Cartilage Volume Research Articles

Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial

BackgroundKnee osteoarthritis causes pain and disability in many people worldwide, for which no definitive treatment has yet been proposed. In this study, we investigated the safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in patients with knee osteoarthritis.MethodsThis triple-blind, randomized clinical trial included patients suffering from bilateral knee osteoarthritis with grade 2 or 3. The knees of each patient were randomized to intervention and control. For the intervention knee, 5 cc of placental mesenchymal stromal cells-derived extracellular vesicles were injected, and for the control knee, 5 cc of normal saline was injected. The patients’ symptoms were evaluated before the intervention and 2 and 6 months after the intervention using VAS, WOMAC questionnaire, and Lequesne index. MRI was performed before the intervention and 6 months after the intervention to evaluate retropatellar and tibiofemoral cartilage volume, medial and lateral meniscal disintegrity, ACL injury, and effusion-synovitis.Results62 knees (31 patients) were enrolled in this study. There were 31 knees as intervention and 31 knees as control. Finally, the data of 58 knees (29 patients) were analyzed, including 28 women and 1 man. The mean age of the patients was 55.38 ± 6.07 years. No statistically significant difference was detected between the two groups in clinical outcomes (including VAS, WOMAC, and Lequesne scores) before treatment and 2 and 6 months after treatment. Also, no statistically significant difference was detected between the two groups in MRI findings before treatment and 6 months after treatment. No systemic complications or severe local reactions occurred in the patients.ConclusionA single intra-articular injection of placental mesenchymal stromal cells-derived extracellular vesicles (5 cc, 7 × 109 particles/cc) is safe, but does not improve clinical symptoms or MRI findings in knee osteoarthritis beyond placebo. The protocol of this study was approved on 11 May 2022 with registration number IRCT20210423051054N1.

Treatment with a superoxide dismutase mimetic for joint preservation during 35 and 75 days in orbit aboard the International Space Station, and after 120 days recovery on Earth.

Reduced weight-bearing during spaceflight has been associated with musculoskeletal degradation that risks astronaut health and performance in transit and upon reaching deep space destinations. Previous rodent experiments aboard the international space station (ISS) have identified that the spaceflight-induced molecular arthritic phenotype was characterized with an increase in oxidative stress. This study evaluated if treatment with a superoxide dismutase (SOD) mimetic on orbit could prevent spaceflight-induced damage to the knee and hip articular cartilage, and the menisci in rodents. Cartilage and meniscal degradation in mice were measured via microCT, histology, and transcriptomics after: (1) ∼ 35 days on the ISS, (2) ∼ 35 days on the ISS followed by 120 days weight-bearing readaptation on Earth or (3) ∼ 75 days on the ISS. The study had a limited sample size, so both significant effects and generalized patterns are reported. After 35 days aboard the ISS, cartilage volume at the tibial-femoral cartilage-cartilage contact point decreased, meniscal volume decreased concurrent with an increase in pro-osteoarthritic signaling in the joint soft tissue. Similarly, a decrease in cortical and trabecular bone volume of the tibia was observed. While treatment with the SOD mimetic preserved the trabecular bone, articular cartilage and the menisci after 35 days aboard the ISS, but had limited efficacy retaining that recovery after 120 days of weight bearing, and after 75 days on orbit. Antioxidants including BuOE may serve as a potential countermeasure option to protect musculoskeletal health during spaceflight missions, and continued use may be necessary upon reaching a destination.

External Focus of Attention Reduces Cartilage Load During Drop Landings.

The aim of the present study was to examine the effects of attentional focus instructions on acute changes in the transverse relaxation time (T2) of the femorotibial cartilage and in cartilage volume during repeated drop-jump landings. Ten healthy females (Mage = 20.4 ± 0.8 years) performed a drop landing task from a 50 cm high box over the course of 3 days (50 repetitions each day) across three attentional focus conditions: external focus (EF: focus on landing as soft as possible), internal focus (IF: focus on bending your knees when you land), and control (CON: no-focus instruction), which was counterbalanced across focus conditions. T2 mapping and the volume of femorotibial cartilage were determined from magnetic resonance imaging scans at 1.5 T for the dominant knee before and after completing the drop landings in each attentional focus condition per day. Results indicated a smaller change in cartilage T2 relaxation time and volumetry in the central load-bearing lateral cartilage under the EF, compared to IF and CON. Moreover, the change in T2 and cartilage volume was greater for lateral tibial cartilage as compared to femoral cartilage and was independent of attentional focus instructions. No significant acute quantitative changes were observed in the medial compartment. The peak vertical ground reaction force was found to be the lowest under the EF, compared to IF and CON. These findings suggest that external focus of attention may reduce cartilage load, potentially aiding in the control or management of cartilage injuries during landing in female athletes.

