Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic review

Background Persistent monoarthritis in otherwise well-controlled rheumatoid arthritis presents a therapeutic challenge. Intra-articular (IA) steroids are a mainstay of treatment, though some have queried whether IA disease modifying anti-rheumatic drugs (DMARD) and biologics can be used in those who fail steroid injections. Methods A systematic literature review was conducted using four medical databases to identify randomized, controlled trials assessing IA therapies in RA patients. Included studies underwent Cochrane Risk of Bias 2 assessment for quality. Results Twelve studies were included, 6 of which examined intra-articular (IA) TNF inhibitors (TNFi), and 6 studies evaluating IA methotrexate. Of those evaluating IA TNFi, one study reported statistical improvement in TNFi therapy when compared with placebo. The remaining 5 studies compared IA TNFi therapy with steroid injections. IA TNFi had statistically improved symptom scores and clinical assessments comparable with IA steroid treatments. In the 6 studies evaluating IA methotrexate, the addition of methotrexate to steroid intra-articular therapy was not found to be beneficial, and singular methotrexate injection was not superior to the control arms (saline or triamcinolone). Risk-of-bias (ROB) assessment with the Revised Cochrane ROB tool indicated that 2 of 6 TNFi studies were at some risk or high risk for bias, compared with 5 out of 6 methotrexate studies. Conclusion For persistent monoarthritis in rheumatoid arthritis, IA methotrexate was not found to have clinical utility. Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown.

Intestinal Decontamination Therapy for Dyskinesia and Motor Fluctuations in Parkinson's Disease

Parkinson's disease is neurodegenerative disorder with an initial robust response to levodopa. As the disease progresses, patients frequently develop dyskinesia and motor fluctuations, which are sometimes resistant to pharmacological therapy. In recent years, abnormalities in gut microbiota have been identified in these patients with a possible role in motor manifestations. Dysbiosis may reduce levodopa absorption leading to delayed “On” or “no-On” states. Among 84 consecutive patients with PD, we selected 14 with levodopa-induced dyskinesia and motor fluctuations with a Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part IV ≥ 8 points following a trial of pharmacological adjustment 2–3 months prior to study enrollment or adjustments in deep brain stimulation therapy. Patients received treatment with sodium phosphate enema followed by oral rifaximin and polyethylene glycol for 7 and 10 days, respectively. Evaluations between 14 to 21 days after starting treatment showed improvement in MDS-UPDRS-IV (P = 0.001), including duration (P = 0.001) and severity of dyskinesia (P = 0.003); duration of medication “Off”-state (P = 0.004); functional impact of motor fluctuations (P = 0.047) and complexity of motor fluctuations (P = 0.031); no statistical improvement was observed in “Off” dystonia (P = 0.109) and total motor scores (P = 0.430). Marked to moderate improvement in dyskinesia was observed in 57% of cases with blinded evaluation of videos. About 80% of patients perceived moderate to robust improvement at follow-up. A therapeutic strategy aimed at decontamination of intestines showed benefit in motor fluctuations and dyskinesia. Further studies should confirm and clarify the mechanism of improvement observed in these patients.

Impact of Technology-Based Intervention for Improving Self-Management Behaviors in Black Adults with Poor Cardiovascular Health: A Randomized Control Trial

Cardiovascular disease (CVD) is the number one killer of adults in the U.S., with marked ethnic/racial disparities in prevalence, risk factors, associated health behaviors, and death rates. In this study, we recruited and randomized Blacks with poor cardiovascular health in the Atlanta Metro area to receive an intervention comparing two approaches to engagement with a behavioral intervention technology for CVD. Generalized Linear Mixed Models results from a 6-month intervention indicate that 53% of all participants experienced a statistical improvement in Life’s Simple 7 (LS7), 54% in BMI, 61% in blood glucose, and 53% in systolic blood pressure. Females demonstrated a statistically significant improvement in BMI and diastolic blood pressure and a reduction in self-reported physical activity. We found no significant differences in changes in LS7 or their constituent parts but found strong evidence that health coaches can help improve overall LS7 in participants living in at-risk neighborhoods. In terms of clinical significance, our result indicates that improvements in LS7 correspond to a 7% lifetime reduction of incident CVD. Our findings suggest that technology-enabled self-management can be effective for managing selected CVD risk factors among Blacks.

