In der Schweinehaltung sind Erkrankungen des Bewegungsapparates und des Zentralnervensystems neben Erkrankungen des Gastrointestinal- und Respirationstraktes von größter Bedeutung hinsichtlich der Betriebswirtschaftlichkeit und des Wohlergehens der Tiere. Infektionen durch verschiedene bakterielle Erreger sind hierbei die häufigste Ursache. Über die altersabhängige Häufigkeitsverteilung der Erreger sind allerdings keine jüngeren Studien veröffentlicht. Streptococcus (S.) suis verursacht beim Schwein neben Polyarthritiden und Meningitiden auch Septikämien, Endokarditiden und plötzliche Todesfälle. Weltweit sind die Serotypen 1 bis 9 unter den invasiven Isolaten besonders prävalent. In Europa und auch Deutschland dominieren die Serotypen 2 und 9. Obwohl eine Vielzahl von Publikationen zur molekularen Pathogenese von S.-suis-Infektionen erschienen sind, sind die Infektionswege, die zur Bakteriämie führen, nicht hinreichend geklärt. Während beim Schwein als Eintrittspforte der Nasopharynx, die Tonsillen oder der obere Respirationstrakt angenommen wird, wird beim Menschen der Eintritt des Erregers über eine verletzte Hautregionen nach Kontakt mit infektiösen Tieren oder Tierprodukten oder über den oralen Weg beim Verzehr von nicht oder unzureichend gegartem Schweinefleisch postuliert. Zwar konnte der gastrointestinale Infektionsweg beim Schwein unter Ausschluss des Magens experimentell bestätigt werden, aber inwieweit diese Eintrittspforte unter Feldbedingungen eine Rolle spielt, ist bisher unklar. Zum einen war das Ziel dieser Studie, die Häufigkeit verschiedener bakterieller Erreger, die Arthritis und Erkrankungen des Zentralnervensystems (ZNS) bei Schweinen verursachen, unter Berücksichtigung des Alters der Tiere und des Pathotyps von S. suis zu untersuchen. Zur Differenzierung des Pathotyps sollten die Gene der Kapselbiosynthese und die Gene der Virulenz-assoziierten Faktoren Suilysin (sly), Muramidase-released Protein (mrp) und Extracellular Factor (epf) nachgewiesen werden. Zum anderen sollte durch die Untersuchung einer Reihe von Lymphknoten der Schweine überprüft werden, I) ob sich S. suis bei Feldinfektionen im Lymphknoten von Schweinen nachweisen lässt, II) ob durch die Untersuchung der Lymphknoten die Eintrittspforte des Erregers eingegrenzt werden kann und III) ob sich Hinweise für den gastrointestinalen Infektionsweg finden. Für die vorliegende Arbeit wurden zwischen Mai 2016 und Juli 2017 insgesamt 201 Schweine seziert, die schwerpunktmäßig aus Nordwestdeutschland stammten und nach dem Vorbericht klinisch mit Gelenkserkrankungen, oder zentralnervösen Symptomen aufgefallen oder plötzlich verendet waren. Pathologisch-anatomische Veränderungen der Gelenke und des ZNS wurden pathohistologisch verifiziert. Gelenk- und Hirnhauttupfer, Niere, Lobus medius der Lunge, Tonsilla veli palatini, Nl. cervicalis superficialis dorsalis dexter, Nl. bifurcationis medius, Nl. gastricus, Nl. jejunalis, Nl. ileocolicus, Nl. colicus, Nl. iliacus medialis dexter und Nl. inguinalis superficialis dexter wurden kulturell untersucht und isolierte Erreger molekularbiologisch identifiziert. Die Bestimmung des Kapseltyps 1 oder 14, 2 oder 1/2, 4, 7 und 9 sowie der oben genannten virulenzassoziierten Faktoren von S. suis erfolgte mittels Multiplex-Polymerase-Kettenreaktion. S. suis war bei den erregerpositiven Gelenk- (70,8 %) und Hirnhauttupfern (85,4 %) der untersuchten Schweine der bei Weitem häufigste Erreger und war in beiden Lokalisationen bei Saug- und Absetzferkeln am häufigsten nachzuweisen. Nach molekulargenetischer Serotypisierung der 677 S.-suis-Isolate konnten 572 Isolate einem der untersuchten Kapseltypen zugeordnet werden, wobei cps-Typ 2 oder 1/2 mit 35,6 % (n=241) und 9 mit 32,3 % (n=219) dominierten. Bei Saugferkeln zählten die S.-suis-Isolate am häufigsten zu den cps-Typen 1 oder 14 und 7, während beim Absetzferkel die cps-Typen 2 oder 1/2 und 9 am häufigsten nachzuweisen waren. Der Genotyp mrp+ sly+ epf+ cps2 oder 1/2 und der Genotyp mrp+ sly+ epf- cps9 traten bei 70,0 % bzw. fast der Hälfte der Tiere (44,9 %), bei denen der jeweilige Genotyp nachweisbar war, in mehr als drei Lokalisationen auf sowie bei jeweils 18 Tieren in mehr als zwei Lymphknoten gleichzeitig. S. suis war mit einer Nachweisrate zwischen 13,9 % (n=28) im Nl. ileocolicus und 20,4 % im Nl. cervicalis superficialis dorsalis dexter in allen untersuchten Lymphknoten einschließlich der mesenterialen (15,8 %; n=121/765) nachweisbar, wobei der