Critical evaluation of the current role of SYSADOA in the management of osteoarthritis (literature review)

Background. Osteoarthritis is a common chronic disease characterized by progressive degradation of all joint components and inflammation. The priority issue in the management of OA is sear­ching for drugs that simultaneously relieve symptoms, modify the course of the disease, and are safe for use. Symptoma­tic slow-ac­ting drugs (SYSADOA) are of considerable interest due to their potential to slow cartilage degeneration and potential osteoarthritis di­sease mo­difying effect. The purpose of the study was to ana­lyze current literature data on several types of SYSADOA, their biological role, mecha­nisms of effect on joints, effectiveness and safetye. ­Materials and methods. An analytical review of literature data was conducted using the ana­lysis of scientific databases PubMed, Web of Science, Scopus, Google Scholar for the period 2005–2024, the search was conducted using the keywords “osteoarthritis”, “SYSADOA”, “DMOAD”, “effectiveness”, “safety”. Results. Glucosamine salts (GA) and chondroitin sulfate (CS) are the most stu­died slow-acting drugs and have positive biological effects on joint tissues. Prescription salts of GA and CS have effect of pain relieve and joint function improvement as separate agents and also potentiate the effect in combination. Studies revealed limiting of cartilage volume loss and joint space narrowing – a potential DMOAD effect of these drugs. GA salts and CS drugs are safe, as they have no difference in the frequency of side effects compared to placebo. The quality of drugs largely depends on the type of raw materials and technological production process, which are not standardized now. Conclusions. The role of SYSADOA in the treatment of OA has not been definitively determined, and studies on the effectiveness of drugs such as SYSADOA and the study of their DMOAD effect are still ongoing. Further stu­dies should focus on the use of pharmacological class SYSADOA that have been properly purified and quality strictly supervised.

Phosphotungstic acid-enhanced micro-computed tomography and RNA sequencing provide a new perspective on temporomandibular joint arthritis induced by complete Freund's adjuvant and collagen-induced arthritis in rat models

Background/PurposeTemporomandibular joint (TMJ) arthritis causes inflammation and degradation of the mandibular condylar cartilage and subchondral bone. Complete Freund's adjuvant (CFA) and collagen-induced arthritis (CIA) are models for studying TMJ arthritis. While micro-computed tomography (micro-CT) is crucial for three-dimensional (3D) bone analysis, it has limitations in imaging nonmineralized tissues. Phosphotungstic acid (PTA) enhances soft tissue contrast. However, research on the 3D imaging of mandibular condylar cartilage and the molecular mechanisms of CFA- and CIA-induced arthritis remains unclear. This study aimed to investigate the bone and PTA-stained cartilage in the mandibular condyle using 3D reconstruction and explore the characteristics of enriched gene ontology terms underlying CFA- and CIA-induced TMJ arthritis in rat models. Materials and methodsRat mandibular condyles were collected from control, CFA, and CIA groups. Live micro-CT created 3D bone structures, and PTA-enhanced micro-CT constructed 3D mandibular condylar cartilage. Gene ontology enrichment analysis identified enriched gene ontology terms from differentially expressed genes through RNA sequencing. ResultsMajor deformities in cartilage volume and bone morphology were observed in the arthritis-induced groups. The CIA group exhibited significant correlations between cartilage volume and bone parameters changes. Gene ontology enrichment analysis indicated fewer terms with upregulated differentially expressed genes related to inflammation and immune response in the CIA group than in the CFA group. ConclusionThis study reveals distinct responses between CFA- and CIA-induced TMJ arthritis models. The CIA group exhibited strong correlations between cartilage volume and bone parameter changes and had less pronounced inflammation and immune response than the CFA group.

Safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation in the treatment of knee osteoarthritis: A Phase I/IIa randomised controlled trial

ObjectivesTo assess the safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation (MAG200) in the treatment of knee osteoarthritis over 12 months. DesignA single-centre, double-blind, ascending dose, randomised controlled trial. 40 participants with moderate knee osteoarthritis were randomised to receive a single intra-articular injection of MAG200 (dose cohorts:10, 20, 50, 100 ​× ​106 ​cells) or placebo. Primary objectives were safety and efficacy according to a compound responder analysis of minimal clinically important difference in pain (numerical pain rating scale [NPRS]) and function (Knee Injury and Osteoarthritis Outcome Score - Function in Daily Living subscale [KOOSADL]) at month 12. Secondary efficacy outcomes included changes from baseline in patient reported outcome measures and evaluation of disease-modification using quantitative MRI. ResultsTreatment was well tolerated with no treatment-related serious adverse events. MAG200 cohorts reported a greater proportion of responders than placebo and demonstrated clinical and statistically significant improvement in pain and clinically relevant improvement in all KOOS subscales. MAG200 demonstrated a reproducible treatment effect over placebo, which was clinically relevant for pain in the 10 ​× ​106 dose cohort (mean difference NPRS:-2.25[95%CI:-4.47,-0.03, p ​= ​0.0468]) and for function in the 20 ​× ​106 and 100 ​× ​106 dose cohorts (mean difference KOOSADL:10.12[95%CI:-1.51,21.76, p ​= ​0.0863] and 10.81[95%CI:-1.42,23.04, p ​= ​0.0810] respectively). A trend in disease-modification was observed with improvement in total knee cartilage volume in MAG200 10, 20, and 100 ​× ​106 dose cohorts, with progression of osteoarthritis in placebo, though this was not statistically significant. No clear dose response was observed. ConclusionThis early-phase study provides supportive safety and efficacy evidence to progress MAG200 to later-stage trial development. Trial registrationACTRN12617001095358/ACTRN12621000622808.

Cross-species transcriptomics identifies obesity associated genes between human and mouse studies

BackgroundFundamentally defined by an imbalance in energy consumption and energy expenditure, obesity is a significant risk factor of several musculoskeletal conditions including osteoarthritis (OA). High-fat diets and sedentary lifestyle leads to increased adiposity resulting in systemic inflammation due to the endocrine properties of adipose tissue producing inflammatory cytokines and adipokines. We previously showed serum levels of specific adipokines are associated with biomarkers of bone remodelling and cartilage volume loss in knee OA patients. Whilst more recently we find the metabolic consequence of obesity drives the enrichment of pro-inflammatory fibroblast subsets within joint synovial tissues in obese individuals compared to those of BMI defined ‘health weight’. As such this present study identifies obesity-associated genes in OA joint tissues which are conserved across species and conditions.MethodsThe study utilised 6 publicly available bulk and single-cell transcriptomic datasets from human and mice studies downloaded from Gene Expression Omnibus (GEO). Machine learning models were employed to model and statistically test datasets for conserved gene expression profiles. Identified genes were validated in OA tissues from obese and healthy weight individuals using quantitative PCR method (N = 38). Obese and healthy-weight patients were categorised by BMI > 30 and BMI between 18 and 24.9 respectively. Informed consent was obtained from all study participants who were scheduled to undergo elective arthroplasty.ResultsPrincipal component analysis (PCA) was used to investigate the variations between classes of mouse and human data which confirmed variation between obese and healthy populations. Differential gene expression analysis filtered on adjusted p-values of p < 0.05, identified differentially expressed genes (DEGs) in mouse and human datasets. DEGs were analysed further using area under curve (AUC) which identified 12 genes. Pathway enrichment analysis suggests these genes were involved in the biosynthesis and elongation of fatty acids and the transport, oxidation, and catabolic processing of lipids. qPCR validation found the majority of genes showed a tendency to be upregulated in joint tissues from obese participants. Three validated genes, IGFBP2 (p = 0.0363), DOK6 (0.0451) and CASP1 (0.0412) were found to be significantly different in obese joint tissues compared to lean-weight joint tissues.ConclusionsThe present study has employed machine learning models across several published obesity datasets to identify obesity-associated genes which are validated in joint tissues from OA. These results suggest obesity-associated genes are conserved across conditions and may be fundamental in accelerating disease in obese individuals. Whilst further validations and additional conditions remain to be tested in this model, identifying obesity-associated genes in this way may serve as a global aid for patient stratification giving rise to the potential of targeted therapeutic interventions in such patient subpopulations.

