BACKGROUND: Up to 37% of people with knee osteoarthritis (OA) present with varus thrust, an abrupt and dynamic worsening of varus alignment during the load-bearing stages of gait. Varus thrust is associated with up to 4-fold increased odds of medial knee OA progression as well as worsening clinical outcomes. While the implications of varus thrust have been well studied, the neuromuscular factors related to varus thrust are still not well understood and many studies report contradictory findings. Additionally, many potential factors remain unstudied. This warrants further efforts to determine associations between neuromuscular factors and varus thrust. The purpose of this study is to investigate knee muscle strength and muscle activation during walking in relation to biomechanical measures of varus thrust. METHODS: Analyses of existing data from participants with and without knee OA recruited at three institutions were used for this study. All participants underwent gait analyses at their self-selected pace while kinematics, kinetics, and surface EMG data were collected. Quadriceps and hamstrings strength was measured using isokinetic dynamometry. Gait data were used to calculate adduction excursion and peak knee adduction velocity as measures of varus thrust. A custom MATLAB code was used to calculate the rate of force development of the quadriceps, and a muscular co-contraction equation was used to calculate co-contraction values for four antagonist muscle pairs (VL-LH, VM-MH, VL-LG, and VM-MG) from surface EMG data during walking. Correlational analyses were performed to assess associations of strength, rate of force development, and muscle co-contraction variables with measures of varus thrust. RESULTS: A total of 183 participants were enrolled, however, a varying number of participants were used for different analyses based on available data. Peak isokinetic quadriceps strength at 60 degrees/second and peak hamstrings strength at both 60 and 120 degrees/second were negatively correlated with knee adduction velocity in people with knee OA. This association was not observed for people without knee OA. VLLH and VMMH co-contraction indices during preactivation were positively correlated with knee adduction excursion. VLLG co-contraction during midstance was positively correlated with peak knee adduction velocity. Association between rate of force development and varus thrust variables was not significant. CONCLUSIONS: Lower isokinetic thigh muscle strength and greater preactivation during walking are related to greater magnitude of varus thrust measured using motion capture. These results advance our understanding of neuromuscular factors related to varus thrust and could inform future interventions to reduce thrust and prevent further progression of OA. / 2020-06-14T00:00:00Z

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21460号 / 人健博第67号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 杉本 直三, 教授 藤井 康友, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21672号 / 医博第4478号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 上杉 志成 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Medicine, Johannesburg, 2017 / Objective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients. / XL2018

Little research has focused on the involvement of oxidative stress as it relates to the pathophysiology of osteoarthritis (OA); while inflammation has been extensively studied. The present study evaluates the ability to modulate the response of canine chondrocytes to both inflammation and oxidative stress in an in-vitro model. Chondrocytes were incubated and then stimulated to under-go oxidative stress by using hydrogen peroxide or inflammation using interleukin-1 beta and tumor necrosis factor alpha. For inhibition of oxidative stress an antioxidant, N-acetyl-cysteine, was used prior to induction with hydrogen peroxide in a subset of chondrocytes. Measures of oxidative stress were superoxide dismutase and reduced glutathione. Prostaglandin E2 was used as a measurement of inflammation. Chondrocytes responded appropriately to both oxidative stress and inflammation. The antioxidant N-acetyl-cysteine provided adequate protection against oxidative stress. Oxidative stress and inflammation should be considered to play a role in the pathophysiology of canine OA.

Kreuzbandrupturen stellen nach wie vor eine Herausforderung in der klinischen Praxis hinsichtlich kurz- und langfristiger unerwünschter Nebenwirkungen dar (z.B. Reruptur und Arthrosebildung). In der vorliegenden Arbeit wird der entwickelte Ansatz eines Kollagen-I-basierten künstlichen Kreuzbandkonstruktes hinsichtlich der Reißfestigkeit, Lagerung, Verstärkungsmöglichkeit mittels Fiber-tape und langfristigen Arthroseentstehung untersucht mittels in-vitro und in-vivo Untersuchungen unter zur Hilfe nahme des Minipig Tiermodels. Die Ergebnisse zeigen keinen Einfluss der Lagerungstemperatur sowie des Lagerungszeitraums auf die Reißfestigkeit des Konstruktes, sowie eine mögliche initiale Verstärkung mittels Fibertape im Minipig. Darüber hinaus wurde mikroskopisch wie makroskopische Arthroseentstehung nachgewiesen. Das Ausmaß der Arthroseentstehung ist diesbezüglich mit einer Abweichung der Konstruktimplantation von der ursprünglichen Kreuzbandinsertion mittels MRT bestätigt worden. / Cruciate ligament ruptures remain a challenge in clinical practice with regard to short- and long-term undesirable side effects (e.g. rerupture and osteoarthritis formation). In the present study, the developed approach of a collagen-I-based artificial cruciate ligament construct is investigated with regard to tear strength, storage, reinforcement possibility by means of fibre-tape and long-term arthrosis development by means of in vitro and in vivo investigations using the Minipig animal model. The results show no influence of the storage temperature and the storage period on the tensile strength of the construct, as well as a possible initial reinforcement by means of fibre-tape in the Minipig. Furthermore, both microscopic and macroscopic osteoarthritis was detected. The extent of osteoarthritis development was confirmed in this regard with a deviation of the construct implantation from the original cruciate ligament insertion by means of MRI.

