Progression Of Osteoarthrosis Research Articles

Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements.

The aim of the present study was to assess the effectiveness of balloon implantation in patients with irreparable supraspinatus tears alone or in combination withother rotator cuff (RC) tendon tearsand the effect of several covariables, such as age, gender, status of the long head biceps, with or without tendon repair and regardless the number of tendon involved. Patients enrolled from 'San Carlo' Hospital of Potenza (Italy, IT), from January 2012 to September 2014, underwent arthroscopic implantation of shoulder balloon by a single surgeon, and followed for 3 years. The American Shoulder and Elbow Surgeons (ASES) and Constant score (CS) were administered pre-, post-operatively at 12 months, and then annually. Patients were classified on the basis of the number of tendons involved in the tears and treatment performed, considering the reparability of the tendons themselves. Gleno-humeral joint osteoarthrosis (OA) was evaluated through shoulder radiographs and classified according to the Samilson-Prieto classification, at the first examination and at the final follow-up. Statistical improvements were evaluated using a variance model (least-squares means)and a T distribution test for the evaluation between different treatment groups. A total of 61 procedures were performed, and eight patients were lost during follow-up. The mean baseline CS was 30.2 ± 15.4 with statistically significant improvement, respectively, at 1-, 2- and 3-year follow-up to 69.3 ± 4.2, 74.6 ± 3.6 and 69.7 ± 5.1 respectively. ASES score at baseline was 22.5 ± 10.9, with a statistically significant improvement to 69.7 ± 9.2, 68 ± 17.8 and 71.2 ± 16.6 at 1-, 2- and 3-year follow-up, respectively. Tenotomy or absence of long head biceps at presentation did not influence results (n.s.), with no difference according to gender and age. At final follow-up, 24 patients (43.9%) showed progression of glenohumeral OA. One patient required secondary surgery for shoulder replacement after 18 months for persistent pain and one patient required implant removal following post-operative laser treatment. Arthroscopic rotator cuff tears repair with subacromial spacer balloon implantation showed statistically significant clinical and functional improvement at 3-year follow-up. Patients treated with combined partial repair and subacromial spacer balloon implantation experienced good results independent of gender, age, type of tear and long-head biceps tendon status. The risks related to this procedure appear to be minimal. Level IV.

Allotendoplasty in Treatment of Habitual Patella Dislocation in Adults

Background. Habitual dislocation of patella is a congenital disease that manifests in early childhood or adolescent age and requires surgical treatment. In case this condition has not been rectified timely, the congenial patellar luxation develops the properties of a habitual dislocation accompanied by pain syndrome and osteoarthrosis development in the patellofemoral and knee joints. In most cases reconstructive surgery is used for this disease treatment; it is aimed at the strengthening of the knee joint interval compartment, with the formation of a fibrous graſt or a vertical strip of it, which are moved to the knee joint outside compartment and fixed to adjacent tissues with sutures. However, such surgery is possible only in case of preserved anatomic structures of the knee medial compartment. In adult patients, aſter multiple patellar dislocations, the interval joint capsule and medial aponeurosis lose their normal structure, become weakened, strained, and loose. That is why the patient’s own tissues from that area cannot be used for reconstructive surgery.The purpose of the study is to develop the new low-traumatic method of treatment for habitual dislocation of kneecap in adult patients to ensure its reliable stabilization as related to the joint surface on distal femoral epimetaphys, and to prevent patella dislocation relapse.Material and methods. Surgery technique consists of the lateral release of knee joint, mobilization of patellar ligament and its excision together with the fragment of tibial tuberosity osseous. On 1.5–2.0 cm medially from the area of own patellar ligament harvesting in tibia epimetaphys, the new bed with the similar form and shape is formed, and the excised tibial tuberosity fragment with patellar ligament is introduced there and fixed with a Cancellous screw.The area of own patellar ligament harvestingis filled up with autogenous osseous tissue taken from the medial part of tibia epimetaphys when forming the new bed for the excised tibial tuberosity fragment. Transversal tunnelis formedin the quadriceps tendon above the patella; allotendonis pulledvia this tunnel. The allotendon ends are sutured together, thus forming the duplication, analogous to the ligament, and fixit, stretched to “pes anserinus” of the shin onits anterior-interior surface.Conclusion. The new technology of allotendoplasty for the treatment of habitual kneecap dislocation in adult patients facilitates the surgical technique, additionally strengthens medial compartment tissues of the knee, reliably stabilizes the patella as related to its joint surface on distal femoral epimetaphys, eliminates patella dislocation relapse, normalizes the knee and patellofemoral joints functioning by preventing osteoarthrosis progression in them.