Association between medial meniscal extrusion and knee structural progression in adults with symptomatic knee osteoarthritis - a prospective cohort study.

To examine the association between medial meniscal extrusion and structural progression in adults with symptomatic knee osteoarthritis (OA). This prospective cohort study examined 176 participants with symptomatic knee OA recruited into a randomised controlled trial. The participants underwent magnetic resonance imaging (MRI) of the study knee at baseline and approximately 2years later. Meniscal extrusion, tibial cartilage volume, and tibiofemoral bone marrow lesions (BMLs) were measured from MRI using validated methods. Participants with medial meniscal extrusion ≥ 3mm had a higher prevalence of lateral tibiofemoral BMLs at baseline (OR = 2.21, 95% CI 1.06-4.61, p = 0.035), and those with medial meniscal extrusion 2-3mm had a higher likelihood of lateral BML worsening over 2years (OR = 3.76, 95% CI 1.35-10.52, p = 0.011), compared with those with medial meniscal extrusion < 2mm. Participants with stable medial meniscal extrusion had a lower likelihood of lateral BML worsening compared with those with regression of medial meniscal extrusion over 2years (OR = 0.20, 95% CI 0.07-0.56, p = 0.002). There were no associations between medial meniscal extrusion and tibial cartilage volume or medial tibiofemoral BMLs. Our study showed associations between medial meniscal extrusion and baseline prevalence and worsening over 2years of lateral tibiofemoral BMLs in people with symptomatic knee OA. Although the reasons for the lack of associations in the medial compartment are not clear, our results suggest a role of medial meniscal extrusion in predicting structural progression in lateral knee OA and that meniscal extrusion might be a potential target in the management of knee OA.

Versatility and Outcomes of ‘Mumbai Technique’ of Stacked Cartilage Grafts in Indian Rhinoplasty

Abstract Background Augmentation rhinoplasty requires graft with substantial volume. In cases where patient is reluctant to use costal cartilage, this can be done using septum and conchal cartilage graft. Using the technique of “stacked cartilage graft” an assembly is made using septum and conchal cartilage for nasal augmentation and contour defects. Although multilayered grafts have been described before, we propose an elaborate and effective method named after our city, Mumbai, to shape these grafts and highlight economical use of conchal and septal cartilage to overcome its limited volume. It also describes its clinical and aesthetic outcome of this technique in Indian patients. Methods A retrospective study from 2005 to 2020 was done in our institute. Data was collected from medical and hospital records. Preoperative and postoperative photographs were obtained for preoperative planning and outcome analysis. Rhinoplasty Outcome Evaluation score was used for outcome analysis. Minimum follow-up was 1 year in our study. Results A total of 210 patients were included in our study. In all cases, the stacked cartilage graft technique produced a natural appearing dorsum. Complications of cartilage such as resorption, extrusion, and warping were minimum. All the patients were satisfied with their results. Conclusion Although the limited volume of conchal cartilage is criticized, in reality it can be used effectively for larger requirement with “economy of use” using our technique. The curvatures and convolutions of conchal cartilage can be effectively neutralized by using this technique to obtain a smooth surface.However, this technique requires incorporation of every bit of cartilage and meticulous stacking of the pieces to get the desired shape. Thus, the stacked cartilage grafts have excellent versatility and produce natural and long-lasting results and minimal complications.

Cartilage Oligomeric Matrix Protein in Osteoarthritis and Obesity-Do New Considerations Emerge?