cps-Typ 2 oder 1/2 mit 38,5 % (n=104) und 9 mit 40,0 % (n=108) dominierten. Im Nl. gastricus war der Anteil der Kapseltypen, die keinem der untersuchten cps-Typen entsprachen, mit 26,5 % (n=9) vergleichsweise hoch. Die Ergebnisse der vorliegenden Studie sind auf die selektierte Studienpopulation begrenzt, da keine repräsentative Stichprobe untersucht wurde. Dennoch bestätigen die Ergebnisse die Bedeutsamkeit von S. suis als wichtigstem Erreger von Arthritiden und Meningitiden beim Schwein und insbesondere beim Absetzferkel. Dabei wurden altersspezifische Unterschiede bezüglich der am häufigsten nachweisbaren Kapseltypen festgestellt. Bei einer systemischen Infektion mit Nachweis des Erregers in mehreren Lymphknoten konnte die Untersuchung der Lymphknoten nicht zur Klärung der Eintrittspforte von S. suis beitragen. Die Ergebnisse legen aber nahe, dass eine gastrointestinale Translokation bei Feldinfektionen vorkommen kann, allerdings finden sich keine Hinweise für eine große Relevanz des gastrointestinalen Infektionsweges. / In pigs, diseases of the locomotor and central nervous system (CNS), as well as diseases of the gastrointestinal and respiratory tract, are of major importance in regard to economic efficiency and animal welfare. Bacterial infections are the most common cause. However, no recent studies have been published on the age-dependency of these pathogens. In pigs, Streptococcus (S.) suis can cause polyarthritis, meningitis, as well as septicemia, endocarditis and sudden death. Serotypes 1 to 9 of the bacteria are particularly prevalent among the invasive isolates worldwide whilst serotypes 2 and 9 dominate in Europe and Germany. Although a large number of publications have been published on the molecular pathogenesis of S. suis infections, the infection pathways leading to bacteremia have not been fully demonstrated. In pigs, the nasopharynx, tonsils, or upper respiratory tract are assumed to be the portal of entry for S. suis, whilst in humans the portal of entry for the pathogen is postulated to be via a contact of injured skin with infectious animals or animal products, or via the oral route as a result of eating raw or undercooked pork. Although the gastrointestinal route of infection in pigs has been confirmed experimentally with the exclusion of the stomach, its role in the field is still unclear. One aim of this study was to determine the frequency of various bacterial pathogens that cause arthritis and diseases of the CNS in pigs, taking into account the age of the animals and the pathotype of S. suis. Detection of capsular biosynthesis genes and genes of virulence-associated factor suilysin (sly), muramidase-released protein (mrp), and extracellular factor (epf) are used to differentiate the pathotype. Another aim of this study was to investigate whether S. suis can be detected in the lymph nodes of naturally infected pigs and whether the examination of the lymph nodes can be used to narrow down the portal of entry, and especially whether there are any indications of the gastrointestinal route of infection. Between May 2016 and July 2017, a total of 201 pigs, with clinical history of joint disease, meningitis or sudden death, mainly from north-west Germany, were necropsied for the study. Pathological-anatomical changes in the joints and the CNS were verified pathohistologically. Joint and meningeal swabs, as well as kidney, Lobus medius of the lung, Tonsilla veli palatini, Nl. cervicalis superficialis dorsalis dexter, Nl. bifurcationis medius, Nl. gastricus, Nl. jejunalis, Nl. ileocolicus, Nl. colicus, Nl. iliacus medialis dexter and Nl. inguinalis superficialis dexter were examined culturally and isolated pathogens were identified using polymerase chain reaction. The capsule typing of S. suis was carried out using the multiplex polymerase chain reaction (1 or 14, 2 or 1/2, 4, 7 or 9) including the detection of the described genes of virulence-associated factors mrp, sly and epf. S. suis was determined to be the most important pathogen in the pathogen-positive joint (70.8%) and meningeal swabs (85.4%) of the examined pigs and was most frequently detected in both locations in suckling and weaning piglets. After molecular genetic serotyping of the 677 S. suis isolates, 572 isolates could be assigned to one of the examined types of capsule (1 or 14, 2 or 1/2, 4, 7 and 9), with cps-type 2 or 1/2 35.6% (n=241) and 9 32.3% (n=219) being the most dominating cps types. In suckling piglets, the