Almost 79% survival rate at 10-year follow-up for the patellofemoral joint arthroplasty: An Italian prosthetic registry study.

The aims of the present study were (1) to evaluate the survival of patellofemoral joint (PFJ) arthroplasty in a large cohort of patients using data obtained from an Italian regional arthroplasty registry and (2) to collect clinical outcomes of a subgroup of patients, with a minimum follow-up of 4 years. The hypotheses were that PFJ arthroplasty is a procedure that had good survival and clinical outcomes, not inferior to those reported in the literature for primary total knee arthroplasty (TKA). The Register of Orthopaedic Prosthetic Implants (RIPO) of Emilia-Romagna (ER) (Italy) database was searched for the inclusion of all PFJ arthroplasties implanted between 2003 and 2019. PFJ arthroplasties were excluded if they were implanted in patients who lived outside of the ER. The survival information was extrapolated from the RIPO considering the partial or total revision of the implant as failure; moreover, a subgroup of patients was contacted and interviewed by telephone to collect clinical outcomes. Descriptive statistics were used to summarise the data. The survival curve was calculated and plotted using the Kaplan-Meier method. A total of 126 arthroplasties in 114 patients were included in the final analysis (mean age at surgery 60.1 ± 11.5 years old). The main causes of patellofemoral arthroplasty were primary osteoarthritis (88%) and posttraumatic arthritis (7%). The survival was 90.4 ± 30.6 and 78.8 ± 51.5 at 5 and 10 years of follow-up, respectively. At the latest follow-up, 23 implants failed (18.3%). The main cause of revision was osteoarthrosis progression (34.8%). A total of 44 patients were contacted by telephone to collect clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index, functional Knee Society Score, Forgotten Joint Scoreand Oxford Knee Score. These patients reported good to excellent scores at a medium follow-up of 10.3 ± 4.7 years. The PFJ showed good survival and clinical outcomes and could be considered a valuable option for patients affected by isolated patellofemoral osteoarthritis. Level IV.

Study of the Early Effects of Chitosan Nanoparticles with Glutathione in Rats with Osteoarthrosis.

Due to cartilage's limited capacity for regeneration, numerous studies have been conducted to find new drugs that modify osteoarthrosis's progression. Some evidence showed the capability of chitosan nanoparticles with glutathione (Np-GSH) to regulate the oxide-redox status in vitro in human chondrocytes. This work aimed to evaluate the capacity of Np-GSH in vivo, using Wistar rats with induced surgical osteoarthritis. Radiographic, biochemical (GSH and TBARS quantification), histopathological, and immunohistochemical (Col-2 and MMP-13) analyses were performed to evaluate the progress of the osteoarthritic lesions after the administration of a single dose of Np-GSH. According to the results obtained, the GSH contained in the NPs could be vectored to chondrocytes and used by the cell to modulate the oxidative state reduction, decreasing the production of ROS and free radicals induced by agents oxidizing xenobiotics, increasing GSH levels, as well as the activity of GPx, and decreasing lipid peroxidation. These results are significant since the synthesis of GSH develops exclusively in the cell cytoplasm, and its quantity under an oxidation-reduction imbalance may be defective. Therefore, the results allow us to consider these nanostructures as a helpful study tool to reduce the damage associated with oxidative stress in various diseases such as osteoarthritis.

Can a Musculoskeletal Model Adapted to Knee Implant Geometry Improve Prediction of 3D Contact Forces and Moments?

