Quantitative Radiographic Features of Early Knee Osteoarthritis: Development Over 5 Years and Relationship with Symptoms in the CHECK Cohort

2012 ◽  
Vol 40 (1) ◽  
pp. 58-65 ◽  
Author(s):  
MARGOT B. KINDS ◽  
ANNE C.A. MARIJNISSEN ◽  
JOHANNES W.J. BIJLSMA ◽  
MAARTEN BOERS ◽  
FLORIS P.J.G. LAFEBER ◽  
...  
Keyword(s):  
Bone Density ◽  
Clinical Outcome ◽  
Joint Space Width ◽  
Joint Damage ◽  
Computer Assisted ◽  
Digital Analysis ◽  
Radiographic Features ◽  
Early Oa ◽  
Varus Angle ◽  
Over Time

Objective.To evaluate whether computer-assisted, interactive digital analysis of knee radiographs enables identification of different quantitative features of joint damage, and to evaluate the relationship of such features with each other and with clinical characteristics during 5-year followup in early osteoarthritis (OA).Methods.Knee radiographs from the Cohort Hip and Cohort Knee (CHECK) study, including 1002 individuals with early OA complaints, were evaluated for different measures with knee images digital analysis (KIDA). To aid definition of different radiographic features of OA, principal component analysis of KIDA was used. Features were correlated (Pearson) to each other, evaluated for changes over time, and related to clinical outcome (Western Ontario and McMaster Universities Osteoarthritis Index for pain and function) using baseline, 2-year, and 5-year followup data.Results.The identified radiographic features were joint space width (JSW: minimum, medial, lateral), varus angle, osteophyte area, eminence height, and bone density. The features progressed in severity at different times during followup: early (medial JSW, osteophyte area), late (minimum and lateral JSW, eminence height), and both early and late (varus angle, bone density). Correlations between different radiographic features varied between timepoints. The JSW features were most strongly related to each other (largest r = 0.82), but also, e.g., osteophytes and bone density were correlated (largest r = 0.33). The relationships with clinical outcome varied over time, but were most commonly found for osteophyte area and JSW.Conclusion.In this early OA cohort, different radiographic features were identified that progressed at different rates between timepoints. The relations between radiographic features and with clinical outcome varied over time. This implies that longitudinal evaluation of different features can improve insight into progression of OA.

Identifying Phenotypes of Knee Osteoarthritis by Separate Quantitative Radiographic Features May Improve Patient Selection for More Targeted Treatment

2013 ◽  
Vol 40 (6) ◽  
pp. 891-902 ◽  
Author(s):  
Margot B. Kinds ◽  
Anne C.A. Marijnissen ◽  
Max A. Viergever ◽  
Pieter J. Emans ◽  
Floris P.J.G. Lafeber ◽  
...  
Keyword(s):  
Bone Density ◽  
Clinical Characteristics ◽  
Joint Space Width ◽  
Specific Treatment ◽  
Joint Space ◽  
Radiographic Features ◽  
Knee Oa ◽  
Improve Patient Selection ◽  
Space Width ◽  
Varus Angle

Objective.Expression of osteoarthritis (OA) varies significantly between individuals, and over time, suggesting the existence of different phenotypes, possibly with specific etiology and targets for treatment. Our objective was to identify phenotypes of progression of radiographic knee OA using separate quantitative features.Methods.Separate radiographic features of OA were measured by Knee Images Digital Analysis (KIDA) in individuals with early knee OA (the CHECK cohort: Cohort Hip & Cohort Knee), at baseline and at 2-year and 5-year followup. Hierarchical clustering was performed to identify phenotypes of radiographic knee OA progression. The phenotypes identified were compared for changes in joint space width (JSW), varus angle, osteophyte area, eminence height, bone density, for Kellgren-Lawrence (K-L) grade, and for clinical characteristics. Logistic regression analysis evaluated whether baseline radiographic features and demographic/clinical characteristics were associated with each of the specific phenotypes.Results.The 5 clusters identified were interpreted as “Severe” or “No,” “Early” or “Late” progression of the radiographic features, or specific involvement of “Bone density.” Medial JSW, varus angle, osteophyte area, eminence height, and bone density at baseline were associated with the Severe and Bone density phenotypes. Lesser eminence height and bone density were associated with Early and Late progression. Larger varus angle and smaller osteophyte area were associated with No progression.Conclusion.Five phenotypes of radiographic progression of early knee OA were identified using separate quantitative features, which were associated with baseline radiographic features. Such phenotypes might require specific treatment and represent relevant subgroups for clinical trials.