Book Summary: Serves the needs of advanced practice nurses because it’s written by nurse practitioners for nurse practitioners, in collaboration with a physician. Organizes content around the Circle of Caring framework for nursing-based knowledge and holistic care. Explores complementary and alternative treatments for each disorder. Covers the broadest range of human disease and disorders using a systems-based approach, presenting both common complaints and common problems to help students narrow down the possible differentials to the most likely diagnosis. Considers interactions of pharmaceuticals with alternative medications and nutraceuticals. Features coverage of pathophysiology and diagnostic reasoning as well as up-to-date guidance on laboratory and diagnostic tests. Emphasizes evidence-based practice with information on evidence levels and more references to primary studies. Integrates discussions of health policy and primary care throughout the text.

Introduction: Hand osteoarthritis (OA) is characterized by gradual destruction of cartilage in the joints of the hand. It is commonly characterized by pain, reduced grip strength, stiffness, and reduced pinch strength, resulting in difficulty performing basic daily tasks. Pharmacological and non-pharmacological practices are employed for hand OA treatment. Many research has been conducted on the effectiveness of treating hand OA using pharmacological and non-pharmacological practices. However, not many studies are carried out to review the effectiveness of those treatment processes, especially the non-pharmacological practices. In this thesis, I systematically review the literature to evaluate and analyze the existing non-pharmacological interventions to provide evidence-based knowledge of existing hand OA treatments. Methods:  PRISMA guidelines were used to design the study selection protocol. The identification of non-pharmacological treatments was performed using PubMed, Scopus, PEDro, Cochrane Library, and Web of Science. Initially, 268 articles were selected through a search process. Following the selection procedure, 10 articles were chosen to address the research question. The PEDro scale was used to assess the methodological quality and eligibility of the selected studies.  Result:  In the selected studies, a variety of interventions were examined for managing hand OA, such as exercise therapy, blood flow resistance training (BFRT), high intensity training (HIT)), patient education, conservative therapies (education, splints, and hand exercises), splinting. Other interventions such as paraffin therapy and kinesio taping (KT) and functional consultation were also employed. The selected studies examined pain, grip strength, hand function, pinch strength, and stiffness.  Conclusion: Based on the selected studies, it is found that non-pharmacological rehabilitative intervention has a significant impact on pain, grip strength, hand function, pinch strength, and stiffness.  BFRT and HIT are the two most feasible options for individuals with hand OA that relieve pain, grip strength and hand function and achieve the clinical outcomes that were previously set or examined by the physician.  Additionally, KT combined with paraffin therapy, splinting, and hand exercises can also significantly decrease pain and improve pinch strength, grip strength.

