Clinical utility of quantitative analysis of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis

Background The purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis. Methods We retrospectively enrolled 65 patients with rheumatoid arthritis who underwent bone scintigraphy for diagnostic work-up. Quantitative analysis of bone scintigraphy images was conducted using an in-house software, and joint uptake ratio of 28 joints was measured for the calculation of the disease activity score of 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The relationship between joint uptake ratio and clinical findings and the efficiency of joint uptake ratio in detecting clinically active joint and high disease activity were assessed. Results Clinically active joint (tender and/or swollen joints) showed significantly higher joint uptake ratio than did other non-affected joints (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of joint uptake ratio for identifying clinically active joint were 78.7%, 52.0%, 32.9%, and 89.1%, respectively, and those of the summed joint uptake ratio for detecting high disease activity were 92.9%, 66.8%, 43.3%, and 97.1%, respectively; the joint uptake ratio showed high detection ability, especially for active joints of the elbow, wrist, and metacarpo-phalangeal joint areas. The summed joint uptake ratio of 28 joints showed a significantly strong positive correlation with DAS28-ESR (p < 0.001; correlation coefficient, 0.725). Conclusion Quantitative parameters of bone scintigraphy showed high sensitivity and NPV for detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.

Pengaruh Pemberian Metode Gerakan Sendi Aktif dengan Menggunakan Media Video Bermusik terhadap Ketahanan Otot Pasien Stroke di Ruangan Medicina Interna, Hospital Nasional Guido Valadares, Dili–Timor Leste

AbstrakStroke merupakan masalah kesehatan global umum yang memerlukan penanganan yang komprehensif. Rehabilitasi pasca stroke merupakan bagian terpenting dari perawatan pasien stroke. Intervensi yang diberikan kepada pasien selain terapi medis, latihan sendi juga menjadi pilihan bagi pasien pasca stroke. Untuk mengetahui pengaruh Metode Gerakan Sendi Aktif terhadap Daya Tahan Otot Pasien Stroke Dengan Menggunakan Video Musik di Rumah Sakit Nasional Guido Valadares Dili - Timor Leste. Penelitian ini merupakan penelitian eksperimen semu dengan rancangan Non Equivalent Control Group Design. Teknik pengambilan sampel menggunakan simple random sampling (teknik undian). Sampel penelitian 10 kelompok eksperimen dan 10 kelompok kontrol. Dengan menggunakan uji Wilcoxon Rank diperoleh hasil pre-test post-test kelompok eksperimen P-value = 0,007, kelompok kontrol P-value = 1000. Hasil Paired Sample Statistics P-value = 0,003 berarti ada pengaruh pemberian latihan gerak sendi aktif menggunakan media video bermusik terhadap kekuatan otot pasien stroke. Ada pengaruh pemberian latihan gerak sendi terhadap daya tahan otot pasien stroke. Setelah dilakukan pengujian pada kedua kelompok yaitu kelompok eksperimen dan kelompok kontrol didapatkan bahwa pada kelompok eksperimen terjadi peningkatan hasil daya tahan otot setelah diberikan intervensi latihan gerak sendi aktif, sedangkan pada kelompok kontrol tidak terjadi peningkatan hasil daya tahan otot. Kata kunci : Gerakan Sendi Aktif, Ketahanan Otot, Pasien Stroke Abstract Stroke is a common global health problem that needs comprehensive management. Post-stroke rehabilitation is the most important part of care for stroke patients. Interventions given to patients in addition to medical therapy, joint exercises are also an option for stroke patients after a stroke. To determine the effect of Active Joint Movement Method on Muscle Endurance of Stroke Patients Using Music Videos in Guido Valadares National Hospital, Dili - Timor Leste. The study was a Quasi experimental design with a Non equivalent control group design. The sampling technique used simple random sampling (lottery technique).Sample research 10 of eksperiment group and 10 of control group. By using the Wilcoxon Rank test, the results of the pre-test post-test experimental group P-value = 0.007, control group P-value = 1000. The results of Paired Sample Statistics P-value = 0.003 means that there is an effect of giving active joint movement exercises on the muscle strength of stroke patients. There is an effect of providing joint movement exercises on the muscle endurance of stroke patients. After testing the two groups, the experimental group and the control group, it was found that in the experimental group there was an increase in muscle endurance results after being given active joint movement training interventions, while in the control group there was no increase in muscle endurance Keyword : Active joint movement, Muscle strength, stroke patient