scholarly journals OP0083 DORSAL ROOT GANGLIA INFILTRATING MACROPHAGES MAINTAIN OSTEOARTHRITIS PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 55.2-56
Author(s):  
R. Raoof ◽  
C. Martin ◽  
H. De Visser ◽  
J. Prado ◽  
S. Versteeg ◽  
...  
Keyword(s):  
Knee Joint ◽  
Dorsal Root Ganglia ◽  
Immune Cells ◽  
Dorsal Root ◽  
Weight Bearing ◽  
Joint Damage ◽  
Osteoarthritis Pain ◽  
Knee Pathology ◽  
Femoral Condyles ◽  
Over Time

Background:Pain is a major debilitating symptom of knee osteoarthritis (OA). However, the extent of joint damage in OA does not correlate well with the severity of pain. The mechanisms that govern OA pain are poorly understood. Immune cells infiltrating nervous tissue may contribute to pain maintenance.Objectives:Here we investigated the role of macrophages in the initiation and maintenance of OA pain.Methods:Knee joint damage was induced by an unilateral injection of mono-iodoacetate (MIA) or after application of a groove at the femoral condyles of rats fed on high fat diet. Pain-like behaviors were followed over time using von Frey test and dynamic weight bearing. Joint damage was assessed by histology. Dorsal root ganglia (DRG) infiltrating immune cells were assessed over time using flow cytometry. To deplete monocytes and macrophages, Lysmcrex Csfr1-Stop-DTR were injected intrathecal or systemically with diptheria toxin (DT).Results:Intraarticular monoiodoacetate injection induced OA and signs of persistent pain, such as mechanical hyperalgesia and deficits in weight bearing. The persisting pain-like behaviors were associated with accumulation of F4/80+macrophages with an M1-like phenotype in the lumbar DRG appearing from 1 week after MIA injection, and that persisted till at least 4 weeks after MIA injection. Macrophages infiltrated DRG were also observed in the rat groove model of OA, 12 weeks after application of a groove at the femoral condyles. Systemic or local depletion of DRG macrophages during established MIA-induced OA completely ablated signs of pain, without affecting MIA-induced knee pathology. Intriguingly when monocytes/macrophages were depleted prior to induction of osteoarthritis, pain-like behaviors still developed, however these pain-like behaviors did not persist over time.In vitro,sensory neurons innervating the affected OA joint programmed macrophages into a M1 phenotype. Local repolarization of M1-like DRG macrophages towards M2 by intrathecal injection of M2 macrophages or anti-inflammatory cytokines resolved persistent OA-induced pain.Conclusion:Overall we show that macrophages infiltrate the DRG after knee damage and acquire a M1-like phenotype and maintain pain independent of the lesions in the knee joint. DRG-infiltrating macrophages are not required for induction of OA pain. Reprogramming M1-like DRG-infiltrating macrophages may represent a potential strategy to treat OA pain.Acknowledgments:This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreements No 814244 and No 642720. Dutch Arthritis SocietyDisclosure of Interests:Ramin Raoof: None declared, Christian Martin: None declared, Huub de Visser: None declared, Judith Prado: None declared, Sabine Versteeg: None declared, Anne Heinemans: None declared, Simon Mastbergen: None declared, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Niels Eijkelkamp: None declared

scholarly journals Significant increase in quantity and quality of knee arthroplasty related research in KSSTA over the past 15 years

2021 ◽  
Author(s):  
Stephanie Kirschbaum ◽  
Thilo Kakzhad ◽  
Fabian Granrath ◽  
Andrzej Jasina ◽  
Jakub Oronowicz ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Special Topic ◽  
Computer Assisted ◽  
Time Interval ◽  
Search Term ◽  
Level Of Evidence ◽  
The Past ◽  
Patient Reported ◽  
Over Time ◽  
Number Of Authors

