It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee ...osteoarthritis (ROA).
The participants in this nested case-control study were selected from persons in the Osteoarthritis Initiative with knees that had a Kellgren Lawrence grading (KLG)=0 at baseline (BL). These knees were evaluated annually with radiography and non-contrast-enhanced MRI over 4 years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by ROA (KLG≥2) on the postero-anterior knee radiographs at any assessment after BL. Radiographs were assessed at P0 (time of onset of ROA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from BL to 48 months).
133 knees of 120 persons with ROA (83 women) were matched to 133 control knees (83 women). ORs for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and P0 were 1.56 (95% CI 0.86 to 2.81), 3.23 (1.72 to 6.06) and 4.7 (1.10 to 2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1 to 2.95), 2.47 (1.45 to 4.23) and 2.40 (1.43 to 4.04), respectively.
Effusion-synovitis and Hoffa-synovitis strongly predicted the development of iROA.
Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously ...attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol <300 nmol/L were empirically treated with iv hydrocortisone.
Main Outcome Measures:
Plasma sodium concentration was recorded daily along with a variety of clinical and biochemical criteria. The cause of hyponatremia was determined clinically. Later measurement of plasma AVP and BNP concentrations enabled a firm biochemical diagnosis of the cause of hyponatremia to be made.
Results:
Forty-nine of 100 developed hyponatremia <135 mmol/L, including 14/100 <130 mmol/L. The cause of hyponatremia, and determined by both clinical examination and biochemical hormone measurement, was SIAD in 36/49 (71.4%), acute glucocorticoid insufficiency in 4/49 (8.2%), incorrect iv fluids in 5/49 (10.2%), and hypovolemia in 5/49 (10.2%). There were no cases of CSWS.
Conclusions:
The most common cause of hyponatremia after acute nontraumatic aneurysmal SAH is SIAD. Acute glucocorticoid insufficiency accounts for a small but significant number of cases. We found no cases of CSWS.
Context:
Published data demonstrates that hypopituitarism is common after traumatic brain injury (TBI). Hormone deficiencies are transient in many, but the natural history of the acute changes after ...TBI has not been documented. In addition, it is not clear whether there are any early parameters that accurately predict the development of permanent hypopituitarism.
Objectives:
There were 3 main objectives of this study: 1) to describe the natural history of plasma cortisol (PC) changes and sodium balance after TBI; 2) to identify whether acute hypocortisolemia or cranial diabetes insipidus (CDI) predict mortality; and 3) to identify whether the acute pituitary dysfunction predicts the development of chronic anterior hypopituitarism.
Design:
Each TBI patient underwent sequential measurement of PC, plasma sodium, urine osmolality, and fluid balance after TBI. All other anterior pituitary hormones were measured on day 10 after TBI. The results from 15 surgical comparisons defined a PC less than 300 nmol/L as inappropriately low for an acutely ill patient. CDI was diagnosed according to standard criteria. Surviving TBI patients underwent dynamic anterior pituitary testing at least 6 months after TBI.
Setting:
The patients were recruited from the Irish National Neurosurgery Centre.
Patients:
One hundred sequential TBI patients were recruited. Fifteen patients admitted to Intensive Therapy Unit (ITU) after major surgery were recruited as comparison patients.
Main Outcome Measures:
PC in TBI patients was compared with that of comparison patients. The mortality rate was compared between TBI patients with and without acute hypocortisolemia. Results of follow-up dynamic pituitary testing were compared between those with and without acute hypocortisolemia.
Results:
Most of the TBI patients (78%) developed inappropriately low PC after TBI. Low PC and CDI were predictive of mortality. Thirty-nine percent of the patients who had follow-up testing had at least 1 pituitary hormone deficit, all of whom had had previous acute hypocortisolemia or CDI.
Conclusions:
Acute hypocortisolemia and CDI are predictive of mortality and long-term pituitary deficits in TBI.
