Arthritis Conditions Research Articles

Review of Wearable Sensor-Based Health Monitoring Glove Devices for Rheumatoid Arthritis.

Early detection of Rheumatoid Arthritis (RA) and other neurological conditions is vital for effective treatment. Existing methods of detecting RA rely on observation, questionnaires, and physical measurement, each with their own weaknesses. Pharmaceutical medications and procedures aim to reduce the debilitating effect, preventing the progression of the illness and bringing the condition into remission. There is still a great deal of ambiguity around patient diagnosis, as the difficulty of measurement has reduced the importance that joint stiffness plays as an RA identifier. The research areas of medical rehabilitation and clinical assessment indicate high impact applications for wearable sensing devices. As a result, the overall aim of this research is to review current sensor technologies that could be used to measure an individual’s RA severity. Other research teams within RA have previously developed objective measuring devices to assess the physical symptoms of hand steadiness through to joint stiffness. Unfamiliar physical effects of these sensory devices restricted their introduction into clinical practice. This paper provides an updated review among the sensor and glove types proposed in the literature to assist with the diagnosis and rehabilitation activities of RA. Consequently, the main goal of this paper is to review contact systems and to outline their potentialities and limitations. Considerable attention has been paid to gloved based devices as they have been extensively researched for medical practice in recent years. Such technologies are reviewed to determine whether they are suitable measuring tools.

RANKL Signaling Pathway: A Potential Target for Antiresorptive Therapy in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic polyarthritic autoimmune condition characterized by severe bone erosion. Osteoclasts, the bone resorbing cells, Rheumatoid arthritis (RA) is a chronic polyarthritic autoimmune condition characterized by severe bone erosion. Osteoclasts, the bone resorbing cells, are overly produced from the synovial inflammatory tissues in RA leading to excessive bone loss. RANKL-signaling pathway has been established to be the major pathway involved in osteoclastogenesis. This review highlights the role of around 40 osteoclastogenic factors involved in RANKL signaling and their potential to be targeted for antiresorptive therapy in RA. Furthermore, inhibitors of these proteins, which are already known to exhibit antiresorptive potential, have been reviewed. Elucidating new potential candidate therapeutic targets in the osteoclastogenesis pathway will open new avenues into the treatment and diagnosis of the arthritic conditionsare overly produced from the synovial inflammatory tissues in RA leading to excessive bone loss. RANKL-signaling pathway has been established to be the major pathway involved in osteoclastogenesis. This review highlights the role of around 40 osteoclastogenic factors involved in RANKL signaling and their potential to be targeted for antiresorptive therapy in RA. Furthermore, inhibitors of these proteins, which are already known to exhibit antiresorptive potential, have been reviewed. Elucidating new potential candidate therapeutic targets in the osteoclastogenesis pathway will open new avenues into the treatment and diagnosis of the arthritic conditions.

Prise en charge de l’arthrose du sujet très âgé

Osteoarthritis (OA) is one of the most disabling arthritic condition. Aging is a major risk factor and represent one of the three OA phenotypes currently identified, including mechanical or obesity-related osteoarthritis. In the very elderly, loss of function and pain due to osteoarthritis are primary concerns. Other conditions related to osteoarthritis are associated with aging, as malnutrition and sarcopenia. Management of osteoarthritis in the oldest old require a global evaluation and care. This evaluation emphasizes ethical concerns after a look at the cognitive impairment and functional disability, taking into account often-underestimated pain and stiffness. Assessment of muscular and nutritional parameters seem to be as important as the rheumatologic evaluation in this frail population. Symptomatic care is the best option in the impaired elderly whereas global care with a multidisciplinary approach is preferred in the frail population. Individualized decision making after global assessment is one of the specificities of the very elderly care because of the major risks of safety concerns, especially with pharmacological therapies.