Uretero-Pelvic Junction Stenosis: Considerations on the Appropriate Timing of Correction Based on an Infant Population Treated with a Minimally-Invasive Technique

There is no univocal consensus about timing of intervention and best surgical approach for infants with asymptomatic uretero-pelvic junction obstruction (UPJO). We conducted a retrospective analysis of patients undergoing one-trocar-assisted pyeloplasty (OTAP) in a 13 year range period by creating two homogenous groups (indications for surgery were the same for all patients): patients operated on in the first 90 days of life (34 patients; Group 1) and patients operated on between 3 and 12 months of life (34 patients; Group 2). We observed no statistically significant differences between groups in regard to mean operative time, conversion rate to open surgery, mean hospital stay, early complications (urinary leakage) rate and mean antero-posterior diameter (APD) reduction rate. Moreover, no statistical improvement was seen between groups in regard to separate renal function (SRF) at 1-year-follow-up renogram. Thanks to the HSS calculated before and 1 year after surgery, we registered an important improvement in Group I patients (p = 0.023). In our study, there was no significant evidence, in terms of intraoperative data and early postoperative outcomes, between patients who underwent an early pyeloplasty and those who underwent a delayed correction. Nevertheless, we registered a significant improvement in those patients with an impaired SRF that underwent an early surgical correction, especially in terms of urinary flow. Even though this study cannot definitely establish the superiority of early timing of correction, it is evident that further research is needed to clarify this aspect.

Resampling algorithms for high energy physics simulations

We demonstrate that the method of interleaved resampling in the context of parton showers can tremendously improve the statistical convergence of weighted parton shower evolution algorithms. We illustrate this by several examples showing significant statistical improvement.

Catalogue of the central stars of planetary nebulae

Planetary nebulae represent a potential late stage of stellar evolution, however, their central stars (CSPNe) are relatively faint and, therefore, pertinent information is available for merely < 20% of the Galactic sample. Consequently, the literature was surveyed to construct a new catalogue of 620 CSPNe featuring important spectral classifications and information. The catalogue supersedes the existing iteration by 25% and includes physical parameters such as luminosity, surface gravity, temperature, magnitude estimates, and references for published spectra. The marked statistical improvement enabled the following pertinent conclusions to be determined: the H-rich/H-poor ratio is 2:1, there is a deficiency of CSPNe with types [WC 5-6], and nearly 80% of binary central stars belong to the H-rich group. The last finding suggests that evolutionary scenarios leading to the formation of binary central stars interfere with the conditions required for the formation of H-poor CSPN. Approximately 50% of the sample with derived values of log L⋆, log Teff, and log g, exhibit masses and ages consistent with single stellar evolutionary models. The implication is that single stars are indeed able to form planetary nebulae. Moreover, it is shown that H-poor CSPNe are formed by higher mass progenitors. The catalogue is available through the Vizier database.

Quality of Life of Men after Cementless Hip Replacement – a Pilot Study

Background. Hip osteoarthritis is a significant health, social and economic problem. The associated pain and pathological and pathological proliferative joint lesions significantly reduce patients’ quality of life. Material and methods. The study involved 61 male patients aged 30 to 75 years qualified for hip arthroplasty due to osteoarthritis. A short version of the WHOQoL-BREF and EQ-5D-5L questionnaires were used to assess the quality of life. The questionnaires were administered before surgery, during the first outpatient visit (6 weeks after the surgery) and 6 months after the surgery. Results. The WHOQoL-BREF questionnaire showed that the quality of life had improved significantly after just 6 weeks by 5% and 19% (p <0.01). After 6 months, there was also an improvement, of 13% and 42% (p <0.001). The most marked statistical improvement was found in the somatic domain after 6 weeks (8%) and after 6 months (11%) (p <0.001). The quality of life according to the EQ-5D-5L questionnaire showed statistically significant improvement of 13-23% after 6 weeks and of 32-42% after 6 months (p <0.001). The most marked improvement was achieved in terms of pain relief (p <0.001). Conclusions. 1. The quality of life improved significantly after just six weeks following hip arthroplasty. 2. The results were significantly higher also after 6 months. 3. The functional status of the patients improved significantly at both 6 weeks and 6 months after hip arthroplasty, especially in terms of pain reduction.

