Joint Examination Research Articles

OA03 Trauma secondary to a horse riding accident as a potential accelerating factor in inflammatory axial sponyloarthropathy: a case report and literature review

Abstract Introduction Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterised by axial involvement and sacroiliitis. The etiology of AS remains elusive, with genetic and environmental factors implicated in disease development and progression. This case report aims to investigate the potential association between trauma and the acceleration of AS in individuals positive for HLA-B27. Furthermore one purpose of this case-report is to ascertain any link between horse riding accidents in jockeys or professionals undertaking horse riding as a career choice. Is there a correlation between trauma and development of inflammatory axial spondyloarthropathy subsequently or not. Case description A 24-year-old female patient with a medical history of eczema and Graves' disease, currently undergoing propylthiouracil treatment, was referred to the rheumatology clinic due to persistent back pain for the past six to seven years following a horse riding accident. The patient had previously received physiotherapy and found relief with naproxen and co-codamol. The pain primarily affects her lower spine and radiates down her legs. While movement provides some relief, lying down exacerbates the pain. The patient experiences stiffness for approximately 30 minutes in the morning but does not exhibit peripheral joint symptoms. Exercise helps alleviate her symptoms. The patient reported a family history of psoriasis but denied any history of uveitis, inflammatory bowel disease, weight loss, night sweats, heartblock or achilles tendinitis. She also gave a history of joint hyper mobility with reduced flexion at the spine over the years. Blood tests revealed normal levels of ANA, CCP, ESR, rheumatoid factor, B12, HbA1c, and thyroid function. Ferritin levels were 30.2, and HLA B27 was positive. Joint examination did not reveal any signs of synovitis. The patient exhibited good range of motion in the spine. SLR's were positive on both sides and no tenderness over spine or sacroiliac joints. Systemic Examination was normal. BASDAI score was 4. Occiput to wall distance of 0 centimeters. Beighton score 4/9. Subsequently MRI whole spine/SI Joints were organised and results indicated a central disc protrusion at the L4-L5 level leading to critical spinal stenosis and likely impinging on the transitioning L5 and S1 nerve roots. Additionally, a disc protrusion at the L5-S1 which was impinging on the left S1 nerve root. Bilateral sacroiliitis was also observed. Patient was treated with NSAIDs and physiotherapy with good results with a view for a subsequent MRI, and escalation to biologics if symptoms were to worsen. Discussion The presented case raises the question of whether trauma accelerates the progression of ankylosing spondylitis (AS) in individuals who are positive for HLA-B27. Although this specific case involves a 24-year-old female patient with a history of back pain following a horse riding accident, additional research and studies would be required to draw definitive conclusions regarding the relationship between trauma and the development or acceleration of AS in HLA-B27 positive individuals. The question this case report poses and there is little in terms of research and case reports present, whether the involvement of the lady in question in a horse riding accident unmasked her ankylosing spondylitis given her HLA B27 positivity and the presence of sacroilitis on MRI scans. Literature review revealed a potential role of trauma accelerating the progression of ankylosing spondylitis in individuals who are also positive for HLA B-27, in addition in some cases it lead to detection and unmasking of chronic back pain which was inflammatory in nature rather than mechanical or a combination of both. This was revealed by the horse riding accident given the nature of the pain which had been constant and worsening which lead to a suspicion of a possible inflammatory component and hence further investigations were done. In conclusion this case report highlights the importance of a possible correlation between AS in HLA B27 positive individuals and raises the question whether trauma secondary to sports injuries like horseback riding accidents in our patients case, accelerates the progression of AS in individuals who are positive for HLA-B27. Key learning points This case report highlights the potential role of trauma following a sports injury as a contributing factor in the acceleration of AS in individuals positive for HLA-B27. Further investigations, including prospective studies, are warranted to elucidate the complex interplay between trauma, genetic predisposition, and disease progression in AS. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes/sports personnel. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition.