Tibiofemoral contact loads are crucial parameters in the onset and progression of osteoarthrosis. While contact loads are frequently estimated from musculoskeletal models, their customization is often limited to scaling musculoskeletal geometry or adapting muscle lines. Moreover, studies have usually focused on superior-inferior contact force without investigating three-dimensional contact loads. Using experimental data from six patients with instrumented total knee arthroplasty (TKA), this study customized a lower limb musculoskeletal model to consider the positioning and the geometry of the implant at knee level. Static optimization was performed to estimate tibiofemoral contact forces and contact moments as well as musculotendinous forces. Predictions from both a generic and a customized model were compared to the instrumented implant measurements. Both models accurately predict superior-inferior (SI) force and abduction-adduction (AA) moment. Notably, the customization improves prediction of medial-lateral (ML) force and flexion-extension (FE) moments. However, there is subject-dependent variability in the prediction of anterior-posterior (AP) force. The customized models presented here predict loads on all joint axes and in most cases improve prediction. Unexpectedly, this improvement was more limited for patients with more rotated implants, suggesting a need for further model adaptations such as muscle wrapping or redefinition of hip and ankle joint centers and axes.

Possible pathogenetic features of the development and progression of osteoarthritis in the metabolic syndrome (diabetes mellitus, obesity, arterial hypertension)


 The paper emphasizes the pathogenetic features of osteoarthritis in the metabolic syndrome (type 2 diabetes, obesity, and arterial hypertension), such as the violation of the structure of the bone and cartilage tissue of the joints. Attention is paid to such mechanisms as oxidative stress, low-grade chronic systemic inflammation, and participation of the cartilage extracellular matrix, where matriline-3 protein plays an important role. It is involved in cartilage development and possible pathological mechanisms contributing to the onset and progression of osteoarthritis/osteoarthritis.
 The significance of abnormal levels of reactogenic forms of oxygen, superoxide anion, and nitrogen monoxide, which provide an increase in the level of peroxynitrite, hydrogen peroxide, myeloperoxidase, and hypochlorous acid, is discussed in detail. It is indicated that in the presence of iron and hydrogen peroxide, chondrocytes release hydroxyl radicals that react with unsaturated fatty acids of membranes and start a chain reaction, producing radicals with a long lifetime. This causes degradation of both the cellular and intercellular components of the cartilage. In addition, intra-articular connections are formed, and the vascular wall is restructured, leading to impaired microcirculation in bone and cartilage tissue due to damage to the vascular endothelium, vasospasm, increased blood clotting, the formation of microemboli, and venous occlusion. As a result, ischemia of the subchondral bone develops, along with damage to the cartilage tissue and a local disturbance of microcirculation. The thickness of the subchondral bone decreases due to angiogenesis at the junction of the articular hyaline cartilage and adjacent subchondral bone in patients with osteoarthritis. This process enhances degenerative-inflammatory changes in the structure of the cartilage due to a violation of metabolic processes in it.
 The importance of lipid and protein peroxidation in the regulation of intracellular calcium homeostasis and the ability of smooth muscles to undergo persistent contractions, which cause muscle pain, are emphasized. Pathogenetically, an important role in this process is played by the inhibition of calcium-ATPase in the sarcoplasmic reticulum, the activation of calcium flow through calcium channels, and an increase in intracellular calcium. Hypocalcemia and hypercalciuria in patients with metabolic syndrome contribute to the progression of not only osteoarthritis but other components of the syndrome.
 Attention is drawn to the significance of the cytokine link as an important mechanism for the onset and progression of osteoarthritis/osteoarthritis. The features of the reaction of chronic systemic inflammation with the participation of IL-18 and IL-10 in the structure of the extracellular matrix of cartilage, where matrilin-3 protein plays an important role since it is involved both in the development of cartilage and in the progression of osteoarthrosis, depending on multimorbidity with other components of metabolic syndrome, are highlighted.