The diagnosis of osteoarthritis (OA) is based on radiological changes that are delayed, along with clinical symptoms. Early and very early diagnosis at the stage of molecular pathology may eventually offer an opportunity for early therapeutic intervention that may retard and prevent future damage. Cartilage oligomeric matrix protein (COMP) is a non-collagenous extracellular matrix protein that promotes the secretion and aggregation of collagen and contributes to the stability of the extracellular matrix. There are contradictory literature data and currently, the parameter is used only for scientific purposes and its significance is not well-determined. The serum level of COMP in patients with metabolic type OA of the knee has not been evaluated. The aim of the study was to analyze serum COMP levels in metabolic knee OA and controls with different BMI. Our results showed that the mean COMP values were significantly higher in the control group (1518.69 ± 232.76 ng/mL) compared to the knee OA patients (1294.58 ± 360.77 ng/mL) (p = 0.0012). This may be related to the smaller cartilage volume in OA patients. Additionally, COMP levels negatively correlated with disease duration (p = 0.04). The COMP level in knee OA with BMI below 30 kg/m2 (n = 61, 1304.50 ± 350.60 ng/mL) was higher compared to cases with BMI ≥ 30 kg/m2 (n = 76, 1286.63 ± 370.86 ng/mL), but the difference was not significant (p = 0.68). Whether this finding is related to specific features in the evolution of the metabolic type of knee OA remains to be determined. Interestingly, comparison of COMP levels in the controls with different BMI revealed significantly higher values in overweight and obese individuals (1618.36 ± 203.76 ng/mL in controls with BMI ≥ 25 kg/m2, n = 18, 1406.61 ± 216.41 ng/mL, n = 16; p = 0.0092). Whether this finding is associated with increased expression of COMP in the adipose tissue or with more intensive cartilage metabolism in relation to higher biomechanical overload in obese patients, considering the earlier development of metabolic type knee OA as an isolated finding, remains to be determined.

Effects of high-intensity interval exercise training on knee health and articular cartilage volume in patients with obesity: A comparative study between bicycle and treadmill groups

ObjectiveIt's a comparative study between bicycle and treadmill groups to observe the effects of high-intensity interval exercise training on knee health and articular cartilage volume in patients with obesity, thus to provide a scientific basis for the healthy exercise methods to lose weight. Methods60 patients with simple obesity were randomly divided into two groups of 30: the bicycle group and the treadmill group. Both groups received high-intensity interval exercise training, power bicycle training and moving treadmill training (MTT) were accepted respectively. Both groups received consecutive treatment for 12 weeks, five times a week, and every single time lasted for 30 min. Before and after treatment, the body mass index (BMI), the knee's articular cartilage volume was measured with magnetic resonance imaging (MRI),the pain of knee was assessed with visual analogue scale (VAS). Before and after each training session, the local skin temperature of the knee was measured with an electronic thermometer. ResultsAfter 12 weeks of treatment, the BMI was both decreased, the VAS and the local skin temperature of knee was increased significantly, the knee's articular cartilage volume in the treadmill group was reduced significantly, while the above indicators in the bicycle group did not change significantly, and the difference between the two groups was statistically significant (p < 0.001). ConclusionPower bicycle training can avoid a decrease in the volume of knee joint cartilage, while MTT can easily lead to a decrease in the volume of knee joint cartilage, an increase in local skin temperature and pain of knee joint.

Relationship Between Two Years of Muscle Strength Decrease and Volume Loss of Menisci and Cartilage According to Knee Pain in Mild and Moderate Knee Osteoarthritis.

To explore the relationship between two-year changes in muscle strength and cartilage according to knee pain in mild and moderate knee Osteoarthritis (OA). 279 participants were retrospectively obtained from the Osteoarthritis Initiative. Western Ontario McMaster University (WOMAC) and Knee Injury and Osteoarthritis Outcome Score were used to assess pain and function. Five muscles strength (maximum extensor and flexor, normalized maximum extensor and flexor, and extensor/flexor ratio) were measured from isometric strength test. Menisci and cartilage volumes were measured from MRI to assess two-year of OA progression. Mild and moderate knee OA progression was characterized by patellofemoral cartilage loss and meniscal degeneration. For WOMAC pain >2 participants, decrease in extensor strength and normalized extensor strength were positively correlated with medial meniscus volume loss (r = 0.261, P = 0.021; r = 0.232, P = 0.041, respectively). The extensor/flexor ratio changes were positively associated with WOMAC function changes (r = 0.291, P = 0.013) over two-year. The study observed a positive correlation between quadriceps strength decrease and medial meniscus degeneration in mild and moderate knee OA patients with WOMAC pain >2. These findings suggested quadriceps-hamstrings balance possibly plays a protective role in knee function for participants with weaker quadriceps and severe pain.