S. suis isolates were most frequently cps-types 1 or 14 and 7, while cps-types 2 or 1/2 and 9 were most frequently detected in weaning piglets. The genotype mrp+ sly+ epf+ cps2 or 1/2 occurred in more than three locations in 70.0% of the animals and genotype mrp+ sly+ epf- cps9 in almost half of the animals (44.9%) that were positive for the respective genotype and in 18 animals in more than two lymph nodes simultaneously. S. suis was detected with a detection rate ranging from 13.9% (n=28) in the Nl. ileocolicus to 20.4% in the Nl. cervicalis superficialis dorsalis dexter in all examined lymph nodes including the mesenteric lymph nodes (15.8%; n=121/765), with cps-types 2 or 1/2 38.5% (n=104) and 9 40.0% (n=108) being the most dominating cps types. In the Nl. gastricus, the proportion of S. suis isolates that did not correspond to any of the examined cps types was comparatively high 26.5% (n=9). The results of the present study are limited by the selected study population as no representative sample was examined. Nonetheless, the results highlight the importance of S. suis as a causative agent of arthritis and meningitis in pigs and especially in weaning piglets. There are age-specific differences concerning the frequency of the detectable cps types. In case of systemic infection with detection of the pathogen within multiple locations, the examination of the lymph nodes could not help clarify the portal of entry for S. suis. The results suggest that gastrointestinal translocation may occur in naturally infected pigs, but there are no indications that the gastrointestinal route of infection is of great relevance.

Depression is a common comorbidity in rheumatoid arthritis (RA), yet it may not be adequately recognized during routine clinical care. RA symptoms may confer a risk for depression, and vice versa; depression may affect RA disease activity and response to treatment. The study aims were to compare patient- and physician-reported depression measures, evaluate the temporal bi-directional association between RA disease activity and depressive symptomology, and assess depression as a moderator of RA treatment. Patients were identified using a national RA registry sample (Consortium of Rheumatology Researchers of North America; CORRONA). Depression prevalence and incidence rates were estimated, and concordance and disagreement using measures reported separately by patients and physicians, as well as baseline cross-sectional associations between RA disease and a history of depression. A survival analysis was conducted to temporally predict the incident onset of self-reported depressive symptoms using the different metrics of RA disease activity. Also, mixed effects models were used to assess prospective changes in RA disease activity by prevalent and incident depressive symptom status. Lastly, logistic regression models compared the likelihood of clinical response to RA treatment during follow-up in those with and without depression when starting biologic disease modifying anti-rheumatic drug (DMARD) therapy. Patient-reported depression rates were much higher and significantly different from physician based comorbidity estimates. Patient and physician RA disease activity measures were associated with an increased risk for depression onset, but not laboratory-reported serum biomarkers. Similarly, depression was temporally associated with significantly slower rates of decline regarding every patient-reported disease activity measure, some physician-reported metrics, but not acute phase reactants. Moreover, there was a significantly lower probability of achieving clinical remission among those with depression on a biologic DMARD after 6 months and an analogous effect at 12-months that was slightly lower in magnitude, which did not reach statistical significance. Rheumatologists under-reported the occurrence of prevalent and incident depressive symptoms, and thus are likely unaware of its presence in their RA patients. Further, the results suggest the bi-directional effects between these conditions are related to the cognitive and behavioral aspects of depression and their interactions with disease activity, rather than shared immunological mechanisms in the context of cell-mediated immunity. When also considering the impact on clinical response to biologic DMARDS, the findings collectively imply that rheumatologists must address any challenges due to depression to provide the best care to their patients.