PROSEDUR PEMERIKSAAN MRI KNEE JOINT DENGAN KASUS CEDERA ANTERIOR CRUCIATE LIGAMENT (ACL) DI INSTALASI RADIOLOGI RS MARDI RAHAYU KUDUS

Background: MRI examination of knee joints with Anterior Cruciate Ligament (ACL) injuries at the Radiology Installation of Mardi Rahayu Kudus Hospital using spin echo sequences, including PD_TSE, PD_TSE_fatsat, T1_SE, T2_TSE, and T2_TSE_fatsat, with the addition of STIR, and using DOT engine technology. This study aims to determine the procedures for examining knee joint MRI with cases of ACL injury, as well as the role of the DOT machine in the examination.Methods: This type of research is a qualitative research with a case study approach. The research subject was an MRI examination of the knee joint with ACL injury cases. Data collection is done by using the method of observation, study, and documentation. Data analysis includes data transcription, data reduction, data presentation, as well as discussing and drawing conclusions.Results: The results showed that the STIR sequence was used as a fat comparison. The resulting ACL image is an isointense image. The use of DOT engine technology helps to standardize inspections. The advantages are ease of making cuts, time efficiency, and uniformity of inspection techniques, and not finding operational weaknesses.Conclusions: The conclusion of this study is MRI of the knee joint using spin echo and STIR sequences, with DOT engine method. STIR could be used in certain indications.

Five Steps for the Maintenance and Interception of Complications in Zygomatic Implants.

Zygomatic implants are used for the rehabilitation of the upper jaw of patients with severe and moderate bone atrophy. Possible post-surgical complications include soft tissue dehiscence, sinusitis, and prosthodontic fractures, and maintaining an accurate control is crucial. Additionally, zygomatic implants have a unique peri-implant anatomy, making traditional periodontal parameters unsuitable. The present paper aims to provide guidelines for the maintenance and interception of complications in patients rehabilitated with these kinds of implants. The proposed protocol includes: 1. intra/extraoral and temporo-mandibular joint examination; 2. soft tissue and transmucosal path observation with magnifiers; 3. peri-implant health indices and digital stimulation of tissues; 4. examination of prosthodontic devices; and 5. photographic recording. These steps facilitate the comprehensive evaluation and monitoring of clinical conditions of zygomatic-supported rehabilitations, including dehiscence and occlusal wear during follow-up appointments.

Informasi Anatomi Mri Knee Joint Sekuen T2 Space FS dan PD Space FS pada Potongan Sagital Dengan Klinis Ruptur Anterior Cruciate Ligament (ACL)

Background: The T2 and PD sequences are the most sensitive sequences in evaluating injury to the ACL and surrounding soft tissue. Based on observations at the Radiology Installation of Dr. Sardjito Hospital Yogyakarta, the anatomical information generated in the MRI knee joint examination of the PD SPACE FS sequence is almost the same as the T2 SPACE FS sequence. The purpose of this study is to determine the differences in anatomical information and optimal sequences on MRI examination of the knee joint sagittal section sequences of PD SPACE FS and T2 SPACE FS in clinical ACL rupture.Method: This research was a quantitative study with an experimental approach, carried out at the Radiology Installation of Dr. Sardjito Hospital Yogyakarta on 10 samples with the application of different sequences for each sample, with the anatomy assessed by the informant namely ACL, meniscus, articular cartilage, and bone marrow. Further data analysis was carried out using the Wilcoxon test. Result: There was a difference in anatomical information between PD SPACE FS sequences and T2 SPACE FS sequences on MRI examination of the sagittal knee joint with clinical ACL rupture, with the ρ-value of the Wilcoxon test 0.001 or ρ-value0.05. This was due to differences in the use of TR and TE parameters in each sequence. The PD SPACE FS sequence was more optimal in visualizing anatomical information than the T2 SPACE FS sequence with an anatomical mean rank of meniscus 3.50, articular cartilage 3.50, and bone marrow 5.50, whereas in ACL anatomy the mean rank value was the same between the two sequences, which is 2.00. Conclusion: It was because the PD SPACE FS sequence had a more heterogeneous contrast difference than the T2 SPACE FS sequence so each anatomy could be well evaluated in the PD SPACE FS sequence.