Abstract Purpose This study aimed to evaluate both publication and authorship characteristics in Knee Surgery, Sports Traumatology, Arthroscopy journal (KSSTA) regarding knee arthroplasty over the past 15 years. Methods PubMed was searched for articles published in KSSTA between January 1, 2006, and December 31st, 2020, utilising the search term ‘knee arthroplasty’. 1288 articles met the inclusion criteria. The articles were evaluated using the following criteria: type of article, type of study, main topic and special topic, use of patient-reported outcome scores, number of references and citations, level of evidence (LOE), number of authors, gender of the first author and continent of origin. Three time intervals were compared: 2006–2010, 2011–2015 and 2016–2020. Results Between 2016 and 2020, publications peaked at 670 articles (52%) compared with 465 (36%) published between 2011 and 2016 and 153 articles (12%) between 2006 and 2010. While percentage of reviews (2006–2010: 0% vs. 2011–2015: 5% vs. 2016–2020: 5%) and meta-analyses (1% vs. 6% vs. 5%) increased, fewer case reports were published (13% vs. 3% vs. 1%) (p < 0.001). Interest in navigation and computer-assisted surgery decreased, whereas interest in perioperative management, robotic and individualized surgery increased over time (p < 0.001). There was an increasing number of references [26 (2–73) vs. 30 (2–158) vs. 31 (1–143), p < 0.001] while number of citations decreased [30 (0–188) vs. 22 (0–264) vs. 6 (0–106), p < 0.001]. LOE showed no significant changes (p = 0.439). The number of authors increased between each time interval (p < 0.001), while the percentage of female authors was comparable between first and last interval (p = 0.252). Europe published significantly fewer articles over time (56% vs. 47% vs. 52%), whereas the number of articles from Asia increased (35% vs. 45% vs. 37%, p = 0.005). Conclusion Increasing interest in the field of knee arthroplasty-related surgery arose within the last 15 years in KSSTA. The investigated topics showed a significant trend towards the latest techniques at each time interval. With rising number of authors, the part of female first authors also increased—but not significantly. Furthermore, publishing characteristics showed an increasing number of publications from Asia and a slightly decreasing number in Europe. Level of evidence IV.

Calcium absorption and bone density in immature horses fed two levels of crude protein

2013 ◽  
Vol 9 (2) ◽  
pp. 119-124
Author(s):  
H.S. Spooner ◽  
G.D. Potter ◽  
P.G. Gibbs ◽  
E.M. Eller
Keyword(s):  
Bone Density ◽  
Dietary Protein ◽  
Protein Intake ◽  
Crude Protein ◽  
Calcium Absorption ◽  
National Research Council ◽  
High Protein ◽  
Urine Ph ◽  
Over Time ◽  
Faecal Ph

Research in other animal models indicate that high protein diets increase urinary calcium (Ca) excretion and may lead to a negative Ca balance and reduced bone density. This study was undertaken to determine the effects of two common levels of dietary protein intake on physiological parameters, Ca absorption, and bone density in immature horses. Sixteen 10-month old horses were blocked by age and sex into two dietary treatments. The control diet (C) was formulated using common ingredients to provide 100% of the National Research Council (NRC) for crude protein (CP), while the high protein diet (H) was formulated at 150% of NRC recommendations. Lower than expected dietary intake resulted in mean protein intake of 769±16 g/d in C and 978±18 g/d in H, equivalent to 91% and 116% of NRC, respectively. Blood, urine, and faeces were collected during the 112-day study to determine pH and mineral balance. Radiographs of the left third metacarpal were used to estimate bone density via radiographic bone aluminum equivalence (RBAE). Although urine pH decreased over time (P<0.001), no change in blood or urine pH was observed due to diet. Faecal pH, normalised to day 0, was significantly lower in H (P<0.02). Faecal Ca loss was greater in H (P<0.005); while Ca absorption and absorption as a percent of intake were lower for H (P<0.02). RBAE of dorsal and palmar cortices increased over time (P<0.001), but no differences were observed between diets. While excess dietary protein decreased faecal pH, increased faecal Ca excretion, and decreased Ca absorption, there appeared to be no effect on bone density over the course of this study.

Do Radiographic Joint Damage and Disease Activity Influence Functional Disability Through Different Mechanisms? Direct and Indirect Effects of Disease Activity in Established Rheumatoid Arthritis

2013 ◽  
Vol 40 (9) ◽  
pp. 1505-1512 ◽  
Author(s):  
Sandhya C. Nair ◽  
Johannes W.J. Bijlsma ◽  
Jacobien H. van der Werf ◽  
Maaike J. van der Veen ◽  
Suzanne P. Linn-Rasker ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Functional Disability ◽  
Functional Decline ◽  
Joint Damage ◽  
Treatment Strategies ◽  
Joint Disease ◽  
Influence Functional ◽  
Over Time ◽  
Predictive Effect