Epigenetic profiling of articular chondrocytes

Purpose: Osteoarthrosis, the degeneration of the articular cartilage, is a severe health problem of the aging population, but the mechanisms regulating the differentiation of embryonic chondrocytes into mature articular cartilage of the synovial joints are still not sufficiently understood. Several lines of evidence indicate that the differentiation of embryonic into permanent articular cartilage is guided by epigenetic reprogramming. Additionally, recent data provide evidence that changes in enhancer accessibility are linked to osteoarthrosis progression.

Inflammatory Factor in Pathogenesis of Early Knee Osteoarthrosis

Osteoarthrosis (OA) is a polyetiologic pathology of the musculoskeletal system with various complicated mechanisms of progression, therefore making the investigation of an inflammatory factor role in the incidence of early primary knee osteoarthrosis in patients lacking clinical signs of the disease an important and promising research trend. We ran a complete examination of 27 patients with early OA lacking prominent clinical signs of the disease as well as 20 apparently healthy individuals (without musculoskeletal pathologies) using clinical (orthopedic status), instrumental (ultrasonography, X-ray radiography, MRI) and lab tests including quantification of main lymphocyte subpopulations, determination of inflammatory mediators – C-reactive protein, erythrocyte sedimentation rate, neopterin, proinflammatory cytokines as well as defining the specifics of cartilaginous tissue metabolism and free-radical oxidation condition. The investigation of the inflammatory factor role through the specifics of changes in its certain indicators in patients with early knee OA lacking clinical signs of the disease showed the presence of inflammatory response signs manifested in the certain increase of C-reactive protein, erythrocyte sedimentation rate and neopterin, relative activation of proinflammatory cytokines expression as well as an abnormality of cell immunity indicators and an emerging trend for the enhancement of free-radical oxidation along with the destructive changes in cartilaginous tissue proved with the increased cartilaginous glycoprotein-39 and cartilage oligomeric matrix protein in serum. The processes described above may accompany further activation of catabolic processes and facilitate the initiation of the immune response with cartilaginous tissue antigenic determinants. The immune response in its turn triggers the inflammatory destruction of the joint connective tissue components. The results are worth considering in the researches of pathogenetic mechanisms of primary OA progression at its early stages with no X-ray evidence, and therefore facilitate timely revealing of the disease and designing pathogenetic approaches for the administration of this cohort of patients.

Short-term outcomes and complications of 65 cases of porous TTA with flange: a prospective clinical study in dogs

BackgroundCranial cruciate ligament rupture (CrCLR) is the most common orthopaedic cause of lameness in the hind limb in dogs. Many surgical treatments have been described, but tibial tuberosity advancement (TTA) is one of the most commonly used today. Since it was first described, TTA has evolved to reduce major complications and to arrest the progression of osteoarthrosis. The aim of this study was to assess a surgical technique called Porous TTA with flange prospectively. This study was performed in 61 dogs that underwent 65 Porous TTA with flange procedures, to validate it as an alternative CrCLR treatment. Complications and clinical outcomes (pain, lameness, weight bearing, flexion, extension, crepitation and atrophy) were reported over 3 months, i.e. at 3, 6 and 12 weeks postoperatively.ResultsThe results showed a positive clinical outcome, a minor complication rate of 47.69% at the first review 3 weeks postoperatively, 10.77% at the second one (6 weeks after the surgery) and 4% at the third one (at 12 weeks). Major complications were observed only at the last review, with one case that had an infection requiring implant removal; this represented 1.5% of cases. Variables evaluated for a relationship with complication scores and improvement were body condition score, sex, age, breed, body weight, breed size, side of the affected limb, traumatic anamnesis and time of lameness before surgery. No relationship was detected.ConclusionsClinical outcomes and complications show that Porous TTA with flange is an efficient alternative for surgical treatment of CrCLR in dogs.