140 Introduction of a post fall medical review pro forma for hospital inpatients

Abstract Background Falls are the most common adverse incident in Irish hospital inpatients. 30–50% of inpatient falls result in injury. Older people are more likely to fall and are more likely to sustain an injury. The post fall medical review is critical to assess why a patient fell and if they sustained any injuries. We aimed to audit the quality of the post fall medical review compared to the ‘HSE Service User Falls’ guideline in a university hospital and if the introduction of a post fall pro forma improved the quality of this review. Methods We retrospectively audited the post fall medical review entries of 20 charts of patients who had fallen in hospital. We assessed details such as patient/doctor identifiers, history, examination, management and falls prevention. We introduced a post fall medical review pro forma on two wards in the hospital to aid doctors in their medical review. We then re-audited the quality of the medical review of 9 patients who fell over a two months period and were reviewed using the pro forma. We compared these results to our first audit. Results The post fall medical review pro forma improved the quality of the medical review in multiple domains. 30% of doctors asked if there had been a head strike pre pro forma versus 100% who asked with the pro forma. Joint examination improved from 45% pre to 100% post pro forma. Hip strike history taking improved from 15% to 89%. 70% of doctors recorded the date and 15% recorded the time of assessment pre pro forma. 100% recorded both with the pro forma. Conclusion The post fall pro forma resulted in quality improvement of the post fall medical review. It is a memory aid and also encourages accurate documentation. This pro forma will be introduced hospital wide to improve patient care.

Penerapan Pemeriksaan Saksi Secara Bersama-Sama Dalam Persidangan Perkara Pidana

The examination of witnesses regulated by Act No. 8 of 1981 on the Code of Criminal Procedure Law (hereinafter referred to as KUHAP) is a provision concerning formal criminal law. In the case No. PDM-242/JKTSL/10/2022 with the accused Ferdy Sambo (FS) and the case N. P.D.M-246/Jktsl/10/2022 with Princess Chandrwati (PC) there is an event conducted examination of witnesses jointly, becoming a material of investigation, whether such examination can be carried out simultaneously considering the witness in giving explanations must be independent. To respond to the focus of research in this research use normative jurisprudential research methods with conceptual approaches and legislative approaches. The conclusion is that the joint examination of witnesses is based on Article 172 (1) of the Convention. Accordingly, the public prosecutor or the accused or the legal counselor may prepare a witness of a qualitative nature, subject to the provisions of applicable law, so that the testimony of the witnesses may have a valid proof force. Furthermore, it is expected that the law enforcement agencies will be able to carry out witness examination procedures accurately and honestly in order to the objective of the examination in the trial, which is to material truth.

Parapharyngeal space carcinoma disguised as temporomandibular joint disorder: A clinical report

Parapharyngeal space neoplasms tend to have a considerable volume by the time of diagnosis because of their deep location in the neck and may have a relatively long progression before becoming symptomatic. Common presenting signs and symptoms of parapharyngeal space neoplasms include swelling in the neck, intraoral mass, dysphagia, dysphonia, heaviness in the ear, otalgia, and rarely, trismus. Some of these signs and symptoms could be mistaken for signs of temporomandibular disorder (TMD). This clinical report presents the incidental discovery of parapharyngeal space carcinoma initially presenting as TMD. A thorough clinical examination of the temporomandibular joints, supported by their magnetic resonance imaging, led to early detection of the neoplasm, thereby improving the patient's post-treatment survival probability.

The use of intraoral ultrasound in the evaluation of the benign lesions in pediatric patients.

Ultrasonography (US) or diagnostic sonography is a radiographic technique that uses sound waves with frequencies higher than 20 kHz to demonstrate soft tissues such as muscles, internal organs, joints, and tendons. The US has various applications in dentistry such as cervical lymph node examination, salivary gland examination, periodontal examination, maxillofacial fracture examination, temporomandibular joint examination, and orofacial swelling examination. One of the most important advantages of the US is it does not produce any ionizing radiation. Since the US does not produce any ionizing radiation, it is a favorable technique especially for the patients who are susceptible to ionizing radiation such as pregnant patients and pediatric patients. In this article, we presented benign tumor lesions that were examined with the US in children and conducted a review of the literature.

Juxtaposing Joint Displays with Mixed Methods Research Rationales: A Mixed Methods Research Systematic Methodological Review

Systematic integration of quantitative and qualitative research is a known challenge when conducting mixed methods research (MMR) and joint displays are one method to make the integration process more concrete. A systematic review of the published literature on joint displays and MMR rationales was conducted in order to juxtapose joint display typologies with corresponding MMR rationales. Data from the mixed methods research systemic methodological review (MMR-SMR) were summarized using descriptive statistics, and a codebook was used to look for patterns and to develop themes that were integrated with descriptive codes. There were 71 joint displays across 27 studies that met the inclusion criteria. The MMR-SMR provides a comprehensive, updated examination of joint displays in the methodological literature and includes several contributions to the field of mixed methods research. One finding suggests that joint displays have evolved beyond their original typologies and an updated typology is provided. The current MMR-SMR identified a novel data transformation joint display that presented the conversion of qualitative data into quantitative data in a tabular format. It is unique that combinations of joint displays are being used (e.g., a side-by-side joint display that incorporates a theoretical lens or a path diagram) and that multiple joint displays are being used in individual studies. Researchers are recommended to strongly consider using joint displays as a method of integration because it can provide a structure to think about integration and to report the results of integration, which can further enhance transparency of the mixed methods research integration process.

