Objective
National estimates of arthritis prevalence rely on a single survey question about doctor‐diagnosed arthritis without using survey information on joint symptoms, even though some subjects ...with only the latter have been shown to have arthritis. The sensitivity of the current surveillance definition is only 53% and 69% in subjects ages 45–64 years and ages ≥65 years, respectively, resulting in misclassification of nearly one‐half and one‐third of subjects in those age groups. This study was undertaken to estimate arthritis prevalence based on an expansive surveillance definition that is adjusted for the measurement errors in the current definition.
Methods
Using the 2015 National Health Interview Survey, we developed a Bayesian multinomial latent class model for arthritis surveillance based on doctor‐diagnosed arthritis, joint symptoms, and whether symptom duration exceeded 3 months.
Results
Of 33,672 participants, 19.3% of men and 16.7% of women ages 18–64 years and 15.7% of men and 13.5% of women ages ≥65 years affirmed joint symptoms without doctor‐diagnosed arthritis. The measurement error–adjusted prevalence of arthritis was 29.9% (95% Bayesian probability interval 95% PI 23.4–42.3) in men ages 18–64 years, 31.2% (95% PI 25.8–44.1) in women ages 18–64 years, 55.8% (95% PI 49.9–70.4) in men ages ≥65 years, and 68.7% (95% PI 62.1–79.9) in women ages ≥65 years. Arthritis affected 91.2 million adults (of 247.7 million; 36.8%) in the US in 2015, which included 61.1 million persons between 18 and 64 years of age (of 199.9 million; 30.6%). Our arthritis prevalence estimate was 68% higher than the previously reported national estimate.
Conclusion
Arthritis prevalence in the US population has been substantially underestimated, especially among adults younger than 65 years of age.
ObjectivesAlthough treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive ...tissues may be involved.MethodsUsing data from the Osteoarthritis Initiative, we quantified the relation between cartilage loss and worsening knee pain after adjusting for bone marrow lesions (BMLs) and synovitis, and examined how much these factors mediated this association. 600 knee MRIs were scored at baseline, 12 months and 24 months for quantitative and semiquantitative measures of OA structural features. We focused on change in medial cartilage thickness using an amount similar to that seen in recent trials. Linear models calculated mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score with cartilage loss, adjusted for baseline BMLs, synovitis and covariates. Mediation analysis tested whether change in synovitis or BMLs mediated the cartilage loss–pain association. We carried out a subanalysis for knees with non-zero baseline WOMAC pain scores and another for non-valgus knees.ResultsCartilage thickness loss was significantly associated with a small degree of worsening in pain over 24 months. For example, a loss of 0.1 mm of cartilage thickness over 2 years was associated with a 0.32 increase in WOMAC pain (scale 0–20). The association of cartilage thickness loss with pain was mediated by synovitis change but not by BML change. Subanalysis results were similar.ConclusionsCartilage thickness loss is associated with only a small amount of worsening knee pain, an association mediated in part by worsening synovitis. Demonstrating that chondroprotection reduces knee pain will be extremely challenging and is perhaps unachievable.
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Design of bioactive scaffolds with osteogenic capacity is a central challenge in cell-based patient-specific bone tissue engineering. Efficient and spatially uniform seeding of (stem) ...cells onto such constructs is vital to attain functional tissues. Herein we developed heparin functionalized collagen gels supported by 3D printed bioceramic scaffolds, as bone extracellular matrix (ECM)-mimetic matrices. These matrices were designed to enhance cell seeding efficiency of mesenchymal stem cells (MSCs) as well as improve their osteogenic differentiation through immobilized bone morphogenic protein 2 (BMP2) to be used for personalized bone regeneration.
A 3D gel based on heparin-conjugated collagen matrix capable of immobilizing recombinant human bone morphogenic protein 2 (BMP2) was synthesized. Isolated dental pulp Mesenchymal stem cells (MSCs) were then encapsulated into the bone ECM microenvironment to efficiently and uniformly seed a bioactive ceramic-based scaffold fabricated using additive manufacturing technique. The designed 3D cell-laden constructs were comprehensively investigated trough in vitro assays and in vivo study.
In-depth rheological characterizations of heparin-conjugated collagen gel revealed that elasticity of the matrix is significantly improved compared with freely incorporated heparin. Investigation of the MSCs laden collagen-heparin hydrogels revealed their capability to provide spatiotemporal bioavailability of BMP2 while suppressing the matrix contraction over time. The in vivo histology and real-time polymerase chain reaction (qPCR) analysis showed that the designed construct supported the osteogenic differentiation of MSCs and induced the ectopic bone formation in rat model.
The presented hybrid constructs combine bone ECM chemical cues with mechanical function providing an ideal 3D microenvironment for patient-specific bone tissue engineering and cell therapy applications. The implemented methodology in design of ECM-mimetic 3D matrix capable of immobilizing BMP2 to improve seeding efficiency of customized scaffolds can be exploited for other bioactive molecules.
Purpose
The safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer ...protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination.
Methods
A comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines.
Results
Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3–21 days) and 10.0 days (ranged: 1–60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5–37 days) and 14.0 days (ranged: 2–35 days) after vaccination, respectively.
Conclusion
Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.
Context.
The physical conditions leading the sunspot penumbra decay are poorly understood so far.
Aims.
We investigate the photospheric magnetic and velocity properties of a sunspot penumbra during ...the decay phase to advance the current knowledge of the conditions leading to this process.
Methods.