Hyponatraemia is the commonest electrolyte abnormality found in hospital inpatients, and is associated with a greatly increased morbidity and mortality. The syndrome of inappropriate antidiuretic ...hormone (SIADH) is the most frequent cause of hyponatraemia in hospital inpatients. SIADH is the clinical and biochemical manifestation of a wide range of disease processes, and every case warrants investigation of the underlying cause. In this review, we will examine the prevalence, pathophysiology, clinical characteristics and clinical consequences of hyponatraemia due to SIADH.
Our aim was to introduce a simplified MRI instrument, Rapid OsteoArthritis MRI Eligibility Score (ROAMES), for defining structural eligibility of patients for inclusion in disease-modifying ...osteoarthritis drug trials using a tri-compartmental anatomic approach that enables stratification of knees into different structural phenotypes and includes diagnoses of exclusion. We also aimed to define overlap between phenotypes and determine reliability.
50 knees from the Foundation for National Institutes of Health Osteoarthritis Biomarkers study, a nested case-control study within the Osteoarthritis Initiative, were selected within pre-defined definitions of phenotypes as either inflammatory, subchondral bone, meniscus/cartilage, atrophic or hypertrophic. A focused scoring instrument was developed covering cartilage, meniscal damage, inflammation and osteophytes. Diagnoses of exclusion were meniscal root tears, osteonecrosis, subchondral insufficiency fracture, tumors, malignant marrow infiltration and acute traumatic changes. Reliability was determined using weighted kappa statistics. Descriptive statistics were used for determining concordance between the a priori phenotypic definition and ROAMES and overlap between phenotypes.
ROAMES identified 43 of 50 (86%) pre-defined phenotypes correctly. Of the 50 participants, 27 (54%) had no additional phenotypes other than the pre-defined phenotype. 18 (36%) had one and 5 (10%) had two additional phenotypes. None had three or four additional phenotypes. All features of ROAMES showed almost perfect agreement. One case with osteonecrosis and one with a tumor were detected.
ROAMES is able to screen and stratify potentially eligible knees into different structural phenotypes and record relevant diagnoses of exclusion. Reliability of the instrument showed almost perfect agreement.
In the UK a significant proportion of Multi-Owned Properties (MoPs) – characterised by buildings segmented into individually owned flats – must undergo retrofitting to achieve net zero emissions. ...Despite this requirement, advancement has been minimal, with existing government policy failing to consider a pivotal role of social dynamics among residents in the retrofit decision-making process. This research adopts an innovative perspective grounded in relational sociology, leveraging Viviana A. Zelizer's concept of ‘relational work’ and integrating two of the three types of social relations identified by Hargreaves and Middlemiss' (intimacy and institutions) to dissect the retrofit challenges faced by owners of historic MoPs in South Glasgow, UK. The study reveals that the necessity for heightened relational work among property owners acts as a barrier to retrofit initiative. Nevertheless, it identifies potential pathway to invigorate the retrofit sector by enhancing neighbourly connections and recognising the influential, yet underexplored, role of property managers in facilitating retrofit activities within MoPs. This inquiry not only underscores the significance of social relations in environmental retrofit projects but also suggests a re-evaluation of policy frameworks to accommodate the social intricacies inherent in MoPs, thereby fostering a more conducive environment for achieving net-zero targets.
•Progress is minimal for retrofit in Multi-owned properties (MoPs).•Current policies ignore social dynamics in retrofit decision-making.•Relational sociology holds promise for the retrofit challenge in historic MoPs.•Better connecting key retrofit actors drives retrofit progress in MoPs.
To investigate whether infrapatellar fat pad (IPFP) signal intensity (SI) alteration predicts the occurrence of knee replacement (KR) in knee osteoarthritis (OA) patients over 5 years.