Self-management interventions enhance the health self-management techniques and physical and psychological health outcomes among people with long-term health conditions (LTHCs). Few individuals from South Asian backgrounds attended the pilot phase of one such intervention: the Expert Patients Programme (EPP), a community-based self-management course. This raised concerns about exacerbating health inequalities. South Asian people have increased prevalence and severity of certain musculoskeletal conditions, yet little is known about their experiences of living with and self-managing these. This research aimed to rectify these omissions, by describing Punjabi Sikh women's experiences of living with and self-managing arthritis, and identifying barriers and facilitators to EPP. Three studies explored White and Punjabi Sikh EPP tutors‟ experiences of delivering EPP to South Asian attendees, and Punjabi Sikh women's experiences of living with and self-managing arthritis, both before and after they attended a Punjabi-language EPP. White and Punjabi Sikh tutors' sometimes dichotomous experiences of delivering EPP to South Asians, captured barriers to South Asian people's attendance, engagement and self-management. Facilitators identified included the need for sensitive tailoring of the Course, involving the Punjabi Sikh community. The Punjabi Sikh women's vibrant experiential accounts revealed the detrimental psychological and physical consequences that arthritis had upon their lives. Highly versatile in their proactive arthritis self-management prior to attending EPP, participants' refined techniques encompassed combinations of medication and Indian remedies, empowered by their religious and spiritual values. Following EPP attendance, the participants reported psychological and physical improvements in their arthritis. Thus, this Study established Punjabi Sikh 4 Abstract women's inherent acceptance of the concept of self-management, and, notwithstanding its current limitations, the likely appropriateness of EPP. Every Study represents a novel contribution to knowledge. Meaningful engagement with Punjabi Sikh community-members may produce a culturally-competent intervention that could better improve this group's physical and psychological outcomes, thus addressing one small area of health inequalities.

In this paper, a rheumatoid arthritis (RA) medicine clinical dataset with an ordinal response is selected to study this new medicine. In the dataset, there are four features, sex, age,treatment, and preliminary. Sex is a binary categorical variable with 1 indicates male, and 0 indicates female. Age is the numerical age of the patients. And treatment is a binary categorical variable with 1 indicates has RA, and 0 indicates does not have RA. And preliminary is a five class categorical variable indicates the patient’s RA severity status before taking the medication. The response Y is 5 class ordinal variable shows the severity of patient’s RA severity after taking the medication. The primary aim of this study is to determine what factors play a significant role in determine the response after taking the medicine. First, cumulative logistic regression is applied to the dataset to examine the effect of various factors on ordinal response. Secondly, the ordinal response is categorized into two classes. Then logistic regression is conducted to the RA dataset to see if the variable selection would be different. Moreover, the shrinkage methods, elastic net and lasso are used to make a variable selection on the RA dataset of two-class response for the purpose of adding penalization to increase the model’s robustness.The four model results were compared at the end of the paper. From the comparison result, logistic regression has a better performance on variable selection than the other three approaches based on P-value.

Thesis (M.Tech.:Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2006 xvi, 82 leaves, Annexures A-L / To determine the efficacy of the Harpago and celery seed cream in mild to moderate degenerative joint disease of the knee in terms of subjective and objective clinical findings

No description available.