Gender differences in patterns of cartilage loss: Data from the Osteoarthritis Initiative

OBJECTIVEUnderstanding gender-specific differences in patterns of cartilage loss can improve our knowledge of the pathogenesis of knee osteoarthritis (KOA) development and progression and may inform clinical trials of treatments for KOA. The goal of our observational study was to examine gender differences in patterns of cartilage loss in the central weight-bearing regions of the femur. METHODSWe measured cartilage volume change in the indexed knee of 700 subjects with Kellgren-Lawrence (KL) 1, 2, or 3 from the OAI for four follow-up periods (BL to 24mo, BL to 48mo, BL to 72mo, and BL to 96mo) using the local area cartilage segmentation (LACS) method. Briefly, the LACS method uses robust coordinate systems fixed to anatomical landmarks to measure patterns of change in cartilage volume in sub-regions using responsiveness heat maps. RESULTSWe observed a statistically significant gender difference in cartilage change in the medial femur (MF), lateral femur (LF), and medial tibia (MT). The heat maps, showed loss was primarily in the posterior central weight-bearing portion of the LF and more general in the LT and MF. Similar patterns were observed for each of the four follow-up periods. CONCLUSIONSThe LACS method was capable of illustrating gender-specific differences in patterns of cartilage loss that may offer insight into the variation of gender differences in the natural history of KOA and may be useful in evaluating the benefit of interventions for KOA.

Evaluation of the consistency of the MRI- based AI segmentation cartilage model using the natural tibial plateau cartilage.

The study aims to evaluate the accuracy of an MRI-based artificial intelligence (AI) segmentation cartilage model by comparing it to the natural tibial plateau cartilage. This study included 33 patients (41 knees) with severe knee osteoarthritis scheduled to undergo total knee arthroplasty (TKA). All patients had a thin-section MRI before TKA. Our study is mainly divided into two parts: (i) In order to evaluate the MRI-based AI segmentation cartilage model's 2D accuracy, the natural tibial plateau was used as gold standard. The MRI-based AI segmentation cartilage model and the natural tibial plateau were represented in binary visualization (black and white) simulated photographed images by the application of Simulation Photography Technology. Both simulated photographed images were compared to evaluate the 2D Dice similarity coefficients (DSC). (ii) In order to evaluate the MRI-based AI segmentation cartilage model's 3D accuracy. Hand-crafted cartilage model based on knee CT was established. We used these hand-crafted CT-based knee cartilage model as gold standard to evaluate 2D and 3D consistency of between the MRI-based AI segmentation cartilage model and hand-crafted CT-based cartilage model. 3D registration technology was used for both models. Correlations between the MRI-based AI knee cartilage model and CT-based knee cartilage model were also assessed with the Pearson correlation coefficient. The AI segmentation cartilage model produced reasonably high two-dimensional DSC. The average 2D DSC between MRI-based AI cartilage model and the tibial plateau cartilage is 0.83. The average 2D DSC between the AI segmentation cartilage model and the CT-based cartilage model is 0.82. As for 3D consistency, the average 3D DSC between MRI-based AI cartilage model and CT-based cartilage model is 0.52. However, the quantification of cartilage segmentation with the AI and CT-based models showed excellent correlation (r = 0.725; P values < 0.05). Our study demonstrated that our MRI-based AI cartilage model can reliably extract morphologic features such as cartilage shape and defect location of the tibial plateau cartilage. This approach could potentially benefit clinical practices such as diagnosing osteoarthritis. However, in terms of cartilage thickness and three-dimensional accuracy, MRI-based AI cartilage model underestimate the actual cartilage volume. The previous AI verification methods may not be completely accurate and should be verified with natural cartilage images. Combining multiple verification methods will improve the accuracy of the AI model.

Are there gender-specific differences in hip and knee cartilage composition and degeneration? A systematic literature review

The aim of the present review is to systematically analyse the current literature about gender differences in hip or knee cartilage composition and degeneration, to help explaining how and why osteoarthritis affects women more often and more severely than men. A systematic review of the literature in English was performed. Eleven studies on 1962 patients (905 females and 787 males) that reported differences on cartilage composition between males and females were included. Nine evaluated the knee, one the hip, and one both. They were heterogeneous in their methods: one conducted histological analyses, and all the others evaluated cartilage characteristics (volume, width, and composition) through magnetic resonance imaging. All authors reported gender differences in both volume and morphology of the cartilage, from infancy to menopause. In fact, a study on 92 healthy children statistically showed significant gender differences in cartilage thickness at all sites, even after adjustment for age, body, and bone size. Gender differences become more evident after menopause, when women have a lower cartilage volume and a higher cartilage loss. Men show significantly higher knee and hip cartilage volumes than women, and women carry a significantly greater risk to develop osteoarthritis. This is in part due to body and bone size, but also depends on qualitative and quantitative differences in the composition of cartilage and its degeneration rate after menopause. Structural changes in cartilage that occur between genders during ageing have significance in the development of osteoarthritis.