Age-specific incidence of joint disease in paediatric patients with haemophilia: A single-centre real-world outcome based on consecutive US examination.

Joint health is one of the most important factors contributing to a healthy life in patients with haemophilia. Recent study revealed that starting early prophylaxis was not enough to prevent joint disease in most paediatric patients with haemophilia. In this study, we aimed to determine the age-specific incidence of acute joint disease during childhood at single haemophilia treatment centre (HTC). The joint health in 48 patients was evaluated based on consecutive US testing for 5 years at annual multidisciplinary comprehensive care. During the study period, 23 patients (47.9%) had no joint disease since the initial examination, whereas 13 patients (27.0%) showed development from negative to positive findings. The incidence of joint disease increased with age: 0% in preschool, 5.3% in elementary school, 14.3% in junior high school and 35% beyond high school age. Among the 13 patients who developed joint disease, two experienced acquired synovitis that resolved during the follow-up period. Statistical analysis revealed that the patients who routinely underwent follow-up by the HTC exhibited a significantly lower incidence of joint disease than did those followed up at other institutions (p<.001). These results indicated that close check-up, including routine joint examination using US as well as frequent assessment of pharmacokinetic profile at the HTC, might play an important role in avoiding joint disease among paediatric patients with haemophilia.

Evaluation of Uveitis Induced in Rats by a Type I Collagen Peptide as a Model for Childhood Arthritis-associated Uveitis.

Chronic asymptomatic and acute symptomatic anterior uveitis are forms of ocular inflammation associated with juvenile idiopathic arthritis (JIA) Chronic JIA-associated uveitis is characterized by young age of onset, female predilection, oligoarthritis, and antinuclear antibody (ANA) positivity. Acute JIA-associated uveitis predominantly affects older male juveniles who also develop enthesitis. A type I collagen-derived peptide (melanin-associated antigen [MAA]) induces anterior uveitis in rodents. In this study, we evaluated MAA-induced uveitis in rats as a potential model for JIA-uveitis. We characterized MAA-induced uveitis by assessing its relationship to age and sex; tracking the occurrence of arthritis, enthesitis, and ANA positivity; and measuring vitreous fluid inflammatory biomarkers. Juvenile and adult and male and female Lewis rats (Rattus norvegicus) were inoculated with MAA. Slit-lamp biomicroscopy, indirect ophthalmoscopy, and joint examinations were performed 3 times weekly. Rats were euthanized at 4 wk after MAA inoculation, and plasma ANA testing, vitreous inflammatory biomarker assays, and globe histopathology assessments were conducted. Uveitis, arthritis, ANA status, levels of inflammatory biomarkers, histopathology, and joint tomographic images were assessed in relation to age and sex and compared with nonuveitic controls. All MAA-immunized rats developed uveitis characterized by anterior chamber fibrin, iridal vessel dilation, and miosis, and uveal and choroidal lymphocytic infiltration. Levels of the vitreous fluid biomarker CCL5 were higher in uveitic rats compared with control rats. Time to uveitis onset, clinical uveitis scores, and biomarker levels did not differ based on age or sex. None of the MAA-exposed rats had arthritis, enthesitis, or ANA. None of the rats inoculated with MAA that had been treated with matrix metallopeptidase 1 had clinical, histologic, or immunohistochemical evidence of ocular inflammation. In contrast to JIA-associated uveitis in humans, MAA-induced uveitis in rats is not associated with age or sex predilections and MAA is not arthritogenic.