Blower-Powered Soft Inflatable Joints for Physical Human-Robot Interaction

Inflatables are safe and lightweight structures even at the human scale. Inflatable robots are expected to be applied to physical human-robot interaction (pHRI). Although active joint mechanisms are essential for developing inflatable robots, the existing mechanisms are complex in structure and it is difficult to integrate actuators, which diminish the advantages of inflatables. This study proposes blower-powered soft inflatable joints that are easy to fabricate and contain enough space for an actuation inside. The joints are driven by tendon wires pulled by linear actuators. We derived a theoretical model for both unilateral and bilateral joints and demonstrated a hugging robot with multiple joints as an application of the proposed joint mechanism. The novelty of the proposed joint mechanism and the inflatable robot is that rigid parts have been thoroughly eliminated and the tendons for actuation have been successfully hidden inside. Moreover, the active control of the internal pressure makes inflatables resistant to punctures. We expect that the contact safety of inflatable robots will facilitate advancement of the pHRI field.

Muscle torques and joint accelerations provide more sensitive measures of post-stroke movement deficits than joint angles.

The whole repertoire of complex human motion is enabled by forces applied by our muscles and controlled by the nervous system. The impact of stroke on the complex multi-joint motor control is difficult to quantify in a meaningful way that informs about the underlying deficit in the active motor control and intersegmental coordination. We tested whether post-stroke deficit can be quantified with high sensitivity using motion capture and inverse modeling of a broad range of reaching movements. Our hypothesis is that muscle moments estimated based on active joint torques provide a more sensitive measure of post-stroke motor deficits than joint angles. The motion of twenty-two participants was captured while performing reaching movements in a center-out task, presented in virtual reality. We used inverse dynamics analysis to derive active joint torques that were the result of muscle contractions, termed muscle torques, that caused the recorded multi-joint motion. We then applied a novel analysis to separate the component of muscle torque related to gravity compensation from that related to intersegmental dynamics. Our results show that muscle torques characterize individual reaching movements with higher information content than joint angles do. Moreover, muscle torques enable distinguishing the individual motor deficits caused by aging or stroke from the typical differences in reaching between healthy individuals. Similar results were obtained using metrics derived from joint accelerations. This novel quantitative assessment method may be used in conjunction with home-based gaming motion-capture technology for remote monitoring of motor deficits and inform the development of evidence-based robotic therapy interventions.

Alterations in sensorimotor function after ACL reconstruction during active joint position sense testing. A systematic review

Background The anterior cruciate ligament (ACL) rupture can lead to impaired knee function. Reconstruction decreases the mechanical instability but might not have an impact on sensorimotor alterations. Objective Evaluation of the sensorimotor function measured with the active joint position sense (JPS) test in anterior cruciate ligament (ACL) reconstructed patients compared to the contralateral side and a healthy control group. Methods The databases MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Library and SPORTDiscus were systematically searched from origin until April 2020. Studies published in English, German, French, Spanish or Italian language were included. Evaluation of the sensorimotor performance was restricted to the active joint position sense test in ACL reconstructed participants or healthy controls. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data was descriptively synthesized. Results Ten studies were included after application of the selective criteria. Higher angular deviation, reaching significant difference (p < 0.001) in one study, was shown up to three months after surgery in the affected limb. Six months post-operative significantly less error (p < 0.01) was found in the reconstructed leg compared to the contralateral side and healthy controls. One or more years after ACL reconstruction significant differences were inconsistent along the studies. Conclusions Altered sensorimotor function was present after ACL reconstruction. Due to inconsistencies and small magnitudes, clinical relevance might be questionable. JPS testing can be performed in acute injured persons and prospective studies could enhance knowledge of sensorimotor function throughout the rehabilitative processes.

Solving the Forward Position Problem of an In-Parallel Planar Manipulator in the Gauss Plane

We study determining the posture of an in-parallel planar manipulator, which has three connectors composed of revolute, prismatic and revolute joints, from specified active joint variables. We construct an ideal in the field of complex numbers, and we introduce self inversive polynomials. We provide results for an in-parallel planar manipulator, which has a base and moving platform in right triangular shape. Using Sage computer algebra system, we compute its Groebner bases. We illustrate that the single variable polynomials obtained from the Groebner bases are self reciprocal.