Dietary Inflammatory Index and Magnetic Resonance Imaging-Detected Knee Structural Change and Pain: A 10.7-Year Follow-up Study.

To determine whether the dietary inflammatory index (DII) scores were associated with knee structural changes and pain over a 10.7-year follow-up. This study used data from a prospective population-based cohort study (mean age 63 years, 51% female) in which 1,099, 875, 768, and 566 participants completed assessments at baseline, 2.6, 5.1, and 10.7 years, respectively. T1-weighted and T2-weighted magnetic resonance imaging was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and 10.7 years. The Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire was used to measure knee pain at each visit. Pain trajectories ("minimal pain," "mild pain," and "moderate pain") were previously identified. Baseline energy-adjusted DII (E-DII) scores were calculated. Linear, log-binomial regression, linear mixed-effects modeling, and multi-nominal logistic regression were used for analyses. The mean ± SD E-DII score at baseline was -0.48 ± 1.39. In multivariable analyses, higher E-DII scores were not associated with tibial CV loss or BML size increase except for medial tibial BML size increase. Higher E-DII scores were associated with a higher pain score (β=0.21; 95% confidence interval [CI] 0.004-0.43) and an increased risk of belonging to the "moderate pain" compared to the "minimal pain" trajectory group (relative risk ratio 1.19; 95% CI 1.02-1.39). A proinflammatory diet, as indicated by a higher DII score, may be associated with a greater pain score and higher risk of more severe pain trajectory over 10 years. However, inconsistent findings related to structural changes suggest a discordance between the potential impact of diet on structural damage and pain in knee OA.

Modified Technique for Auricular Helical Rim Reconstruction in Adult Patients with Subtotal Helical Rim Defects.

In adults, the volume of costal cartilage is enough for reconstruction, but floating cartilage is hard, brittle, and easily broken due to calcification, in addition to being short, making it unsuitable for helical rim reconstruction in such age groups. This study describes a novel technique in which adult patients underwent 2-stage helical rim reconstruction using the syncytium of sixth and seventh costal cartilage. A single-arm clinical trial involves 35 adults with total and subtotal helical rim defects, either congenital, post-traumatic, postburn, or postvascular malformation excision. Twenty-nine unilateral and 6 bilateral cases. The age of patients ranged between 19 and 40 years. In the period between April 2021 and April 2023. Follow-up was 6 months. There were no technique-related complications, such as broken helix. In most cases, scars were invisible, with the normal contour of helical rim. Among the 35 patients, 19 were graded as excellent, 13 as good, and 3 as fair. In objective photographic evaluation, all patients were evaluated with high (3 or 4) ratings; the score was 3 in 19 patients and 4 in 16 patients. All patients were satisfied with the size, contour, position and details of the new helix. Using the syncytium of the sixth and seventh costal cartilage to fabricate the helical rim in adult patients gives a suitable volume of cartilage graft as regards the length and width, which suits the reconstruction of the helical rim, and shows a good configuration with satisfactory surgical results.

Therapeutic use of hematopoietic mesenchymal stem cells in osteoarthritis: a meta-analysis study

Millions of people worldwide suffer from osteoarthritis, which is a major health problem. The accessible medicines are used in changing the side effects of osteoarthritis however missing illness alterations, not with-standing drug after-effects, and care expenses without adequacy of side effects help. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We look for relevant articles in all articles published between December 30, 2007, and December 30, 2022, in the Cochrane Library, PubMed, Embase, Wanfang Database, CNKI, and Web of Science databases. With an average follow-up of 18.33 months, this study included 364 patients with knee joint osteoarthritis from 12 completely published articles. Data from seven studies using the Visual Analog Scale (VAS) score. In Bone Marrow Mesenchymal Stem Cells (BM-MSCs), the baseline score on the Visual Analogue Scale decreased. These results suggested that there was no significant relationship between the BM-MSCs at three months (Weighted Mean Difference (WMD) = 1.07, 95% CI: − 2.44, − 0.39, p= 0.074); and the greatest decrease in VAS score compared to the control at 18.33 months, WMD = 6.04, 95 percent CI: − 10.34, − 0.38, p = 0.017. In clinical applications, intra-articular injection of BM-MSCs has advantages for treating OA because it reduces pain index, improves knee movement, and increases cartilage volume.