Reparación transtibial de la raíz posterior del menisco lateral en lesiones agudas: técnica quirúrgica y seguimiento clínico a corto plazo

Backgroundinjuries of posterior lateral meniscus root (PLMR) affect the transfer of the axial load of the knee. Several surgical techniques have been described for it treatment, but still none has demonstrated superiority. Consequently, there are controversies about which technique is most indicated for these injuries. The aim is to describe the a surgical technique and the clinical follow up of patients operated with transtibial fixation of PLMR in a specialized clinic, during the 2016-2017. MethodsRetrospective case series and description of the surgical technique. We included patients with acute injuries in the PLMR, who were operated using a new variation to the transtibial technique. For the clinical follow-up, the IKDC and Lysholm scores were performed before and after surgery. ResultsSix patients with acute lesion in the PLMR were intervened, four were male. The time between trauma and surgery was on average 2.5 months. All the patients presented a concomitant lesion of the anterior cruciate ligament. When comparing the initial state of the patients and the postoperative period, statistically significant differences were found (p <0.05). Likewise, reinterventions were not performed during follow-up. DiscussionThe repair of PLMR with the new variation of the transtibial fixation provides an improvement in the function, the pain and the level of activity of the patients, which can help to delay the progression of osteoarthrosis in the knee. Likewise, this technique can be performed safely even in cases of concomitant ligament injuries.Level of clinical evidence: Level IV

Hypophosphatemic osteomalacia caused by urinary mesenchymal tumor: A case report

This case report concerns a 34-year-old woman who had been diagnosed with ankylosing spondylitis (AS), fibromyalgia syndrome (FMS), osteoarthritis (OA), lumbar disc herniation and the like in different hospitals during the past 18 months. She had progressive osteoarthrosis, significant muscle weakness, gait abnormalities in weightbearing areas, however without typical inflammatory low back pain, while the treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was invalid, with normal inflammation index, negative results for rheumatic factor (RF) and human leukocyte antigen (HLA)-B27, and normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). She had hyphosphatemia, normal serum calcium, 1,25-(OH)2-D3 reduction, elevated alkaline phosphatase (ALP) and normal parathyroid hormone (PTH), however with elevated urinary phosphorus. Finally, the medial thigh nodule was found in the subcutaneous of her inner leg by careful examination and imaging scans including B-ultrasound and PET/CT. The final pathology confirmed that the nodule was phosphate urinary mesenchymal tumors. After the tumor was removed, the patient was treated with anti-osteoporosis and phosphorus supplementation. The symptoms of bone pain and muscle weakness were alleviated, and hypophosphatemia was corrected. It was confirmed that the patient had low-phosphorus osteomalacia due to tumor. Tumor-induced hypophosphatemia osteomalacia (TIO) was a rare paraneoplastic syndrome which was caused by excessive phosphorus excretion induced by the tumor, and was thus categorized as an acquired hypophosphatemic osteomalacia. TIO had an occult onset and was associated with a high rate of misdiagnosis, although TIO has some typical clinical features. Early diagnosis, correctly positioning of the tumor, and surgical resection can achieve good outcomes.

Analysis of the dynamics of the structural changes development in the humerus of guinea pigs under modeling biomechanical disturbances

Today, the role of the traumatic factor and inflammation in the development and progression of osteoarthrosis is generally recognized, but the available research results do not allow to establish the role of impaired biomechanics as a monofactor in the development of deforming ostearthrosis of the shoulder joint. Violation of the function of the bone and bone-cartilage elements of the joint, which is compensated by soft tissue formations, leads to overloads of the joints, upsets the normal balance of the load forces in the joint, creates abnormal biomechanics and the resulting pathological manifestations of deforming osteoarthrosis. The aim of the study is research of the dynamics of the disturbed biomechanics influence of the shoulder joint on the development of deformation osteoarthrosis and the features of the development of its structural changes. The experiments were conducted on guinea pigs weighing 380-420 grams at the age of 5 months. A model of surgical restriction of joint mobility was reproduced, which caused the formation of contracture. Using the methods of histology and scanning electron microscopy, we studied the relief of the articular surface, the topography of degenerative changes, and structural changes in the articular cartilage and subchondral bone. A statistical evaluation of the obtained data samples was carried out using Student t-test. The results were considered reliable at р&lt;0.05. The results of an experimental study demonstrated a decrease in the thickness and structure of articular cartilage when modeling deforming osteoarthrosis and confirmed the hypothesis that pathological limitation of the mobility of the shoulder joint and violation of biomechanics is an independent factor in the formation of osteoarthrosis. After surgery on day 30, degenerative changes and their progression with the formation of contracture on day 90 of observation were found in the articular cartilage. The features of the development of articular surface degeneration, the dynamics of the pathological changes and topography, which can expand the understanding of the pathogenesis of the disease, were established. The loss of the superficial zone caused the progression of dystrophic changes in the articular cartilage and sclerosis of the subchondral bone at 60 and 90 days.