Age estimation techniques have utilized cranial suture closure, the sternal rib ends, the auricular surface, and the pubic symphysis, each with varying degrees of success. Although recent research has attempted to advance methodologies for age estimation, little progress has been made in discerning forensic age ranges that are beyond general estimates, especially in the old adult (50+) cohort. Since the accuracy of current aging methods decreases as chronological age increases, degenerative changes within the skeleton could potentially yield useful data for establishing and narrowing age estimates for older individuals, especially where only limited or fragmentary remains are recovered. The purpose of the present study was to conduct a visual examination of joint surfaces typically found to be affected by osteoarthritis (OA) by the fourth decade of life using a modified version of the OA scoring system proposed by Buikstra and Ubelaker (1994). According to archaeological, forensic, and clinical research, OA is most commonly found in the shoulder, hip, and knee, making these joints ideal for use in the present study. Within these three joints, ten osseous surfaces were examined: the acromial facet of the scapula, the glenoid fossa of the scapula, the lateral clavicle, the humeral head, the acetabulum of the os coxa, the femoral head, the medial and lateral femoral condyles, and the medial and lateral facets of the patella. Evidence of lipping, surface porosity, osteophyte formation, and eburnation were recorded on an ordinal scale, along with the percentage of the joint surface that was covered by each of the aforementioned traits. The data gathered from this examination were used to create a composite scoring system for age–at–death estimation using a modern North American sample of 206 White individuals from the W. M. Bass Donated Skeletal Collection and the Boston University Donated Osteological Collection. Significance testing indicated that sex differences were not present in the current analysis. A paired-sample t–test determined that the sample was affected with statistically significant levels of bilateral asymmetry. In addition, the current method is affected by low levels of intraobserver error, with only 5% of the sample being affected. Pearson's and Spearman's correlation coefficient were used to examine the relationship between a selected variable and age. The results of the present study indicate that OA has a positive correlation with age, although some joints show weaker associations than others. The right shoulder showed the highest correlation with age (r = 0.776, rs = 0.769; p < 0.01), followed closely by the left shoulder (r = 0.753, rs = 0.753; p < 0.01). The next highest correlation with age was observed for the left knee (r = 0.545, rs = 0.568; p < 0.01), followed by the right knee (r = 0.459, rs = 0.459; p < 0.01). The lowest correlation was observed in the left hip (r = 0.414, rs = 0.377; p < 0.01) and right hip (r = 0.476, rs = 0.377; p < 0.01). Data from multiple joint surfaces were combined for statistical analysis to create composite variables for each joint. The composite variables are combinations of traits for each joint that stepwise regression demonstrated as the best indictors for narrowing prediction intervals. This created a series of composite scores for the left shoulder, right shoulder, left hip, right hip, left knee and right knee. Individual prediction intervals at the 90% confidence interval were generated to create age ranges for each composite score. The mean age and frequency of each composite score was also recorded. This multifactorial approach demonstrated that the left and right shoulders provided the narrowest prediction intervals and also possessed the highest predictive power for estimating age-at-death. Relative predictive power was determined using R^2. The R^2 value for the right shoulder was the highest at 0.603, followed closely by the left shoulder with an R^2 value of 0.567. The R^2 value for all remaining variables was less than 0.3, indicating weak predictive power. The results of the present study were then compared to the four traditional macroscopic aging techniques: suture closure, morphology of the sternal rib ends, morphology of the auricular surface and the pubic symphysis. Sample distribution, correlation data, derived age ranges and error rates were compared between previous research and the results of the present study. All age estimation techniques demonstrated a positive correlation with age. Age ranges that were derived using Bayesian statistics or individual prediction intervals are more accurate at predicting actual age than those that were generated using confidence intervals of the mean, which provide information for mean age rather than actual age. In addition, the relationship between bone density and survivability of elements is discussed. It was determined that the skeletal elements utilized in traditional macroscopic aging are prone to breakage and loss based on their bone mineral density and location within the skeleton. In contrast, the proposed method utilized areas of the skeleton which are not typically examined for aging yet are likely to survive destruction from common taphonomic forces, making the use of OA in fragmentary or damaged contexts possible. Future research is needed to address the effects of ancestral variation and interobserver on the proposed method.

The knee is the most common site of osteoarthritis (OA) and is one of the leading causes of disability in older adults affecting over 53 million people in the United States and more than 302 million people worldwide. These numbers are only expected to grow because of the rise of diseases such as obesity, demographic shifts to an older population, and a more sedentary lifestyle. The rise of obesity and a more sedentary lifestyle comes with increases in joint loading which along with the aging population creates worse outcomes in proprioception. All of which can contribute to worsening OA. Despite the great costs to quality of life and society, there is no cure for OA. Only treatments exist to treat the symptoms of OA; and since knee pain is one of the most common symptoms of OA, it is a powerful driver for treatment because of the disruptive nature it can have on quality of life. Therefore, many treatments focus on pain relief and exercise to reduce the pain and worsening of OA. Radio frequency nerve ablation (RFA) is a procedure that is increasingly being performed for those who want an alternative before resorting to or are not a good match for total knee arthroplasty (TKA). Because RFA is minimally invasive, it can be performed on an outpatient basis and has been shown to be effective in reducing pain for at least 24 months for most patients. Despite the benefits in pain reduction, little is known about the biomechanical effects of RFA and its consequences on proprioception. However, based on prior studies into the pain relieving effects of interventions such as celecoxib or HA injections, we can hypothesize that with a decrease in pain, knee loading increases. Therefore, the pain relieving effects of RFA may increase the incidence of OA. Furthermore, because the RFA procedure involves ablating nerves that carry sensory information, changes to proprioception are expected. However, currently there is no information regarding its effect on proprioception. Again, using prior research that studies the consequences of reduced proprioception on those with OA, we can hypothesize that with RFA, proprioception would be further reduced compared to the reductions experienced by people with OA already, and it may also lead to worsening OA outcomes. Despite the possible issue of worsening OA outcomes with RFA, the pain relieving effects cannot be discounted as it is one of the most disruptive symptoms of OA. Therefore, effects of RFA on knee biomechanics and proprioception should be studied to understand the long-term impacts of this procedure.