvement of the sacroiliac joints (SIJ) and/or the spine. Despite the fact that the prevalence of axSpA is almost the same in men and women, there is evidence of a delay in diagnosis and a more severe course of the disease in females. The available reports on the progression of structural changes in the SIJ in men and women with early axSpA are contradictory. Meanwhile, the analysis of radiographic progression in the SIJ has fundamental importance both for timely diagnosis and for assessing the effectiveness of therapy in axSpA. Such studies have not yet been carried out in the Russian Federation.Objective: to assess the radiographic progression of sacroiliitis (SI) over 3 years in men and women with early axSpA.Material and methods. The study included patients from the cohort of early axSpA CORSAR, formed at the V.A. Nasonova Research Institute of Rheumatology. Currently, it includes 175 patients with axSpA. We analyzed the data of 64 patients, followed for at least 3 years. To assess the radiographic progression of the disease at baseline and after 3 years, the sum of X-ray stages of SI in the left and right SIJ was determined (the total stage of SI). Progression was assessed by the change in the total stage of SI in the right and left SIJ (0-8) during the observation period. We also calculated the proportion of patients with deterioration (increase in the total stage of SI by at least 1 stage), with improvement (decrease in the total stage of SI by at least 1 stage) and without progression. In order to fully exclude the error in measuring the radiographic progression of SI, we counted patients with “net” progression, that is, the proportion of patients with improvement was subtracted from the proportion of patients with deterioration.Results. Among 64 patients with early axSpA, there were 37 (57.8%) men and 27 (42.2%) women. For 3 years, the median of the total stage SI in men was 0 [0; 1], in women - 0 [0; 2] (p>0.05). When assessing the progression of the total stage SI over 3 years, no significant differences were found between the number of men and women with improvement, with deterioration, “net” progression and without progression. Men with early axSpA showed a higher level of C-reactive protein (CRP) at baseline, women had higher BASDAI and ASDAS CRP values after 3 years. In 8% of patients, there was a regression of X-ray signs of SI.Conclusion. The radiographic progression of SI in patients with early axSpA does not depend on gender and disease activity. In some patients with early axSpA, reverse development of structural damage to the SIJ is possible.

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Role of gene Xpert test in clinical TB suspect in children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182584 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1657

Author(s):

Sheenu Gupta ◽

Veerana Kotrashetti ◽

Rizwan Ahmed

Keyword(s):

Diagnostic Tests ◽

Clinical Manifestations ◽

Childhood Tuberculosis ◽

Mantoux Test ◽

Gastric Aspirate ◽

X Ray ◽

Tb Treatment ◽

Childhood Tb ◽

History Of ◽

Chest X Ray

Background: Tuberculosis (TB) is a major global health problem. Childhood tuberculosis (TB) is common in our community but it is relatively neglected, due to greater challenges in diagnosis. Clinical manifestations of childhood TB differ from adults. The diagnosis in most cases is based on clinical evidence but chest X-ray, Mantoux test, history of Kochs contact, malnutrition and sputum/gastric sample microscopy are important supporting investigations. WHO recommended use of newer diagnostic tests like Gene Xpert in pediatric cases where TB is mostly paucibacillary and identification of TB bacilli is difficult for confirmation of diagnosis.Methods: This prospective study was conducted among admitted and OPD patients in the department of Pediatrics over a period of 1and half year. Clinically suspected cases of TB in the age group 0-12 years who met the diagnostic criteria made the study group. Refusal of consent by parent and children already on TB treatment were excluded from this study. Investigations like chest X-ray, Mantoux test, sputum/gastric aspirate microscopy and Gene Expert were done to confirm the clinical diagnosis.Results: Pulmonary tuberculosis was more common (28%), TB lymphadenitis 22%, TB meningitis 14%, Tubercular Pleural effusion 12 %. and rest were no TB. BCG scar was present in 90%. History of contact was present in 76% and Mantoux test was positive in 76%. Gene Expert was positive only in one case in our study rest 49 cases were negative. The most common symptoms were fever (72%), cough (52%) and weight loss (40%).Conclusions: This study supports that detailed history, clinical evaluation and active investigative workup in addition to newer diagnostic tests like Gene Xpert has a major role in diagnosing childhood tuberculosis.

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Clinical and immunologic features in severe and moderate forms of Coronavirus Disease 2019

10.1101/2020.02.16.20023903 ◽

2020 ◽

Cited By ~ 84

Author(s):

Guang Chen ◽

Di Wu ◽

Wei Guo ◽

Yong Cao ◽

Da Huang ◽

...

Keyword(s):