Overlapping features of rapidly progressive osteoarthrosis and Charcot arthropathy

Nerve growth factor (NGF) is the primary neurotrophin in the skeleton and a central mediator of skeletal pain. Recent trials of anti-NGF neutralizing antibodies have resulted in infrequent but well-described incidence of rapidly progressive osteoarthrosis (RPOA). Neuropathy, whether from syphilis or diabetes, is also associated with severe joint destruction, known as neuroarthropathy or Charcot joint. These commonalities of severe joint destruction with either loss of a neurotrophin (anti-NGF) or a deficit of functional skeletal innervation led us to examine our institutional case files for potential radio-pathologic overlap between RPOA and Charcot joint.

Clinical and Radiological Mid-to-Long-term Outcomes Following Ankle Arthrolysis.

The aim of this study was to evaluate the clinical and radiographic success of arthrolysis surgery and the risk of progression of osteoarthrosis at the ankle joint. In a retrospective clinical and radiological study, with a minimum follow-up of 24 months, the pain level and quality of living were evaluated. Following arthrolysis of the ankle joint, 16% of patients required ankle fusion within 2 years. Women had a higher quality-of-life in terms of Foot Function Index. Younger patients scored higher in both quality-of-life and function scores. Radiographic osteoarthrotic changes and the specific follow-up interval did not correlate with clinical outcome. Fewer than 20% of patients required ankle fusion. Female gender and young age had a positive impact. Preoperative radiography and the postsurgical interval are poorly predictive for the progression of osteoarthrosis.

Long-term assessment of a modified tibial tuberosity advancement technique in dogs

ABSTRACT The purpose of study was to assess long-term clinical and radiographic aspects of dogs’ stifle joints which had undergone a modified tibial tuberosity advancement technique (mTTA). A total of 15 stifles that had undergone mTTA for CCL disease of 11 patients were included in this study. Assessments involved patient’s gait analysis, cranial drawer and tibial compression tests, stifle goniometry range of articular motion, thigh and leg girth and radiographic evidence of progression of osteoarthrosis. Variables were compared between operated and healthy limbs and among moments (M0) on the early postop; (M1) 120 days postop; and (M2) approximately 5 years following surgery. A questionnaire regarding owner’s perceptions after approximately 5 years of surgery was assessed. Most dogs presented positive response to cranial drawer and tibial compression tests on operated knees. There was also decrease on goniometry and thigh girth and increase in leg girth. Radiographic evidence of progression of osteoarthritis was seen especially on the long-term follow-up (M2). On gait analysis, most animals presented some degree of lameness in different conditions, in contrast to owners’ perceptions. Osteoarthritis still develops in dogs following mTTA surgery for CCL disease. However, owners were overall satisfied with their recovery and would be willing to accept indication of mTTA for dogs with ruptured CCL.

PATHOGENETIC SUBSTANTIATION OF COMPREHENSIVE TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMBINED WITH OSTEOARTHROSIS AND OBESITY CONCERNING THE CORRECTION OF THE DISORDERS IN THE PROTEINASE INHIBITOR SYSTEM AND METABOLISM OF THE CONNECTIVE TISSUE COM

