Joint Preservation Using Orthobiologic Therapies in Osteoarthritis

Osteoarthritis is estimated to be the most prevalent musculoskeletal disorder in the world. Estimates show that the disease is prevalent in 18% and 10% in women and men that are aged >60 years old. The quality of life of the affected patients can also be significantly impacted due to the associated morbidities and functional loss. Many interventions have been proposed to preserve the joint and enhance the functional outcomes in patients with osteoarthritis. In the present literature review, we have discussed the different orthobiologic therapies for patients with osteoarthritis for joint preservation and subsequent improvement in the functional and pain outcomes. Variable modalities that have been proposed in the literature include Bone Marrow Aspirate Concentrate (BMAC), gene therapy and platelet rich plasma (PRP). All of these modalities were reported with favorable outcomes and minimal complications. PRP has been reported to have a clinical efficacy that is boosed when co-administered with hyaluronic acid. However, it should be noted that the clinical efficacy is limited in the long term, and administration is continuously required. On the other hand, gene therapy is a promising technique that offers maintained favorable outcomes with no adverse events. However, further studies are still needed to indicate the effectiveness and cost-efficacy of this approach.

Alemtuzumab induced red cell aplasia and other immune cytopenias – not so ‘pure’

We report on the presentation and outcome of a 28-year-old female who developed red cell aplasia following alemtuzumab therapy for relapsing remitting multiple sclerosis. The patient also developed synchronous immune thrombocytopenia and immune neutropenia, but not aplastic anemia. This patient received high dose steroids, intravenous immunoglobulin (iv.Ig), rituximab, red cell transfusions, vincristine, G-CSF, cyclosporin and mycophenolate to treat the combination of cytopenias over a period of 6 months with subsequent improvement in bone marrow function. While alemtuzumab has several recognized autoimmune complications, little is known about the potential hematological side effects. The combination of red cell aplasia, immune thrombocytic purpura and autoimmune neutropenia has not previously been described in the literature following alemtuzumab immunotherapy and highlights the importance of monthly blood monitoring post alemtuzumab administration.

Increased Comfort of Polyester Fabrics

The hydrophilicity of fibers is directly related to the comfort of a fabric and represents one of the most important aspects of a textile. Therefore, polyester (PES) modification has focused on an increase in moisture content and a subsequent improvement of the user’s experience. Based on the glycerol hygroscopic properties, the main objective has been the enhancement of the hydrophilicity of polyester by glycerol treatments. Furthermore, microwave irradiation and alkaline treatment have been applied, in order to increase glycerol adhesion. Treated PES samples were characterized by performing moisture content, negative ion, water diffusion and water vapor resistance analyses. The effect of different treatment conditions such as bath ratio (1/10 or 1/15), temperature (40, 60 or 100 °C), time (2 or 5 min) and microwave radiation intensity (300 or 500 W) was evaluated. The moisture content of treated PES results indicated that by decreasing the bath ratio and increasing the time and temperature the moisture gain can reach almost 14%, which can be easily related to increases in the weight of the fiber. The treatment with alkali was done and led to the highest moisture increase. Treatment with 500 W microwave irradiation led to higher glycerol retention after rinsing. Different experimental conditions were applied to the glycerol-treated PES fabrics, and a clear improvement in moisture content was obtained increasing the comfort. The results were compared with the ones obtained for cotton and wool, where the moisture is higher than non treated PES.

Feature Extraction Model with Group-Based Classifier for Content Extraction from Video Data

In today's PC illustration, numerous object locations of videos are quite critical duties to accomplish. Swiftly and reliably recognising and distinguishing the multiple aspects of a video is a crucial attribute for collaborating with one's condition (object). The core issue is that in theory, to ensure that no significant aspect is missing; all aspects of a content in a video must be scanned for elements on various different scales. It requires some investment and effort anyway, to really arrange the substance of a given content region and both time and computational limits that an operator can spend on classification are constrained. Two presumption procedures for accelerating the standard identifier are performed by the proposed method and demonstrate their capability by performing both identification efficiency and velocity. The main enhancement of our group-based classifier focuses on accelerating the grouping of sub features by planning the problem as a selection procedure for consecutive features. The subsequent improvement gives better multiscale features to distinguish objects of all sizes without rescaling the information image from a video. Extracting contents from video is an assortment of successive images with a steady time interim. So video can give more data about contents in it when situations are changing regarding time. Along these lines, physically taking care of contents with features are very unimaginable. In the proposed work, it is suggested that a Group-based Video Content Extraction Classifier (GbCCE) extracts content from a video by extracting relevant features using a group-based classifier. The proposed method is distinct from conventional approaches and the findings indicate that better output is demonstrated by the proposed method.