Factor VIII Level in the Potential Female Carrier Mothers of Patients with Hemophilia A and Its Impact on Joint Health

Background Hemophilia A is an X-linked bleeding disorder. The characteristic bleeding phenotype in patients with severe hemophilia is recurrent spontaneous hemarthrosis with development of hemophilic arthropathy. Heterozygous female carriers with factor VIII (FVIII) activity level lower than 40% may be at risk for bleeding that is usually comparable to that seen in males with mild hemophilia. Aim of the Work To assess factor VIII level in mothers of known patients of hemophilia A correlating it with the frequency of clinically and radiologically documented arthropathy. Patients and Methods A cross sectional study included 40 mothers of patient with hemophilia A during the period from September 2020 to September 2021. Studied participants were subjected to detailed analysis of bleeding history, six major joints range of motion (ROM) examination, functional independence score in hemophilia (FISH), FVIII level one stage assessment and magnetic resonant imaging (MRI) of the reported affected joints. Results Mean age of mothers is 42.25 ± 7.74 years. Eleven mothers (27.5%) had no bleeding symptoms, 16 (40%) had one bleeding symptoms and 13 (32.5%) had two or more bleeding symptoms. As regard joint pain, 13 (32.5%) had severe pain, 3 (7.5%) had ankle pain and 2 (5%) had elbow pain with a mean pain score of 2.55±3.32, and 7 (17.5%) had bilateral pain. Mean FVIII activity was 43.33 IU (± 22.79), ranging from FVIII (0 &amp;lt; 30 IU) in 13 (32.5%), FVIII (30 &amp;lt;60) in 18 (45.0%) and FVIII ≥ 60 IU in 9 (22.5%) among the studied participants. Knees were the most affected joints with decreased mean ROM (±SD) in right and left knees of (123.25 (±12.06) and 120.00 (±15.81)) respectively. The median MRI scores were studied was 5 (2.6%) with median osteochondral changes of 4 (2.5%) and median soft tissue changes of 1 (0-1), their median FISH score of 8 (8-9). By comparing groups at the level of factor VIII, there was no significant difference according to anthropometric bleeding parameters, pain, and MRI score. None of participants needed hospital admission, factor VIII replacement or packed red cells replacement. Conclusion Potential female hemophilia A carriers are at risk of spontaneous bleeding which may entail bleeding in the joints, causing early joint damage. They showed reduced overall joint ROM and structural osteochondral changes in MRI joint examination which mandates further studies about early detection of potential female hemophilia carriers for the possible need of early medical intervention.

Copyright Research Protocol for Comprehensive Assessment of the Dento-Alveolar Complex in Patients with Temporomandibular Joint Disorders: Clinical Cases

Background. Currently, the issues of diagnosis and treatment of patients with dentoalveolar injuries combined with temporomandibular joint disorders are highly relevant due to a progressive increase in the number of cases of this pathology among the population. Despite the availability of the comprehensive methodology in diagnostics of dentoalveolar injuries, dentists lack standardized algorithms for effective examination and systematization of the data obtained in the diagnostics of such groups of patients, which is necessary for personalized planning and pathogenetic therapy. The authors present the algorithm they developed for comprehensive assessment of dentoalveolar injuries in patients with temporomandibular joint disorders.Case descriptions. The paper presents clinical cases of two patients with abnormal occlusion associated with temporomandibular joint disorder. The patients underwent a comprehensive morphofunctional examination of the dentoalveolar complex in accordance with the diagnostic algorithm patented by the authors, including following methods: clinical (interview, examination), anthropometric (anthropometry of dentition), radiological (cone-beam computed tomography, magnetic resonance imaging of the temporomandibular joint), functional (surface electromyography of the masticatory muscles, computer kinesiography, electro-vibrography, ultrasound examination of the temporomandibular joint), to make the final diagnosis and to determine the order and scope of treatment.Conclusion. The authors presented and proved clinically the algorithm of morphofunctional diagnostics for the dento-alveolar complex of patients with temporomandibular joint disorders, combining clinical, anthropometric, radiological and functional methods of examination, which allow the most dento-alveolar characteristics to be considered in order to make the main diagnosis and a personalized treatment protocol for such groups of patients

Examination of Three-Layered Clinch Joints

The reliable operation of an engineering structure is highly influenced by the joints of its structural elements. The selection of the applied joints is often determined by the function of the structure. In addition, the requirements for joints must be considered: strength, elongation, sealing, mobility, assembly, safety against loosening, feasibility, economy, design, etc. of the joint. The range of sheet materials used in the vehicle industry is very broad: manufacturers can choose the most suitable materials for a given purpose from a wide selection of materials, and it is also common to use sheets of several types of materials, with different thicknesses and physical and chemical properties, within a structural element. However, these sheets need to be combined in some way to produce a proper final product design. For combining thin sheet material, several different joining technologies are known. The aim of the study is the examination of clinched joints made of aluminium due to the highly increasing percentage of aluminium sheet usage in car bodies. The applied materials are EN AW 5754 and EN AW-1050 with different thicknesses. The joints were analysed by FEA and experimentally tested as well.