The effect of synovial membrane products and mechanical pressure upon the metabolism of articular cartilage proteoglycans has been studied in vitro. The degradation of cartilage proteoglycans was studied in an organ culture system and measured as the release of [35S ] sulphate from prelabelled cartilage. The effect of synovial membrane products upon the synthesis of proteoglycans was studied in a chondrocyte monolayer system and the effect of mechanical pressure upon the synthesis of proteoglycans in an organ culture system. In both types of experiments [35S] sulphate was used as precursor. The findings may be summarized as follows 1 Conditioned synovial medium (control-SM) enhanced the degradation and reduced the synthesis of cartilage proteoglycans. In addition the degradation was further enhanced when the synovial tissue had been cultured in the presence of dextran sulphate. 2 Conditioned medium from synovial tissue cultured in the presence of indo-methacin (indo-SM), significantly reduced the synthesis of cartilage proteoglycans in chondrocyte cultures and reduced, although non-significantly, the degradation of proteoglycans in whole cartilage cultures. 3 Addition o f the prostaglandins E1 or E2 (PGE1 or PGE2 ) together with indo-SM to the cartilage cultures greatly enhanced cartilage degradation whereas the addition of PGE1 or PGE2 together with control-SM had no effect compared with that of control-SM alone. 4 Conditioned medium from synovial tissue cultured in the presence of low doses of glucocorticoids reduced cartilage degradation compared with control-SM. However, addition of control-SM together w ith low concentrations of glucocorticoids to the cartilage cultures significantly enhanced cartilage degradation. 5 Conditioned medium from synovial tissue cultured with actinomycin D or cycloheximide did not enhance cartilage degradation compared with cartilage cultured alone. 6 A continuous pressure of approximately 30 kgfcm-2 on cultures of cartilage reduced both the synthesis and the degradation o f cartilage proteoglycans. Although it is difficult to extrapolate from the in vitro to the in vivo situation, it is proposed that some factor(s) from the synovial membrane have the capacity to enhance the degradation and reduce the synthesis o f articular cartilage proteoglycans. From these experiments it cannot be completely excluded that treatm ent of arthritic joints with non-steroidal or streroidal anti-inflammatory drugs may result under certain conditions in enhanced joint damage. It is also suggested that under certain conditions the metabolism o f cartilage proteoglycans could be directly affected by mechanical stress. / <p>Diss. Umeå, Umeå universitet, 1982, härtill 6 uppsatser</p> / digitalisering@umu

Knee osteoarthritis (OA) is the commonest form of lower limb OA with a lifetime risk of over 40%. It is a disease characterised by symptoms such as pain and loss of function. In addition there are typical structural features on both radiographs and MRI. Knee OA represents a spectrum of disease, ranging from early preclinical cartilage change to established full thickness disease. Anteromedial knee OA is a particular phenotype of knee OA where disease is confined to the medial compartment. Whilst end stage arthritis is treated reliably with joint arthroplasty, those with early stage disease are treated with a variety of non- surgical interventions with varying success. This thesis is concerned with understanding the disease of patients that have early radiographic changes but symptoms not controlled by conservative measures. Up to 150 of these patients a year present to the Nuffield Orthopaedic Centre, Oxford. They have been described as being in the “Treatment Gap”. A series of validation studies were performed to determine the optimal method for diagnosing cartilage defects within the knee. The three commonest diagnostic methods were examined for their validity. Arthroscopic assessments of cartilage lesions demonstrated a moderate level of intra and inter observer reliability. In contrast, radiographs and MRI demonstrated high levels of reliability. When using MRI as a criterion standard, both radiographs and arthroscopic assessment were found to have poor accuracy. Based on the work in this thesis a formal definition of the cartilage changes exhibited in early knee OA was proposed. A cross sectional cohort of 100 patients with the symptoms and radiological features of early knee OA were identified. Their pain and function profile was compared to two comparison groups of patients at the end stage of knee OA (defined by the need for partial or total arthroplasty). In up to 78% of individual cases those with early OA had pain and function profiles as bad as those with end stage disease. The cross sectional symptoms of early knee OA demonstrate a marked discordance with their mild radiographic changes. The same cohort was extended to 125 patients. They were followed over one year with monthly PROM assessments to determine how symptoms change over time. 43% of patients experience a clinical improvement over 12 months, 31% experience a clinical deterioration and 26% remain unchanged. The range in OKS variation over 12 months was on average 12 points, with clinically relevant variation occurring on 45% of monthly measurements. Patients with early knee OA can expect to experience considerable variation in their symptoms over 12 months and this must be