Hereditary Vitamin-D Dependent Rickets Type II: A Case Report

Hereditary vitamin D dependent rickets type II is a rare genetic disorder in children characterized by early onset of rickets and deranged biochemical parameters. Low serum calcium level, high alkaline phosphatase, high parathyroid hormone, and high values of 1,25-dihydroxy vitamin D are characteristic biochemical findings. We are reporting a rare case of Vitamin D Dependent Rickets and subsequent improvement after addition of cinacalcet. This is a case report of a 2.5-year-child with Hereditary Vitamin D Dependent Rickets type II receiving cinacalcet as adjunct to oral calcium and calcitriol. Oral cinacalcet (0.25mg/kg/day) was added to the regimen as an adjunct after treatment failure with high dose of oral calcium and calcitriol. A significant improvement in radiological findings and normal homeostasis of calcium, phosphate and parathyroid hormone was achieved after initiation of cinacalcet.

Value of imaging detected joint inflammation in explaining fatigue in RA at diagnosis and during the disease course: a large MRI study

ObjectiveFatigue in rheumatoid arthritis (RA) is hypothesised to be caused by inflammation. Still ~50% of the variance of fatigue in RA cannot be explained by the Disease Activity Score (DAS), nor by background or psychological factors. Since MRI can detect joint inflammation more sensitively than the clinical joint counts as incorporated in the DAS, we hypothesised that inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during the follow-up.Methods526 consecutive patients with RA were followed longitudinally. Fatigue was assessed yearly on a Numerical Rating Scale. Hand and foot MRIs were performed at inclusion, after 12 and 24 months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether patients with RA with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year 1 associated with subsequent improvement in fatigue in year 2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.ResultsAt diagnosis, higher DAS scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year 1 associated with fatigue improvement in year 2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.ConclusionSensitive measurements of joint inflammation did not explain fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.

POS0438 IS IMAGING DETECTED JOINT INFLAMMATION HELPFUL IN EXPLAINING FATIGUE IN RHEUMATOID ARTHRITIS AT DIAGNOSIS AND DURING THE DISEASE COURSE? – A LARGE MRI STUDY

Background:Fatigue in rheumatoid arthritis (RA) is hypothesized to be caused by inflammation. Still ~50% of fatigue in RA cannot be explained by the disease activity score (DAS), nor by generic or psychological factors.Objectives:Since MRI can detect joint inflammation more sensitively than DAS, we hypothesized that residual inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during follow-up.Methods:526 consecutive RA-patients were followed longitudinally. Fatigue was assessed yearly on a numerical rating scale. Hand and foot MRIs were performed at inclusion, after 12 and 24-months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether RA-patients with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year-1 associated with subsequent improvement in fatigue in year-2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.Results:At diagnosis, higher DAS-scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year-1 associated with fatigue improvement in year-2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.Conclusion:Sensitive measurements of joint inflammation did not aid in explaining fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.Disclosure of Interests:None declared

ASSESSMENT OF OUTCOME OF TYMPANOPLASTY TYPE-1 ON HEARING AND CONTRIBUTING FACTORS

Aim:To assess the effect of size of perforation on the hearing loss and on the degree of improvement after myringoplasty. Materials and methods: In the present study a series of 100 patients of Tympanoplasty Type I, done by postaural underlay technique using temporalis fascia were studied over a period of 18 months (May 2019 to May 2020). Age of the patient ranged from 10-50 years with an average of 24.9 years. Out of 100 cases 41 were males and 59 were females. The average length of time the ear remained dry prior to surgery was 14 months ranging from 2 months to 6 years. Result:It was seen that the size of the perforation signicantly affects the degree of hearing loss and degree of subsequent improvement after Tympanoplasty Type I; large and medium size perforation had greater hearing loss and greater postoperative hearing improvement compared to small perforations which was statistically signicant (P<0.05). Conclusion: The only factor which signicantly inuenced the hearing outcome post operatively is the size of the perforation. The size of the perforation affects the degree of hearing loss and degree of subsequent improvement after Type I Tympanoplasty; large and medium sized perforations had a greater hearing loss and greater post operative hearing improvement compared to small perforations.