Introduction. The incidence of the co-morbid course of chronic pancreatitis (CP) and obesity has recently increased significantly both in Ukraine and all over the world, especially in individuals being in the second half of their adulthood and in the elderly ones. This combination of interdependent diseases is often complemented by osteoarthrosis (OA) of the large joints, which is characterized by severe, rapidly progressing course. The basis CP and OA progression, among various mechanisms of pathogenesis, is the proteinase-inhibitor imbalance, which leads to proteolytic damage and destruction of acinar epithelium and cartilage tissue, polymorphocyte infiltration of the tissue of the pancreas and synovial epithelium (reactive synovitis) under the influence of increased expression and activation of cellular adhesion factors, hyperproduction of proinflammatory cytokines, growth factors of anabolic action, acidosis, hypoxia, etc.Objective. Тo identify the mechanisms of mutual aggravation of chronic pancreatitis and osteoarthrosis of large joints in obese patients on the basis of the study of protein and carbohydrate-protein components of the extracellular matrix of the proteinase inhibitor system, to increase the efficiency of comprehensive treatment for this polymorbidity.Materials and methods. Тhe study involved 90 patients with CP, aged 45 to 63 years old , 22 of whom had normal body weight (1group 1), 27 patients with CP suffered from the first degree obesity (group 2), 41 patients had CP with comorbid first degree obesity and І-ІІ stage osteoarthritis of the of the hip and knee joints (group 3).To evaluate the effectiveness of the proposed treatment, the patients of group 3 were divided into two subgroups: 3A and 3B. Group 3А (21 individuals) received basic treatment of CP exacerbation: a hypocaloric diet with elimination of extractive foods, antisecretory (proton pump inhibitor), antispasmodic (mebeverine hydrochloride) for 1 month, multienzyme (kreon10-20 thousand units) preparations, L-carnitine (solution) 1.0 (10 ml) twice a day for 90 days. Group 3B (20 people), in addition to the above therapy, received the drinking form of L-carnitine 1.0 (10 ml) twice a day and L-glutathione (hepaval) 250 mg twice a day for 90 days.Results. Тhe proposed therapy contributed to the normalization of proteinase inhibitor homeostasis. Without proteinase inhibitors in the basic therapy the complex application of L-carnitine and L-glutathione contributed to a reliable decrease in the intensity of azole albumin lysis in patients of both groups: 1.2 and 1.6 times, respectively (p &lt;0.05), due to significant inhibition of hyperproduction of proteinase inhibitors: the content of α2- macroglobulins in the blood dropped by 1.6 and 2.2 times (p &lt;0.05) with normalization of the values.Conclusions. Patients with chronic pancreatitis, comorbid obesity and osteoarthrosis of large joints were studied during their therapy, the mechanisms of mutual aggravation were identified: hyperproduction of the extracellular matrix components, acute phase proteins, an increased degradation of fucoglycoproteins and proteinase-inhibitor imbalance.The integrated therapy of patients with CP and obesity which includes antioxidant (L-glutathione) and a metabolism stabilizer (L-carnitine) against the basic treatment resulted in the balance of the processes of synthesis and decomposition of collagen and glycoproteins, proteinase-inhibitor system homeostasis, collagenolysis enhancement with the achievement of the balance in the metabolism of the connective tissue components, homeostasis of hydrogen sulfide, which underlies the achievement of stable remission of CP and OA, reducing the risk of their progression.

CX3CR1 regulates osteoarthrosis chondrocyte proliferation and apoptosis via Wnt/β-catenin signaling

ObjectiveThe study was aimed to investigate the impact of CX3CR1 expression on the proliferation and apoptosis of osteoarthrosis (OA) chondrocytes through Wnt/ β-catenin pathway. MethodsThe expression levels of CX3CR1 and Wnt/β-catenin pathway-related genes mRNA and protein in OA chondrocytes were examined by qRT-PCR and western blot. MTT and flow cytometry (FCM) assays were employed to assess cell proliferation, cell cycle and apoptosis. XAV-939, a Wnt/β-catenin pathway inhibitor, was used to inhibit the pathway. ResultsCX3CR1 was significantly overexpressed in OA cartilages than that in normal articular cartilages (P < 0.05). After siCX3CR1 transfection, the expression level of Wnt 3, nuclear β-catenin, Cyclin D1, MMP-13 and phosphorylated GSK-3β significantly increased, while cytoplasm β-catenin, GSK-3β and phosphorylated β-catenin expression was inhibited (P<0.05). XAV-939abolished the effects of siCX3CR1 on proliferation, apoptosis and cell cycle progression of OA chondrocytes (P<0.05). ConclusionsCX3CR1 regulated chondrocyte proliferation and apoptosis through Wnt/β-catenin signaling pathway. The overexpression of CX3CR1 in chondrocytes of OA may be closely related to the pathogenesis and progression of OA.

The impact of obesity on the structure of osteoarthrosis of large joints of the lower limb.

The prevalence of osteoarthrosis (OA) among adults over 40 years is taking one of the leading places in the common structure of joint pathology. Obesity – is of the comorbidities associated with OA, one of the risk factors of development and progression of OA. The aim of this study was to evaluate the influence of obesity on the structure of knee and hip OA on the stage of total joint replacement, depending on the patient`s gender, age and degree of obesity. The study involved 170 inpatient case histories of patients with OA undergoing treatment in the department of large joints replacement (64 men and 106 women): 95 patients with OA of hip joint and 75 – with OA of knee joint, among whom there were 110 patients with obesity and 60 – without it. The middle age of the patients was by 63,8±7,69 years. High prevalence of obesity among patients with OA of knee and hip joints was found, with significant higher number of obese patients with OA of knee joint and among female patients. It has been demonstrated a significant increase in the frequency of total knee joint replacement associated with the increase of body mass index among patients with OA of knee joint. The presence of obesity was associated with earlier terms of the total joint replacement performing, especially among male patients.

Fisioterapia da articulação escapuloumeral em cães com osteocondrite dissecante – revisão de literatura

Physiotherapy in veterinary medicine can be used to strengthen specific muscle groups, which is particularly interesting in the conservative treatment of osteochondritis dissecans (OCD) of the humeral head. OCD is endochondral ossification disorder and is characterized by an injury to the joint cartilage. There are conservative and surgical treatments for the disease that aim to restore limb functionality and relieve pain. Building the musculature through physical rehabilitation strengthens the periarticular muscles and decreases the progression of osteoarthrosis, reducing clinical symptoms. Some of the main physical activities used in the treatment of dogs with OCD of the humeral head include active and passive movements, hydrotherapy, massage and cryotherapy.

Heat shock proteins - participants in osteoarthrosis pathogenesis

Osteoarthrosis is a disease that affects all tissues of synovial joints, resulting in chronic pain and often a need for replacement. The high prevalence and the lack of reliable conservative approaches impose significant economic sanctions on most economies in the world. Currently the mechanisms of osteoarthrosis progression have been well studied. At the same time, the known pathogenetic concepts do not allow to define reliable targets of conservative treatment. There is a clear need for searching alternative concepts, which will help to expand the understanding of the pathogenesis and identify ways to address therapeutic issues. Heat shock proteins (chaperones) are involved in intra- and extracellular signaling in the pathogenesis of many diseases. The aim of this review is to analyze the current state of the problem of studying the role of heat shock proteins in the pathogenesis of osteoarthrosis. The review considers the fundamental aspects of the activation and functioning of chaperones, experience of studying chondrocyte heat shock proteins is described, issues of programmed cell death mechanisms are mentioned, scheme of shaperone activity in osteoarthrosis is illustrated. The role of heat shock proteins from the perspectives of reparation and alteration carried out in the articular cartilage is described, the prospects for further clarification of their role in the pathogenesis of osteoarthrosis are identified. The role of two key molecules - protein with molecular weight of 70 kD and a small molecule with molecular weight of 27 kD, is emphasized. Heat shock proteins are of fundamental and applicative interest from the perspective of their participation in the key ways of osteoarthrosis pathogenesis and phenomena (oxidative, microcrystalline, hydrodynamical, stress, aging, etc.). Further study of heat shock proteins will allow to significantly expand the knowledge of osteoarthrosis and to identify ways of targeted therapy.