considered when planning interventions. A number of patients with early knee OA were noticed to demonstrate medial meniscal extrusion. Using data from the Osteo Arthritis Initiative (OAI) a nested case control study was designed to determine how the presence of meniscal extrusion in an otherwise normal knee affects the risk of developing knee OA over the next 48 months. This demonstrated an Odds Ratio of 3.5, suggesting that meniscal extrusion is a considerable risk factor for the development of OA. The presence of a knee injury or operative intervention to the index meniscus was shown to increase this risk. Many phenotypes of OA are known to demonstrate familial aggregation. In an attempt to determine where the earliest structural changes occur in medial compartment knee OA, a cohort of patients selected only for their family history of the disease were developed. This cohort was compared to spouse controls for the presence of knee OA, as well as meniscal extrusion and long leg alignment. In addition, a functional analysis of their cartilage was performed. This cohort was not shown to be at increased risk of disease compared to controls. Discussion of the possible reasons for this finding is presented. Early knee osteoarthritis is a considerable clinical problem. This thesis has aided the understanding of the condition by firstly defining the radiological description of these patients. Secondly, their cross sectional and longitudinal symptom profile have been described for the first time. In addition, the presence of an extruded meniscus has been demonstrated as a substantial risk factor for the disease. Finally, family history has not been demonstrated as a risk factor for the disease within the limits of the study described here. Future work has been proposed.

Background: Inflammation is the natural reaction of the body to an antigen. In some conditions, this reaction continues even after the elimination of the antigen, entering a chronic stage; it targets normal cells of the body and causes extensive damage. Rheumatoid arthritis (RA) is such a condition. It associates with significant metabolic alterations that lead to changes in body composition and especially body fat (BF) increases. In the general population, increased body fat (i.e. obesity) associates with a number of health disorders such as systemic low grade inflammation and a significantly increased risk for cardiovascular disease (CVD). Both effects of obesity could have detrimental effects in RA. Increased inflammation could worsen disease activity while obesity could further increase the already high CVD risk in RA. However, obesity in RA has attracted minimal scientific attention. Aims: The present project aimed to: 1) assess whether the existing measures of adiposity are able to identify the changes in body composition of RA patients, 2) if necessary develop RA-specific measures of adiposity, 3) investigate the association of obesity with disease characteristics and CVD profile of the patients, 4) and identify factors that might affect body weight and composition in these patients. Methods: A total of 1167 volunteers were assessed. Of them 43 suffered from osteoarthritis and 82 were healthy controls. These, together with 516 RA patients were used in the first study. Their body mass index (BMI), BF, and disease characteristics were assessed. In the second, third, fourth and fifth studies a separate set of 400 RA patients was assessed. In addition to the above assessments, their cardiovascular profile and more detailed disease characteristics were obtained. For the final study, 126 RA patients were assessed for all the above and also data on their physical activity levels and their diet were collected. Results: Assessments of adiposity for the general population are not valid for RA patients. Thus, we proposed RA-specific measures of adiposity. These are able to better identify RA patients with increased BF. We were also able to find associations between obesity and disease activity. Both underweight and obese RA patients had more active disease compared to normal-weight patients. Obese patients had significantly worse CVD profile compared to normal-weight. The newly devised measures of adiposity were able to identify those at increased risk. However, not all obese individuals were unhealthy and not all normal-weight healthy. Among our patients we were able to identify subtypes of obesity with distinct phenotypic characteristics that warrant special attention. Finally, we were able to identify factors that influence body weight and composition. Cigarette smoking protected against obesity while its cessation associated with increased adiposity. Physical activity was also found to be protective against obesity while diet or inflammation of the disease failed to produce any significant results. Conclusions: Obesity is a significant threat to the health of RA patients. The measures of adiposity developed herein should be used to identify obese RA patients. Physical activity seems like the sole mode for effective weight management in this population. Health and exercise professionals should actively encourage their patients to exercise as much as they can. This study has created more questions than it answered; further research in the association of obesity and inflammation, as well as in ways to treat it, is essential.

published_or_final_version / Social Work / Master / Master of Social Work