The subjects ...were selected from Osteoarthritis Initiative (OAI) study. Case knees (n = 127) were defined as those who received KR during 5 years follow-up visit. They were matched by gender, age and radiographic status with control knees (n = 127). We used T2-weighted MR images to measure IPFP SI alteration using a newly developed algorithm in MATLAB. The measurements were assessed at baseline (BL), T0 (the visit just before KR) and 1 year before T0 (T-1). Conditional logistic regression was used to analyse the associations between IPFP SI alterations and the risk of KR.
Participants were mostly female (57%), with an average age of 63.7 years old and a mean body mass index (BMI) of 29.5 kg/m2. In multivariable analysis, the standard deviation (SD) of IPFP SI sDev (IPFP) and the ratio of high SI region volume to whole IPFP volume Percentage (H) measured at BL were significantly associated with increased risks of KR after adjustment for covariates. IPFP SI alterations measured at T-1 including sDev (IPFP), Percentage (H) and clustering effect of high SI Clustering factor (H) were significantly associated with higher risks of KR. All measurements were significantly associated with higher risks of KR at T0.
IPFP SI is associated with the occurrence of KR suggesting it may play a role in end-stage knee OA.
Evaluate associations between 2-year change in radiographic or quantitative magnetic resonance imaging (qMRI) structural measures, and knee replacement (KR), within a subsequent 7-year follow-up ...period.
Participants from the Osteoarthritis Initiative were selected based on potential eligibility criteria for a disease-modifying osteoarthritis (OA) drug trial: Kellgren–Lawrence grade 2 or 3; medial minimum joint space width (mJSW) ≥2.5 mm; knee pain at worst 4–9 in the past 30 days on an 11-point scale, or 0–3 if medication was taken for joint pain; and availability of structural measures over 2 years. Mean 2-year change in structural measures was estimated and compared with two-sample independent t-tests for KR and no KR. Area under the receiver operating characteristic curve (AUC) was estimated using 2-year change in structural measures for prediction of future KR outcomes.
Among 627 participants, 107 knees underwent KR during a median follow-up of 6.7 years after the 2-year imaging period. Knees that received KR during follow-up had a greater mean loss of cartilage thickness in the total femorotibial joint and medial femorotibial compartment on qMRI, as well as decline in medial fixed joint space width on radiographs, compared with knees that did not receive KR. These imaging measures had similar, although modest discrimination for future KR (AUC 0.62, 0.60, and 0.61, respectively).
2-year changes in qMRI femorotibial cartilage thickness and radiographic JSW measures had similar ability to discriminate future KR in participants with knee OA, suggesting that these measures are comparable biomarkers/surrogate endpoints of structural progression.
Luminescence monitoring of DNA intercalator complexes is important for assessing their localisation and targeting: We report herein a luminescent hetero-trimetallic complex with europium as a ...luminescent reporter and two attached platinum acetylide terpyridyl units as the DNA recognition units. The ligand, based on a bisamide derivative of diethylenetriaminepentaacetic acid functionalized with two ethynyl groups, provides a backbone to anchor two platinum terpyridyl units, Pt-tpy, leading to the hairpin-shaped heterometallic complex 1. We also prepared a related mono-nuclear platinum complex 2 to compare its intercalation properties with 1. Linear dichroism, UV–visible and melting experiments show the ability of both complexes to interact with calf thymus DNA, with linear dichroism confirming intercalation and demonstrating the expected greater DNA stiffening by the bis-intercalator 1. Importantly, the tri-metallic complex 1 shows a three-fold enhancement in europium luminescence upon addition of calf thymus DNA; other mono-intercalator lanthanide designs have commonly shown a decrease in emission on binding. The ability of the complex to monitor DNA interactions gives the potential use as a luminescence switch in sensing experiments and highlights the design of heterometallic bis-intercalator complexes as an effective approach for DNA-responsive sensitisation of a lanthanide luminescence signal.
Enhanced europium luminescence signal upon DNA bis-intercalation of a trimetallic europium-diplatinum complex. Display omitted
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