Periarticular knee osteotomies for pre-arthritic deformities in the frontal plane : Indications and surgical techniques

Currently, periarticular knee joint osteotomies are an integral part of the treatment of early arthritic deformities in the knee joint. Analysis of the deformity is performed with astandardized full-leg standing x‑ray of both legs, as well as alateral x‑ray of the knee joint that includes 2/3 of the proximal tibial shaft. An MRI examination of the knee joint is obtained to assess the articular cartilage, the ligaments and menisci. Torsion angle measurements with the CT/MRT supplement the diagnostics if necessary. Knowledge of normal physiological values and their standard deviations of the mechanical leg axis and the joint angles around the knee is obligatory. The osteotomy is performed as close as possible to the femoral and/or tibial deformity. Postsurgical deformities including pathological patella position or asignificant difference in leg length must be prevented. Adescription of proximal tibia opening or closing wedge osteotomies based on the nomenclature of the joint angles by Paley is presented. The indications for the various osteotomy techniques in the coronary plane are discussed in detail.

Predictors of inflammatory arthritis among new rheumatology referrals: a cross-sectional study.

Early diagnosis and treatment of inflammatory arthritis (IA) is essential to optimize disease control. We aimed to identify variables that distinguish IA from non-inflammatory arthropathy by performing a cross-sectional study of rheumatology referral letters and visit records. Further work describes time to assessment and documentation of variables within referral letters. We reviewed rheumatology referral letters and new patient visits over a 6-month period. The diagnosis of IA was based on the clinical judgement of the assessing rheumatologist. IA diagnoses included RA, SpAs, unspecified IA, PMR, crystalline arthropathies and remitting seronegative symmetrical synovitis with pitting oedema. Univariate analysis was performed for each variable. Multivariable logistic regression was performed on statistically significant variables. Of 697 patients referred for arthralgia, 25.7% were diagnosed with IA. Variables predictive of IA included tenderness and swelling on examination and ≥1 h of morning stiffness. Increasing arthralgia duration, fatigue and brain fog were negative predictors. The median time from referral to IA diagnosis was 55 days and 20.7% of these patients were seen within 6 weeks. Among referral letters, documentation of arthralgia duration, morning stiffness or joint examination findings was uncommon (31%, 20.5% and 56.7%, respectively). We identified positive and negative predictors of IA. Referral letters often missed key information required for the triaging process. Future efforts will be directed towards build a triaging tool to improve the referral quality and capture of those patients with IA who need earlier access to rheumatology care.

Performance of Fully Automated Algorithm Detecting Bone Marrow Edema in Sacroiliac Joints.

This study evaluates the performance of a fully automated algorithm to detect active inflammation in the form of bone marrow edema (BME) in iliac and sacral bones, depending on the quality of the coronal oblique plane in patients with axial spondyloarthritis (axSpA). The results were assessed based on the technical correctness of MRI examination of the sacroiliac joints (SIJs). A total of 173 patients with suspected axSpA were included in the study. In order to verify the correctness of the MRI, a deviation angle was measured on the slice acquired in the sagittal plane in the T2-weighted sequence. This angle was located between the line drawn between the posterior edges of S1 and S2 vertebrae and the line that marks the actual plane in which the slices were acquired in T1 and STIR sequences. All examinations were divided into quartiles according to the deviation angle measured in degrees as follows: 1st group [0; 2.2], 2nd group (2.2; 5.7], 3rd group (5.7; 10] and 4th group (10; 29.2]. Segmentations of the sacral and iliac bones were acquired manually and automatically using the fully automated algorithm on the T1 sequence. The Dice coefficient for automated bone segmentations with respect to reference manual segmentations was 0.9820 (95% CI [0.9804, 0.9835]). Examinations of BME lesions were assessed using the SPARCC scale (in 68 cases SPARCC > 0). Manual and automatic segmentations of the lesions were performed on STIR sequences and compared. The sensitivity of detection of BME ranged from 0.58 (group 1) to 0.83 (group 2) versus 0.76 (total), while the specificity was equal to 0.97 in each group. The study indicates that the performance of the algorithm is satisfactory regardless of the deviation angle.

Low-Affinity NMDA Receptor Antagonist Hemantane in a Topical Formulation Attenuates Arthritis Induced by Freund's Complete Adjuvant in Rats.