Solving the Forward Position Problem of an In-Parallel Planar Manipulator in the Gauss Plane

We study determining the posture of an in-parallel planar manipulator, which has three connectors composed of revolute, prismatic and revolute joints, from specified active joint variables. We construct an ideal in the field of complex numbers, and we introduce self inversive polynomials. We provide results for an in-parallel planar manipulator, which has a base and moving platform in right triangular shape. Using Sage computer algebra system, we compute its Groebner bases. We illustrate that the single variable polynomials obtained from the Groebner bases are self reciprocal.

OP0162 ETANERCEPT RESPONSE CLUSTERS IN JUVENILE IDIOPATHIC ARTHRITIS

Background:In children and young people (CYP) with JIA, we have previously identified clusters with different patterns of disease impact following methotrexate (MTX) initiation. It is unclear whether clusters of treatment response following etanercept (ETN) therapy exist and whether, in a group of CYP who have responded inadequately to or had adverse events on methotrexate, similar treatment response patterns exist. Novel response patterns would aid stratified treatment approaches through better understanding and potential forecasting of more specific response patterns across multiple domains of disease.Objectives:To identify and characterise trajectories of juvenile arthritis disease activity score (JADAS) components following ETN initiation for JIA.Methods:ETN-naïve CYP with non-systemic JIA were selected if enrolled prior to January 2019 in at least one of four CLUSTER consortium studies: BSPAR-ETN, BCRD, CAPS and CHARMS, at point of starting ETN as their first biological therapy. JADAS components (active joint count, physician’s global assessment (0-10cm), parental global evaluation (0-10cm) and standardised ESR (0-10) were collected at ETN initiation and during the following year.Multivariate group-based trajectory models, that identify clusters of CYP with similar patterns of change over time, were used to explore ETN response clusters across the different JADAS components. Censored-normal (global scores, ESR) and zero-inflated Poisson (active joint count) models were used, adjusting for year of ETN initiation. Optimal models were selected based on a combination of model fit (BIC), parsimony, and clinical plausibility.Results:Of the 1003 CYP included, the majority were female (70%) and of white ethnicity (90%), with rheumatoid factor-negative JIA the most common disease category (39%).The optimal model identified five trajectory clusters of disease activity following initiation of ETN (Figure 1). Clusters following ETN were similar and covered similar proportions of CYP to those previously identified following MTX: Fast (Group 1: 13%) and Slow (Group 2: 10%) response, active joint count improves but either physician (Group 3: 6%) or parent global scores (Group 4: 34%) remain persistently raised and a group with persistent raised scores across all JADAS components (Group 5: 36%). Compared to the persistent disease cluster, those with greater improvement had lower age and higher functional ability at ETN initiation and those with persistent raised parent global scores had lower ESR levels and were less likely to be RF-positive at ETN initiation.Figure 1.Clusters identified following ETN initiation in children and young people recruited to the UK BSPAR-ETN, BCRD, CAPS and CHARMS studies.Conclusion:This study has identified that within CYP initiating ETN, similar response clusters are evident to those previously identified following MTX. This commonality suggests a new framework for understanding treatment response, beyond a simple responder/non-responder analysis at a set point, which applies across multiple drugs despite different mechanisms of action and previous unfavourable treatment outcomes. Understanding both clinical factors associated with, and biological mechanisms underpinning, these clusters would aid stratified medicine in JIA.Acknowledgements:We thank the children, young people and families involved in CLUSTER, as well as clinical staff, administrators and data management teams. Funding for CLUSTER has been provided by generous grants from the MRC, Versus Arthritis, GOSH children’s charity, Olivia’s vision and the NIHR Manchester and GOSH BRC schemes.Disclosure of Interests:Stephanie Shoop-Worrall: None declared, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: BMS, UCB, Pfizer, Lucy Wedderburn Speakers bureau: Pfizer, Grant/research support from: Abbvie, Sobi, Wendy Thomson Grant/research support from: Abbvie, Sobi, Nophar Geifman Grant/research support from: Abbvie, Sobi