T Cells ◽

T Lymphocytes ◽

Clinical Laboratory ◽

Clinical Manifestations ◽

High Sensitivity ◽

Absolute Number ◽

Reactive Protein ◽

History Of ◽

Ifn Γ ◽

Few Data

AbstractBackgroundSince late December, 2019, an outbreak of pneumonia cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and continued to spread throughout China and across the globe. To date, few data on immunologic features of Coronavirus Disease 2019 (COVID-19) have been reported.MethodsIn this single-centre retrospective study, a total of 21 patients with pneumonia who were laboratory-confirmed to be infected with SARS-CoV-2 in Wuhan Tongji hospital were included from Dec 19, 2019 to Jan 27, 2020. The immunologic characteristics as well as their clinical, laboratory, radiological features were compared between 11 severe cases and 10 moderate cases.ResultsOf the 21 patients with COVID-19, only 4 (19%) had a history of exposure to the Huanan seafood market. 7 (33.3%) patients had underlying conditions. The average age of severe and moderate cases was 63.9 and 51.4 years, 10 (90.9%) severe cases and 7 (70.0%) moderate cases were male. Common clinical manifestations including fever (100%, 100%), cough (70%, 90%), fatigue (100%, 70%) and myalgia (50%, 30%) in severe cases and moderate cases. PaO2/FiO2 ratio was significantly lower in severe cases (122.9) than moderate cases (366.2). Lymphocyte counts were significantly lower in severe cases (0.7 × 10□/L) than moderate cases (1.1 × 10□/L). Alanine aminotransferase, lactate dehydrogenase levels, high-sensitivity C-reactive protein and ferritin were significantly higher in severe cases (41.4 U/L, 567.2 U/L, 135.2 mg/L and 1734.4 ug/L) than moderate cases (17.6 U/L, 234.4 U/L, 51.4 mg/L and 880.2 ug /L). IL-2R, TNF-α and IL-10 concentrations on admission were significantly higher in severe cases (1202.4 pg/mL, 10.9 pg/mL and 10.9 pg/mL) than moderate cases (441.7 pg/mL, 7.5 pg/mL and 6.6 pg/mL). Absolute number of total T lymphocytes, CD4+T cells and CD8+T cells decreased in nearly all the patients, and were significantly lower in severe cases (332.5, 185.6 and 124.3 × 106/L) than moderate cases (676.5, 359.2 and 272.0 × 106/L). The expressions of IFN-γ by CD4+T cells tended to be lower in severe cases (14.6%) than moderate cases (23.6%).ConclusionThe SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4+T cells, resulting in significant decrease in number as well as IFN-γ production, which may be associated with disease severity. Together with clinical characteristics, early immunologic indicators including diminished T lymphocytes and elevated cytokines may serve as potential markers for prognosis in COVID-19.

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Morphology

10.1093/med/9780199668847.003.0011 ◽

2016 ◽

Author(s):

Richard Aspden ◽

Jenny Gregory

Keyword(s):

Structural Changes ◽

Imaging Modality ◽

Alpha Angle ◽

Joint Space ◽

Imaging Biomarkers ◽

Shape Variation ◽

Shape Modelling ◽

Knee Oa ◽

Joint Morphology ◽

New Variables

The study of joint morphology can help us to understand the risk factors for osteoarthritis (OA), how it progresses, and aids in developing imaging biomarkers for study of the disease. OA results in gross structural changes in affected joints. Growth of osteophytes, deformation of joint components, and loss of joint space where cartilage has broken down are all characteristics of the disorder. Certain bone shapes as well as malalignment predispose people to future OA, or may be a marker for early OA. Geometrical measures, such as the alpha angle or Wiberg’s CE angle, used to be the primary tool for investigating morphology. In recent years, however, statistical shape modelling (SSM) has become increasingly popular. SSM can be used with any imaging modality and has been successfully applied to a number of musculoskeletal conditions. It uses sets of landmark points denoting the anatomy of one or more bones to generate new variables (modes) that describe and quantify the shape variation in a set of images via principal components analysis. With the aid of automated search algorithms for point placement, the use of SSMs is expanding and provides a valuable and versatile tool for exploration of bone and joint morphometry. Whilst the majority of research has focused on hip and knee OA, this chapter provides an overview of joint morphology through the whole skeleton and how it has helped our ability to understand and quantify the risk and progression of osteoarthritis.

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Synovial Fluid Fatty Acid Profiles Differ between Osteoarthritis and Healthy Patients

Cartilage ◽

10.1177/1947603518798891 ◽

2018 ◽

Vol 11 (4) ◽

pp. 473-478 ◽

Cited By ~ 2

Author(s):

Arne Van de Vyver ◽

Stefan Clockaerts ◽

Chris H. A. van de Lest ◽

Wu Wei ◽

Jan Verhaar ◽

...

Keyword(s):

Synovial Fluid ◽

Joint Disease ◽

Knee Joints ◽

Nervonic Acid ◽

Omega 3 ◽

Knee Oa ◽

Omega 6 ◽

History Of ◽

End Stage ◽

And Control

Objective Free fatty acids (FAs) may influence cartilage metabolism and osteoarthritis (OA) disease progression. It is not clearly studied which FAs are present in the synovial fluid of knee joints and whether there are differences in FA content between nonsymptomatic and OA knee joints. The aim of this study was to investigate the presence of different types of FAs in synovial fluid of both OA- and nonsymptomatic control joints, and to analyze differences between both groups. Design A total of 23 synovial fluid samples were collected from patients with end-stage knee OA undergoing total knee replacement, with approval of the medical ethical committee. As controls, 6 synovial fluid samples were obtained from postmortem donors without any history of joint disease or arthritis. Measurement of free FA concentration was done by mass spectrometry for saturated FAs (SFA), monounsaturated FAs (MUFA), and omega-3 and omega-6 polyunsaturated FAs (n-3 PUFAs and n-6 PUFAs). Results Our measurements demonstrated the presence of SFAs, MUFAs, n-3 and n-6 PUFAs in synovial fluid of both nonsymptomatic and OA knee joints. The n-6/n-3 ratio was significantly lower in the OA group ( P = 0.0005). Arachidonic acid (n-6 PUFA) concentrations were also lower in OA synovial fluid ( P = 0.01), while tetracosadienoic acid ( P = 0.0001) and nervonic acid ( P = 0.001) (MUFAs) were higher in synovial fluid of patients with knee OA. Conclusion Synovial fluid contains a broad spectrum of free FAs. The FAs profile differs between OA and control subjects, including a tendency for less n-6 FAs in OA joints.

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