Comparison of the effectiveness of platelet rich plasma and ozone therapy in plantar fasciitis treatment

Background: Plantar fasciitis (PF) is one of the most common foot problems in adults. Conservative treatments are proportionally 90-95% successful. In this study, author aimed to compare the effectiveness of ozone therapy (OT) treatment of platelet rich plasma (PRP) injections in PF patients.Methods: In the study, which was made prospectively, patients were randomly divided into two groups. In the first group (n=20), patients were injected with PRP in 3 sessions at a one week intervals, and in the second group (n=22) OT was injected in the same way. Each patient was evaluated with visual pain score before as well as 1 month after treatment in terms of pain, whereas the foot function index (FFI) was evaluated with the score in terms of functionality.Results: In both groups, the 1st month VAS score and FFI score showed significant decrease (p<0.05) after treatment compared to before treatment. The decrease in VAS score and FFI score after treatment in the PRP group was significantly higher than the OT group (p˂0.05).Conclusions: As a result of this study, authors found that both PRP and OT were beneficial in terms of pain and functional level in the treatment of PF, but in patients who underwent PRP, authors found that there was more statistical improvement in terms of both parameters than patients who received OT. In light of the absence of a previous publication comparing these two treatment options in PF treatment, this study contributes to the literature.

Subacromial Balloon Interpositional Arthroplasty for the Management of Irreparable Rotator Cuff Tears: Five-year Results

Background: Management of massive irreparable rotator cuff tears can be a source of significant dilemma for the treating surgeon. This is especially true when dealing with patients with poor physiological reserves where options of tendon transfer, superior capsular repair or arthroplasty might be unsuitable. We report the five-year outcomes of 26 patients who underwent balloon interpositional arthoplasty for the management of massive irreparable rotator cuff tears. Methods: Fifty-four consecutive patients underwent balloon interpositional arthroplasty in our institution. Of these, 26 patients completed at least two postoperative functional outcome measures over a five-year period, which included the Visual Analogue Score (VAS), Oxford Shoulder Score (OSS) and the SF12 score. Outcome scores were obtained prospectively. Results: The average age at implantation was 67 years old. Our result shows statistically significant improvement in pain up to five years post-implantation of the device (p = 0.012). Function measured by the OSS and SF12 (PCS) score showed improvement up to two years post-implantation (p = 0.006). Three of the 54 patients in our cohort went on to have arthroplasty surgery for their rotator cuff tears. None of the patients in our cohort suffered from any adverse reactions following implantation. Discussion/Conclusion: Results from our study identify the spacer device as an option in the management of irreparable rotator cuff tears with statistical improvement in pain and function. It may also delay the need for arthoplasty surgery.

The Use of Yoga to Manage Stress and Burnout in Healthcare Workers: A Systematic Review

The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare workers. In February 2017, a literature search was conducted using the databases Medline (PubMed) and Scopus. Studies that addressed this topic were included. Eleven articles met the inclusion criteria. Seven studies were clinical trials that analyzed yoga interventions and evaluated effectiveness by gauging stress levels, sleep quality and quality of life. A study on Chinese nurses showed statistical improvement in stress levels following a six-month yoga program (χ2 = 16.449; p < 0.001). A population of medical students showed improvement in self-regulation values after an 11-week yoga program (from 3.49 to 3.58; p = 0.04) and in self-compassion values (from 2.88 to 3.25; p = 0.04). Four of the included articles were observational studies: They described the factors that cause stress in the work environment and highlighted that healthcare workers believe it is possible to benefit from improved physical, emotional and mental health related to yoga activity. According to the literature, yoga appears to be effective in the management of stress in healthcare workers, but it is necessary to implement methodologically relevant studies to attribute significance to such evidence.