Psychometric characteristics of the health care empowerment questionnaire in a sample of patients with arthritis and rheumatic conditions

BackgroundPatient empowerment can improve health‐related outcomes and is important in chronic conditions, such as arthritis. This study aimed to validate the Health Care Empowerment Questionnaire (HCEQ), a patient‐reported experience measure of empowerment, for use with patients with arthritis and other rheumatic diseases.MethodsThe HCEQ measures Patient Information Seeking (or Involvement in Decisions) and Healthcare Interaction Results (or Involvement in Interactions) and asks respondents to answer questions in two ways: whether they feel something happened and its importance to them. Face validity was assessed through qualitative data (n = 8, nominal group technique; n = 55, focus groups). Measure structure was assessed through confirmatory factor analysis (CFA); internal consistency was also assessed (n = 9226). Test‐retest reliability was assessed with sub‐sample of participants (n = 182).ResultsWe found adequate face validity of the HCEQ for patients with arthritis. The CFA indicated good fit to the data for the two‐factor structure of the HCEQ (RMSEA = 0.075; CFI = 0.987; TLI = 0.978; SRMR = 0.026). Internal consistency was strong (α=0.94 for both subscales). Test‐retest reliability was moderate for Patient Information Seeking (ICC=0.67) and good for Healthcare Interaction Results (ICC=0.77).ConclusionsThe HCEQ, with modifications, demonstrated promising psychometric properties within this sample, laying the foundation for further assessment. This work supports the HCEQ as an appropriate instrument for examining experiences with and perceived importance of empowerment in individuals with arthritis and other rheumatic conditions.Patient ContributionPatients contributed to the assessment of face validity. As a measure of patient empowerment, the HCEQ’s use can enable further participation of patients in health care.

Antibody-based delivery of interleukin-9 to neovascular structures: Therapeutic evaluation in cancer and arthritis.

Interleukin-9 is a cytokine with multiple functions, including the ability to activate group 2 innate lymphoid cells, which has been postulated to be therapeutically active in mouse models of arthritis. Similarly, interleukin-9 has been suggested to play an important role in tumor immunity. Here, we describe the cloning, expression, and characterization of three fusion proteins based on murine interleukin-9 and the F8 antibody, specific to the alternatively spliced EDA domain of fibronectin. EDA is strongly expressed in cancer and in various arthritic conditions, while being undetectable in the majority of healthy organs. Interleukin-9-based fusion proteins with an irrelevant antibody specific to hen egg lysozyme served as negative control in our study. The fusion proteins were characterized by quantitative biodistribution analysis in tumor-bearing mice using radioiodinated protein preparations. The highest tumor uptake and best tumor:organ ratios were observed for a format, in which the interleukin-9 moiety was flanked by two units of the F8 antibody in single-chain Fv format. Biological activity of interleukin-9 was retained when the payload was fused to antibodies. However, the targeted delivery of interleukin-9 to the disease site resulted in a modest anti-tumor activity in three different murine models of cancer (K1735M2, CT26, and F9), while no therapeutic benefit was observed in a collagen induced model of arthritis. Collectively, these results confirm the possibility to deliver interleukin-9 to the site of disease but cast doubts about the alleged therapeutic activity of this cytokine in cancer and arthritis, which has been postulated in previous publications.

Aloe vera gel homogenate shows anti-inflammatory activity through lysosomal membrane stabilization and downregulation of TNF-\u03b1 and Cox-2 gene expressions in inflammatory arthritic animals

BackgroundAloe vera leaf gel has proven efficacious roles in the amelioration of several human diseases and illness-conditions. Specific purified gel-derived bio-constituents as well as the naturally harvested unprocessed A. vera gel have shown promise in modifying systemic inflammation. However, the synergistic role of natural herbal remedies, a mainstay of traditional Indian Ayurveda, has not been evaluated rigorously in this plant. In this study, the prevention of membrane lysis and protein denaturation in the presence of A. vera gel homogenate up to the concentration of 1000 μg/ml of gel has been assessed in vitro. Also, regulation of expression of inflammation-mediator genes (TNF-α and Cox-2) has been investigated in vivo in Freund’s complete adjuvant (FCA)-induced inflammatory arthritic Wistar albino rats in a 28-day long study following the daily oral supplementation of Aloe vera gel homogenate doses up to 0.40 and 0.80 g/kg body weight (low-dose and high-dose groups respectively).ResultsOur results indicated that A. vera gel homogenate inhibits hypotonicity-induced (74.89 ± 1.26%) and heat-induced (20.86 ± 0.77%) RBC membrane lyses respectively at a concentration of 1000 μg/ml, compared to indomethacin standard (80.52 ± 0.65% and 43.98 ± 1.52% respectively at 200 μg/ml concentration). The similar concentration of gel also showed 39.35 ± 4.25% inhibition of protein denaturation compared to standard diclofenac sodium (46.74 ± 1.84% at 100 μg/ml concentration) in vitro. When assessed in vivo, TNF-α expression was found to be decreased by 35.88% and 38.52%, and Cox-2 expression was found to be decreased by 31.65% and 34.96%, in low-dose and high-dose groups respectively, when compared to the arthritic controls.ConclusionsOur findings justify the role of unprocessed A. vera gel homogenate in preventing tissue damage and in the downregulation of TNF-α and Cox-2 gene expressions for the immune-modulation of inflammatory arthritis condition.

Pharmacological screening of ethanolic extract of Pithecellobium dulce for antiarthritic activity in Rats

Arthritis is an inflammatory joint disorder in which cartilage of the joint is gradually lost and categorized by swelling of joints, pain, and loss of function. The present study was conducted to explore the antiarthritic activity of ethanolic extract of Pithecellobium dulce against formaldehyde induced at sub plantar region of the left hind paw during days 1 and 3 of the study period. The changes observed in paw diameter during the study period, various biochemical, and haematological parameters were monitored. The Radiographic analysis and histopathology significantly improved after treatment with test extract P. dulce (250 mg/kg, b.w., p.o. ) as compared to the standard treatment with indomethacin (10 mg/kg, b.w., p.o. ).The results of the current investigation concluded that ethanolic extract of P. dulce possesses significant anti-arthritic activity against formaldehyde induced arthritis model, justifying its therapeutic role in arthritic conditions. The observed antiarthritic activity may be due to the presence of phytoconstituents such as alkaloids and flavonoids. P. dulce significantly suppressed the paw oedema in formaldehyde models ( P <0.001). The Histopathological and radiographic studies of joints also showed a protective effect of P. dulce .

Inflammation and ROS in arthritis: management by Ayurvedic medicinal plants.

Chronic joint inflammatory disorders like osteoarthritis and rheumatoid arthritis, which are manifested by joint dysfunction, show an upsurge in inflammation and oxidative stress. Although conventional anti-arthritic drugs are being used to relieve pain from arthritic symptoms, they usually cause severe side effects. Traditionally used Ayurvedic medicinal plants are a promising alternative for the management of arthritic symptoms, as they are safe and effective. Ayurvedic medicinal plants improve arthritic symptoms by reducing joint tenderness, joint pain, swelling, bone and cartilage damage, and increasing knee flexion, walking distance and sports activities. These beneficial effects of Ayurvedic medicinal plants on arthritis are mediated through various cellular mechanisms including inhibition of the inflammatory markers NF-κB, cytokines, adipokines, PGE2, NO, iNOS, COX-2, and MMPs and induction of antioxidant status by decreasing free radicals, lipid peroxidation, and myeloperoxidase, and increasing antioxidant enzymes, Nrf2, and HO-1. Thus, a strategy requires using these Ayurvedic medicinal plants to treat arthritis. This article describes the status of inflammation and oxidative stress in arthritic conditions. We also provide evidence that Ayurvedic medicinal plants and their bioactive components are highly effective in improving arthritic symptoms.

Tripterine and all-trans retinoic acid (ATRA) – loaded lipid-polymer hybrid nanoparticles for synergistic anti-arthritic therapy against inflammatory arthritis

Arthritis of joints remains a hard-to-treat disease due to the low drug exposure to the articular cavity. Present study was intended to develop a Tripterine (TRI) and all-trans retinoic acid (ATRA)-loaded lipid-polymer hybrid nanoparticles (ATLP) for enhanced antiarthritic efficacy in arthritis conditions. We have showed that two drugs could be loaded with high loading capacity and control the release kinetics in a pH-responsive manner. The ATLP showed strong inhibitory effects on the expressions of TNF-α, IL-6 and IL-1β in lipopolysaccharide (LPS)-stimulated RAW264.7 cells at the in vitro conditions. Compared to individual drugs (TRI and ATRA), ATLP significantly reduced the paw thickness exhibiting potent inhibition of inflammation. Consistently, ATLP resulted in lowest clinical score compared to that of individual drug indicating the remarkable improvement in the recession of inflammation. We have clearly demonstrated that the nanoparticulate based co-delivery of drugs could abolish the adverse effects of free drug as indicated by the body weight changes. Importantly, ATLP resulted in significant reduction of mRNA of TNF-α, IL-6, IFN-ϒ and IL-17 compared to either free drugs or CIA mice. Overall, ATLP represent a promising therapeutic strategy for the treatment of arthritis conditions.

Is Palindromic Rheumatism a Pre-rheumatoid Arthritis Condition? Low Incidence of Rheumatoid Arthritis in Palindromic Rheumatism Patients Treated with Tight Control Strategy

ObjectivesPalindromic rheumatism (PR) is characterized by repetitive, afebrile episodes of acute arthritis and peri-arthritis. The aim of this study was considering the long-term outcomes of patients with PR who were treated with tight control strategy using Disease-modifying anti-rheumatic drugs (DMARDs). MethodsWe reviewed the charts of 106 patients diagnosed with PR who were referred to the Connective Tissue Diseases Research Center (CTDRC). We recruited all the patients diagnosed with PR according to the criteria of Hannonen. They visited the CTDRC clinic regularly and were treated with hydroxychloroquine and low dose prednisolone because of active episodes of PR. In cases that the attacks did not come under control in 3–6 months, methotrexate was added or replaced and the dose was increased up to 25mg/week. In resistant cases, sulfasalazine was added, followed by the addition of leflunomide and then azathioprine. Disease outcome was evaluated by getting complete or partial remission and prevention of disease evolution to rheumatoid arthritis (RA) or other inflammatory connective tissue diseases. ResultsThis study included 92 patients with PR who were treated with DMARDs. Attacks were controlled completely or partially in 76 (82.6%) patients. Medications free remission was obtained in 16.3% of the patients. RA developed in 8.7% of the patients. By multivariate logistic regression analysis, age ≤40 at disease presentation, non-adherence to therapy and PIP joints involvement were the only factors which independently predicted the risk of treatment failure. ConclusionsTight control strategy by using DMARDs may control PR and prevent disease progression to RA.

Novel Combinatorial Dexamethasone and Hyaluronic Acid Micro Particulate Injection for the Treatment of Hip Arthritis: Assesment in Rabbit Model

The aforementioned study emphasis on formulation of Dexamethasone and Hyaluronic acid (DHA) loaded microspheres for intra-articulate injection at hip region to cure arthritic condition. DHA microspheres were formulated by solvent evaporation technique. The microspheres were found with smooth, regular surface characteristics. The loading and encapsulation efficiencies were also found higher. The in vitro release was found to be 15.12% for initial 24 hrs while 97.65% up to 25 days. Such microspheres were injected to hip region of Adult male new Zealand Rabbits (2.5–3 kg) to observe anti arthritic effect. The study result showed excellent ability of microsphere in order to treat arthritis. Therefore the results obtained concluded effectiveness of DHA microspheres in treating arthritic disease.

Older Adult Sexuality, Partnership, and Health: Cohort Comparisons of Baby Boomers and Traditionalists

This paper updates prior work on older adult sexuality, partnership, and health by examining the most current wave of the National Social Life, Health, and Aging Project (2015-16), a population-based study of health and social factors on a national scale. Comparing data from Wave I, Cohort 1 (2005-06) and Wave I, Cohort 2 (2015-16), we ask whether there are differences in partnership, sexual behaviors and health outcomes between two cohorts (‘Traditionalists’ vs. ‘Baby Boomers’). Additionally, we examine whether sexual frequency is related to physical health, particularly the health conditions of arthritis, diabetes, cognitive impairment, and prior stroke, in both cohorts. We find significant differences between cohorts through a logistic model. For Traditionalists, age, gender, education level, partnership status and diabetes were all significantly related to sexual activity (p < 0.001). Older adults were less sexually active; men were more sexually active; the higher educated were more sexually active; diabetes patients were less sexually active; and partnered were more sexually active. For Baby Boomers, only age and partnership status were significantly related to sexual activity (p < 0.001); gender and diabetes diagnosis were also related (p <0.005). Significantly, partnership status for Boomers is negatively related to sexual activity; the other three relationships – age is related to less sexual activity, men have slightly higher sexual activity, and diabetes was related to less sexual activity – were as expected. Importantly, our findings may imply that partnership or marriage is not as significant to sexual activity, or to health outcomes, as previously believed.

Interprofessional Healthcare Education on Aging Increases Students' Confidence in Medication Management Skills

Students studying for health care professions have limited opportunities to learn about medication use and aging in an interprofessional experience. Health Care students who interact in a simulation of age-related sensory changes can identify adaptations for safe medication use and counseling necessary to promote healthy aging. This research assessed the impact of a simulated team experience on pharmacy and physician assistant students’ confidence in understanding age related changes and in learning adaptations to promote safe medication use for older adults who may experience those changes. 63 pharmacy and 113 Physician Assistant students participated in 2-hour Interprofessional Education (IPE) sessions. The teams of pharmacy/physician assistant students utilized glasses to simulate changes in vision and gloves to simulate conditions of arthritis and neuropathy which increase in prevalence with age. Teams practiced skills of medication counseling and empathy towards their peers experiencing the simulations and learned medication administration adaptations for aging well. Pre survey results show a deficit of Pharmacist-Physician Assistant IPE with less than 20% of students reporting a strong understanding of the other profession’s role in developing an older adult’s care plan. Post survey results demonstrate an increase in students’ confidence in both understanding how sensory impairments may affect a patient’s ability to properly administer medication and confidence in counseling older adults on safe medication use. Descriptive data on learning in Interprofessional teams, Pre/Post comparison data and application to students studying other majors will be presented.

Molecular classification of different forms of arthritis using relative expression analysis of lipid metabolism regulatory molecules

IntroductionThe most obvious manifestation of arthritis involves inflammation and damage in synovial joints, whereas effect of lipid metabolism regulatory changes is barely understood. Clinical conditions of lipid abnormality in arthritis patients suggest role of altered lipid metabolism regulation in widespread inflammation-driven metabolic changes. Hence, the present study was undertaken to investigate the quantitative response of different lipid-binding transcriptional and post-transcriptional networks for understanding the effect of metabolic changes among three different forms of arthritis. MethodsA total of 48 individuals (36 patients and 12 healthy controls) were included in this study. The 36 patient samples were distributed in three different categories of arthritis (osteoarthritis; n = 12, osteoporosis; n = 12 and rheumatoid arthritis; n = 12) based on their clinical parameters without overlapping inflammatory diseases. Peripheral blood samples were collected and used for gene transcripts (HFABP-4, HPSP and mTOR) and miRNAs (miRNA-124 and miRNA-497) expression analysis using quantitative polymerase chain reaction. ResultsAmong three different gene transcripts, HFABP-4 was found to have significant increased levels in osteoporosis patients, while HPSP showed significantly increased levels in osteoarthritis and rheumatoid arthritis patients. No significant change was observed for mTOR in all three different forms of arthritis patients. Both the miRNAs (miRNA-124 and miRNA-497) had significant increased levels in osteoporosis and rheumatoid arthritis patients in circulation. ConclusionThe present study has demonstrated that relative expression analysis of circulating lipid metabolism regulatory molecules plays significant role in molecular classification of osteoporosis, osteoarthritis and rheumatoid arthritis conditions.

Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis.

BackgroundEmerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter’s daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques.ObjectiveThe aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic.MethodsFrom March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis.ResultsIn total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection.ConclusionsTweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty.

Simultaneous Determination of 5 Active Components of Periploca forrestii Schltr Extract in Rat Plasma by UPLC-MS and Its Application to Pharmacokinetic Studies in Normal and Adjuvant-Induced Arthritis Model Rats

Periploca forrestii Schltr ( P. forrestii) is a herb used in traditional Chinese medicine for its anti-rheumatoid arthritis effect. The aim of this study was to compare the pharmacokinetic properties of the 5 active components of this plant: neochlorogenic acid, chlorogenic acid, cryptochlorogenic acid, isochlorogenic acid C, and periplocin between normal rats and adjuvant-induced arthritis model rats. After the intravenous administration (177.78 mg/kg) of P. forrestii extract, samples were analyzed by ultra-performance liquid chromatography-tandem mass spectrometry. Compared with normal rats, the area under the curve [(AUC)(0-t), AUC(0-∞)], mean residence time [(MRT)(0-t), MRT(0-∞)] of neochlorogenic acid-treated rats decreased significantly, and drug clearance (CL) and apparent volume of distribution (V) increased significantly; the V of chlorogenic acid-treated rats decreased significantly, and MRT(0-t) significantly increased; the AUC(0-t) and AUC(0-∞) of cryptochlorogenic acid-treated rats decreased significantly, and CL and V increased significantly; the AUC(0-t) and MRT(0-t) of isochlorogenic acid C-treated rats decreased significantly, and V increased significantly; the AUC(0-t) and AUC(0-∞) of periplocin-treated rats increased significantly, and MRT(0-t), MRT(0-∞), CL, and V decreased significantly in model rats. The disease condition of rheumatoid arthritis in rats had a significant effect on the in vivo pharmacokinetics of P. forrestii after the intravenous administration.

Activation of c-Jun N-Terminal Kinase, a Potential Therapeutic Target in Autoimmune Arthritis

The c-Jun-N-terminal kinase (JNK) is a critical mediator involved in various physiological processes, such as immune responses, and the pathogenesis of various diseases, including autoimmune disorders. JNK is one of the crucial downstream signaling molecules of various immune triggers, mainly proinflammatory cytokines, in autoimmune arthritic conditions, mainly including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. The activation of JNK is regulated in a complex manner by upstream kinases and phosphatases. Noticeably, different subtypes of JNKs behave differentially in immune responses. Furthermore, aside from biologics targeting proinflammatory cytokines, small-molecule inhibitors targeting signaling molecules such as Janus kinases can act as very powerful therapeutics in autoimmune arthritis patients unresponsiveness to conventional synthetic antirheumatic drugs. Nevertheless, despite these encouraging therapies, a population of patients with an inadequate therapeutic response to all currently available medications still remains. These findings identify the critical signaling molecule JNK as an attractive target for investigation of the immunopathogenesis of autoimmune disorders and for consideration as a potential therapeutic target for patients with autoimmune arthritis to achieve better disease control. This review provides a useful overview of the roles of JNK, how JNK is regulated in immunopathogenic responses, and the potential of therapeutically targeting JNK in patients with autoimmune arthritis.

Anti-Snake Venom, Anti-Arthritic and Cytotoxic Activities of Tectona grandis L. f. Stem Bark (Lamiaceae)

Tectona grandis L. f. (Lamiaceae) is famous for timber production and has been used in traditional medicine for treating bronchitis, liver-related roubles, urinary discharge amongst other diseases. Methanol extract of the stem bark was investigated for in vivo antiophidian assay against Bitis arietans and Naja nigricollis. Also, the extract and chromatographic fractions were subjected to cytotoxicity tests using tadpole model and antiarthritic assay by proteinase inhibition. Chromatography of crude methanol extract afforded three highly polar vacuum liquid chromatography (VLC) fractions (BVLC-1, BVLC-2 and BVLC-3). BVLC-2 further gave four semi-pure uncharacterized isolates (I, II, III, IV). Only BVLC-2 and BVLC-3 were cytotoxic at 10 - 80 mg/ml, with BVLC-3 being most potent (100% mortality, LC50 40 mg/ml). Concentration-dependent proteinase enzyme inhibition (24 - 71%) at 200 - 1000 μg/ml of BVLC-2 was observed, and this was less (IC50 659.24 μg/ml) than the activity of the standard drug, acetyl salicylic acid. However, neutralization of B. arietans and N. nigricollis snake venoms using methanol extract was not dose-dependent, but the extract atthe least dose, 50 mg/kg offered better protection (75%) on Naja nigricollis envenomed-mice in 48 h. Its activity was comparable to that of the positive antivenin tested at 0.2 mg/kg. These findings justify the folkloric use of T. grandis in the treatment of snake bites, arthritic conditions, and oxidative stress-induced diseases.&#x0D; Keywords: Tectona grandis, methanol extract, anti-snake venom activity, tadpole cytotoxicity, anti-arthritic activity

Anti-arthritic activity of D-carvone against complete Freund’s adjuvant-induced arthritis in rats through modulation of inflammatory cytokines

Chronic joint pain due to loss of cartilage function, degradation of subchondral bone, and related conditions are common plights of an arthritis patient. Antioxidant compounds could solve the problems in arthritic condition. The objective of this study was to evaluate the anti-arthritic activity of D-carvone against complete Freund’s adjuvant (CFA)-induced arthritis in rats. D-carvone was orally administered for 25 days at the doses of 30 and 60 mg/kg against CFA-induced arthritic rats. Changes in body weight, paw swelling, organ index, hematological parameters, oxidative stress markers, inflammatory cytokines, and histopathology were recorded. Oral treatment of D-carvone significantly improved the body weight, reduced the paw swelling, edema formation, and organ index in arthritic rats. The levels of white blood cells were reduced, red blood cells and hemoglobin levels were improved in D-carvone treated arthritic rats. Lipid peroxidation levels were lowered whereas enzymatic and non-enzymatic antioxidants were significantly elevated by D-carvone administration against arthritic rats. D-carvone significantly modulated inflammatory cytokine levels and improved the ankle joint pathology against CFA-induced arthritic inflammation. In conclusion, D-carvone proved significant anti-arthritic activity against CFA-induced arthritis in rats.

Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty.

Since the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.