A penumbral decay was observed with the CRISP instrument at the Swedish 1 m Solar Telescope on 2016 September 4 and 5 in the active region NOAA 12585. During these days, full-Stokes spectropolarimetric scans along the Fe
I
630 nm line pair were acquired over more than one hour. We inverted these observations with the VFISV code to obtain the evolution of the magnetic and velocity properties. We complement the study with data from instruments on board the Solar Dynamics Observatory and Hinode space missions.
Results.
The studied penumbra disappears progressively in time and space. The magnetic flux evolution seems to be linked to the presence of moving magnetic features (MMFs). Decreasing Stokes
V
signals are observed. Evershed flows and horizontal fields were detected even after the disappearance of the penumbral sector.
Conclusions.
The analyzed penumbral decay seems to result from the interaction between opposite polarity fields in type III MMFs and penumbra, while the presence of overlying canopies regulates the evolution in the different penumbral sectors.
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•A bone extracellular-mimetic platform for osteogenic differentiation of DPCs was designed.•A combinatorial scaffold fabrication approach based on 3D-printing technique and ...freeze-drying method was employed.•The fabricated 3D-printed β-TCP/Collagen hybrid constructs showed great promise to harness DPSCs capacity toward craniomaxillofacial bone regeneration.
A systematic characterization of hybrid scaffolds, fabricated based on combinatorial additive manufacturing technique and freeze-drying method, is presented as a new platform for osteoblastic differentiation of dental pulp cells (DPCs).
The scaffolds were consisted of a collagenous matrix embedded in a 3D-printed beta-tricalcium phosphate (β-TCP) as the mineral phase. The developed construct design was intended to achieve mechanical robustness owing to 3D-printed β-TCP scaffold, and biologically active 3D cell culture matrix pertaining to the Collagen extracellular matrix. The β-TCP precursor formulations were investigated for their flow-ability at various temperatures, which optimized for fabrication of 3D printed scaffolds with interconnected porosity. The hybrid constructs were characterized by 3D laser scanning microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and compressive strength testing.
The in vitro characterization of scaffolds revealed that the hybrid β-TCP/Collagen constructs offer superior DPCs proliferation and alkaline phosphatase (ALP) activity compared to the 3D-printed β-TCP scaffold over three weeks. Moreover, it was found that the incorporation of TCP into the Collagen matrix improves the ALP activity.
The presented results converge to suggest the developed 3D-printed β-TCP/Collagen hybrid constructs as a new platform for osteoblastic differentiation of DPCs for craniomaxillofacial bone regeneration.
Abstract
We analyzed state-of-the-art observations of the solar atmosphere to investigate the dependence of the Ca
ii
K brightness of several solar features on spectral bandwidth and spatial ...resolution of the data. In particular, we study data obtained at the Swedish Solar Telescope with the Crisp Imaging Spectropolarimeter and Chromospheric Imaging Spectrometer instruments. The analyzed data, which are characterized by a spectral bandwidth of 0.12 Å and a spatial resolution of 0.″078, were acquired close to the disk center by targeting a quiet-Sun area and an active region. We convolved the original observations with Gaussian kernels to degrade their spectral bandwidth and spatial resolution to the instrumental characteristics of the most prominent series of Ca
ii
K observations available to date. We then studied the effect of data degradation on the observed regions and on parameters derived from Ca
ii
K line measurements that are largely employed as diagnostics of the solar and stellar chromospheres. We find that the effect of degrading the spectral resolution of Ca
ii
K observations and line profiles depends on both the employed bandwidth and observed solar region. Besides, we found that the spatial degradation impacts the data characterized by a broad bandwidth to a larger extent compared to those acquired with a narrow band. However, the appearance of the observed solar regions is only slightly affected by the spatial resolution of data with bandwidths up to 1 Å and in the range 3,10 Å. Finally, we derived relationships that can be used to intercalibrate results from observations taken with different instruments in diverse regions of the solar atmosphere.
Objective
Knee replacement (KR) rates are increasing exponentially in the US and straining insurance budgets. This study was undertaken to investigate how many KRs would be prevented at different ...levels of pain improvement, a major target of osteoarthritis (OA) trials.
Methods
We used data from the Osteoarthritis Initiative (OAI) to emulate a trial of knee pain interventions on KR risk changes. We modeled hypothetical 1‐, 2‐ or 3‐unit reductions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale whenever a person reported a pain score of ≥5 (of 20) in an affected knee at any clinic visit. We used causal inference–based targeted learning to estimate treatment effects for hypothesized pain intervention strategies adjusted for time‐dependent confounding. Sensitivity analyses assessed interventions at WOMAC pain scores of ≥4 and ≥7.
Results
Of the 9,592 knees studied (n = 4,796 participants; 58.5% female; baseline age 61.2 years), 40.7% experienced WOMAC pain scores of ≥5. The estimated knee‐level (reference) risk of a KR, adjusted for loss to follow‐up and death, was 6.3% (95% confidence interval 5.0, 7.7%) in the OAI. Reductions of WOMAC pain scores by 1, 2, or 3 units decreased the KR risk from 6.3% to 5.8%, 5.3%, and 4.9%, respectively. Larger reductions in KR risk were achieved when interventions were applied at a WOMAC pain score of ≥4.
Conclusion
Modest pain reductions from OA interventions would substantially reduce the number of KRs, with greater reductions achieved when pain decreased more and when interventions were introduced at lower pain levels.
OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from ...2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio PTTR, 1.42; 95% confidence interval CI, 1.39-1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44-3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42-1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68-2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584-589.
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