Objective.To explore the relationship between rheumatoid arthritis (RA) disease activity and functional disability over time, considering indirect (predictive) and direct (concurrent) associations as well as the influence of radiographic joint damage and treatment strategy.Methods.Functional disability [Health Assessment Questionnaire (HAQ)], disease activity [28-joint Disease Activity Score (DAS28)], and radiographic joint damage [Sharp/van der Heijde score (SHS)] were measured in 4 consecutive randomized controlled trials with increasingly intensive (tight control) treatment strategies. Average followup time for the 3 cohorts was 97, 53, and 50 months, respectively. Next to current DAS28, the previous DAS28 was used to study the predictive effect of a change in DAS28 on progression of functional disability (HAQ). Finally, it was investigated whether SHS mediated the predictive effect of DAS28.Results.In patients treated with intensive treatment strategies, the progression of HAQ over time was statistically significantly less (p < 0.0001). The predictive influence of DAS28 on HAQ progression increased over the duration of the disease. SHS was not found to influence HAQ progression and did not mediate the predictive effect of DAS28. In the less intensively treated patients, the direct effect of disease activity decreased with disease duration, and contrarily, SHS did influence HAQ progression, but was not found to (fully) mediate the predictive effect of DAS28.Conclusion.In patients with RA treated with modern treatment strategies, there is less functional decline over time. Further, disease activity does predict functional decline but joint damage does not. This might indicate that factors associated with cumulative disease activity but not visible on radiographs can influence functional decline in patients with RA. This further underlines the importance of disease activity as a treatment target in early RA and in established RA.

scholarly journals Chairside CAD/CAM Materials: Current Trends of Clinical Uses

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1170
Author(s):  
Giulio Marchesi ◽  
Alvise Camurri Piloni ◽  
Vanessa Nicolin ◽  
Gianluca Turco ◽  
Roberto Di Lenarda
Keyword(s):  
Clinical Outcome ◽  
Computer Aided Design ◽  
Fabrication Process ◽  
Computer Assisted ◽  
Current Trends ◽  
Computer Aided ◽  
Restorative Materials ◽  
Cad Cam ◽  
Aided Design

Restorative materials are experiencing an extensive upgrade thanks to the use of chairside Computer-aided design/computer-assisted manufacturing (CAD/CAM) restorations. Therefore, due to the variety offered in the market, choosing the best material could be puzzling for the practitioner. The clinical outcome of the restoration is influenced mainly by the material and its handling than by the fabrication process (i.e., CAD/CAM). Information on the restorative materials performances can be difficult to gather and compare. The aim of this article is to provide an overview of chairside CAD/CAM materials, their classification, and clinically relevant aspects that enable the reader to select the most appropriate material for predictable success.

Designing Learning Activities for Sustained Engagement

2011 ◽  
pp. 189-216
Author(s):  
Brock Dubbels
Keyword(s):  
Bone Density ◽  
Learning Environments ◽  
Identity Construction ◽  
Video Game ◽  
Game Design ◽  
After School ◽  
Physically Active ◽  
Phenomenological Interview ◽  
Dance Dance Revolution ◽  
Over Time

The experience of a successful adolescent learner will be described from the student’s perspective about learning the video game Dance Dance Revolution (DDR) through selected passages from a phenomenological interview. The question driving this investigation is, “Why did she sustain engagement in learning?” The importance of this question came out of the need for background on how to create an afterschool program that was to use DDR as an after school activity that might engage adolescents and tweens to become more physically active and reduce the risk of adult obesity, and to increase bone density for these developing young people through playing the game over time. The difficulty of creating this program was the risk that the students would not sustain engagement in the activity, and we would not have a viable sample for the bone density adolescent obesity study. Implications of this study include understanding the potential construction of learning environments that motivate and sustain engagement in learning and the importance of identity construction for teachers to motivate and engage their students. In addition to the analysis of sustained engagement through the four socio- and cultural-cognitive theories, four major principals were extracted from the operationalized themes into a framework for instructional design techniques and theory for engaging learners for game design, training, and in classroom learning.

scholarly journals Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 203-212
Author(s):  
Tomoyuki Ohara ◽  
Bijoy K. Menon ◽  
Fahad S. Al-Ajlan ◽  
MacKenzie Horn ◽  
Mohamed Najm ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Intravenous Alteplase ◽  
Over Time

Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.

Introduction: how language works in politics

2018 ◽  
pp. 3-32
Author(s):  
Matthew Williams
Keyword(s):  
Computer Assisted ◽  
British Politics ◽  
Form And Function ◽  
It Impacts ◽  
Legislative Language ◽  
And Function ◽  
Assisted Analysis ◽  
The Impact ◽  
Over Time

This book examines how language works in democratic politics and how it impacts the effectiveness of policy. Using evidence from the first computer-assisted analysis of all 41.5 million words of legislation enacted from 1900 to 2015, it tracks the major changes in form and function that Parliament's use of language has undergone over time and the reasons for such changes. More importantly, it explores the policy and social implications of changes in legislative language as well as the issue of legislative indeterminacy. This introductory chapter discusses the questions, arguments and aims of the book and reviews the literature on the operation of language in British politics, along with the impact of legislative language on policy effectiveness. It also explains what specifically the book contributes to the existing literature, describes the research design, and provides an overview of the chapters that follow.

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