N-methyl-D-aspartate (NMDA) receptors that are expressed by T-cells modulate T-cell proliferation, cytotoxicity and cell migration toward chemokines. Several studies have shown an anti-inflammatory effect of NMDA receptor antagonists. This study compares the effect of the noncompetitive low-affinity NMDA receptor antagonist N-(2-adamantyl)-hexamethyleneimine hydrochloride (hemantane) in a topical formulation (gel) with the cyclooxygenase (COX) inhibitor diclofenac in a topical formulation (gel) in rats with arthritis induced by Freund's Complete Adjuvant (FCA). On day 14 after an FCA injection into the left hind paw, rats with contralateral hind paw edema were selected for further investigation (29/65). They were treated with 5% hemantane gel or 1% diclofenac gel applied locally to hind paws daily for 2 weeks starting 14 days after the FCA injection. Rats with arthritis were examined hind paw edema, hyperalgesia, and motor deficits; their body weight and hematological parameters were recorded. The rats were euthanized on day 28, followed by histological examination of the ankle joint (HE stain). Rats with arthritis exhibited hind paw inflammation and hyperalgesia, motor deficits, changes of hematological parameters, reduced weight gain and spleen hypertrophy. Histological examination of the ankle joint revealed degenerative-dystrophic lesions of the cartilaginous tissue, proliferative inflammation of the synovium, edema and lymphocytic/macrophage infiltration of periarticular tissues. Hemantane gel reduced hind paw edema, pain, motor deficits and histological signs of inflammation; its effect was comparable to diclofenac gel. Hemantane gel alleviates FCA-induced arthritis in rats, and its effect is comparable to diclofenac gel.

ANALISIS KRITERIA RADIOGRAFI OS PATELLA DAN PATELOFEMORAL JOINT DENGAN PROYEKSI SKYLINE METODE HUNGSTON DAN SETTEGAST

Background: the problem in radiographic examination of Os Patella and Patellofemoral joint is the limitation in showing the picture of Os Patella from the infero-superior aspect which is free from superposition with other surrounding organs and also to show the distance between Os Patella and Condylus Femoralis Joint. Objective: to analyze the criteria for the results of the Os Patella and Patellofemoral joint examination in providing optimal and informative results according to diagnostic needs. Methods: This study used a descriptive qualitative design, with a sample of 10 patients. Research Results: radiographic images of the Hungston method in the prone patient position and knee flexed to form 550 with 450 cranially ray direction can provide informative results in the examination of Os Patella and Patellofemoral Joint because it can provide optimal anatomical image criteria and open Patellofemoral Joint Interspace than the Settegast method. Conclusion: the Hungston method is able to show optimal and informative image results for use in examining the Os Patella and Patellofemoral Joint Skyline projection.

Diagnostic performance of double inversion recovery MRI sequence for synovitis of the wrist joints in rheumatoid arthritis.

To assess the diagnostic accuracy of double inversion recovery (DIR) magnetic resonance imaging (MRI) sequences for synovitis of the wrist joints in patients with rheumatoid arthritis (RA). Participants with newly diagnosed RA were enrolled between November 2019 and November 2020. MRI examinations of the wrist joints were performed using a contrast-enhanced T1-weighted imaging sequence (CE-T1WI) and DIR sequence. We measured synovitis score, number of synovial areas, synovial volume, mean synovium-to-bone signal ratio (SBR), and synovial contrast-to-noise ratio (SNR). The inter-reviewer agreement rated on a four-point scale was evaluated by calculating the weighted k statistics. Two MRI sequences were assessed using Bland-Altman analyses, and the diagnostic performance of DIR images was calculated using the chi-square test. A total of 47 participants were evaluated, and 282 joint regions in 5076 images were reviewed by two readers. There was no significant difference in synovitis scores (P = 0.67), number of synovial areas (P = 0.89), and synovial volume (P = 0.086) between the two MRI sequences. DIR images showed better SBR and SNR (all P < 0.01). There was good agreement between the two reviewers in terms of synovitis distribution (κ = 0.79). The synovitis was well agreed upon by the two readers according to Bland-Altman analyses. Using CE-T1WI as the reference standard, DIR imaging demonstrated a sensitivity of 94.1% and a specificity of 84.6% at the patient level. The non-contrast DIR sequence showed good consistency with CE-T1WI and potential for evaluating synovitis in patients with RA.