HISTOMORPHOMETRIC ASSESSMENT OF CHANGES THE STRUCTURAL COMPONENTS OF THE BONE IN RATS WITH CHRONIC CHOLESTASIS WITH CORRECTION OF THE COMPLEX FROM HEPATOPROTECTOR AND SORBENT

Problem. The disruption of the gastric duct in cholestasis causes insufficient absorption in the small intestine of macro- and microelements and fat-rich vitamins (A, D, E, K), which are necessary for healthy processes, and remodeling of bone tissue. To reduce pathological changes in bone tissue diseases of the hepatobiliary system in rats statement in cholestasis, need a comprehensive approach [6]. In the core of the preventive complex one can see a hepatoprotector, which, due to its main components (lecithin, quercetin), possesses the liver protecting properties, as well as has anti-inflammatory and bile-diluting effects, and a sorbent. Aim. To conduct a histomorphometric research of the femur in rats with chronic cholestasis and evaluate the effectiveness of the prophylactic complex. Methods. The follow-up study was carried out on male rats, divided into three groups: 1st group – intact, 2nd group – rats with simulated chronic cholestasis, 3rd group – rats, who, in parallel with the development of chronic cholestasis pathology, carried out prevention. Cholestasis in rats was modeled by ligation of the biliary duct under thiopental anesthesia [9]. A hepatoprotector at a dose of 500 mg/kg and a sorbent at a dose of 1 g/kg were administered to group 3 of the animals once over a period of 4 months. Histological analysis and photography of sections of the stegnus cyst were carried out using an additional light microscope and a camera for an Olympus LC30 microscope (Japan). Morphometric studies of rat femur were carried out using the following parameters: volume (%) of the articular epiphyseal cartilage, volume (%) of the cartilage, volume (%) of the cerebrum and the number of osteoblasts per the particular area. The main results. Certain histological changes in the epiphysis of the femoral bone were found in rats with chronic cholestasis, namely, noticeable delamination of the periosteum was noted. In the deep layers of the cartilage, a decrease in the number of isogenic groups was noted, in addition, they contained a smaller number of chondrocytes. Desolation of individual lacunae, a decrease in the number of osteoblasts, and thinning of bone trabeculae were also observed, indicating certain pathological changes in bone tissue. Analysis of the morphometric parameters of the femur in rats with chronic cholestasis revealed a decrease in the specific volume of the cartilage of the articular surfaces by 25.8%, a decrease in the specific volume of the bone marrow and the number of osteoblasts by 14.4% and 39.4%, respectively, and as well as an increase of 33.1% in the specific volume of bone beams in relation to the control group. The introduction of the prophylactic complex contributed to a significant increase in the specific volume of the cartilage of the articular surfaces – by 17.2%, the specific volume of bone marrow by 42.9%, the average number of osteoblasts by 34.9%, and a decrease in the specific volume of bone beams by 31 .7% relative to the group of animals with chronic cholestasis. That is, the use of a prophylactic complex, which consisted of a hepatoprotector and a sorbent, effectively eliminated pathological changes in bone tissue that arose against the background of the development of chronic cholestasis. Conclusions. The formation of chronic cholestasis leads to pathological changes in the cartilaginous tissue of the epiphysis of the femur of the animals under study, and it itself changes the volume of cartilage of the subglobular surfaces and causes destruction of the main components in bone tissue (reduces the volume of bone marrow and the number of osteoblasts at the background of the growth the volume of bone beams). The effectiveness of prophylactic in the elimination of pathological changes in bone tissue at the background of chronic cholestasis has manifested itself as a hepatoprotective, antioxidant, anti-inflammatory and anti-inflammatory hepatoprotector and those combined with a sorbent.

New concept of orthosis treatment for knee osteoarthritis: Clinical and radiological outcomes.

Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5males/5 females; median age 57; age range 42-59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0-100; Visual Analogue Scale (VAS), range 0-100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p< 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41-56 points; all p< 0.05). No improvements in mJSW- or MRI-derived parameters were found. This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced.