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[PMID]: 29523973
[Au] Autor:Ausó-Pérez JR; Rodríguez-Blanes GM
[Ad] Address:Orthopedic Surgery and Traumatology Service, Hospital Marina Baixa, Avda. Alcalde En Jaume Botella Mayor, s/n, 03570, La Vila Joiosa, Alicante, Spain. auso_jos@gva.es.
[Ti] Title:Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement.
[So] Source:Eur J Orthop Surg Traumatol;, 2018 Mar 09.
[Is] ISSN:1633-8065
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:BACKGROUND: Synovial proliferation is a rather frequent intraoperative finding during the surgery of a total knee replacement. The aim of this study is to asses whether the standard procedure of a synovectomy results in changes in blood loss and in the need for transfusion in the immediate postoperative time after the total knee replacement. METHODS: A prospective cohort study was performed with 120 patients undergoing total knee replacement (60 with synovectomy and 60 without it). Data on gender, age, and hemoglobin concentration prior to and after surgery were obtained. A bivariate and multivariate logistic regression analysis was performed. RESULTS: The male gender as a protective factor [RR 0.25 (0.06-1.01)] and the low preoperative hemoglobin as a risk factor [RR 6.22 (2.48-15.58)] were significant in bivariate analysis. However, only the presence of low preoperative hemoglobin was shown to have an independent risk factor for the need for transfusion [RR 8.55 (2.77-26.45)]. CONCLUSION: The practice of synovectomy showed no difference either in blood loss or in the number of transfusions. The findings of this study indicate that the practice of a synovectomy in a standard total knee replacement does not generate any benefit or prejudice as to the blood factor of the total knee arthroplasty.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00590-018-2160-8

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[PMID]: 29521078
[Au] Autor:Wilson E; Cox P; Greaves K; Prosad Paul S
[Ad] Address:University of Bristol, England.
[Ti] Title:Recognition and nursing management of children with non-traumatic limp.
[So] Source:Emerg Nurse;25(10):24-30, 2018 Mar 09.
[Is] ISSN:1354-5752
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Children with acute onset non-traumatic limp often present to emergency departments (EDs). The limp can occasionally be associated with medical emergencies such as septic arthritis and slipped upper femoral epiphysis but is often due to less severe conditions. This article discusses the common and self-limiting causes of acute onset of non-traumatic limp in children, such as transient synovitis, reactive arthritis, and benign acute childhood myositis. It also discusses more severe conditions, including septic arthritis, osteomyelitis, slipped upper femoral epiphysis, Perthes disease, malignancies and non-accidental injury. Management and prognosis of these conditions are discussed in the context of guidance from the National Institute for Health and Care Excellence. The article includes two case studies that illustrate different presentations and the challenges that nurses who manage children in EDs are likely to come across in clinical practice.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.7748/en.2018.e1722

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[PMID]: 29508053
[Au] Autor:Bause L; Niemeier A; Krenn V
[Ad] Address:Klinik für Rheumaorthopädie, St. Josef-Stift Sendenhorst, Sendenhorst, Deutschland.
[Ti] Title:Arthur-Vick-Preis der Deutschen Gesellschaft für Orthopädische Rheumatologie 2017. [Arthur Vick Prize 2017 of the German Society of Orthopaedic Rheumatology].
[So] Source:Z Rheumatol;77(2):168-174, 2018 Mar.
[Is] ISSN:1435-1250
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:The German Society of Orthopaedic Rheumatology (DGORh) honored Prof. Dr. med. Veit Krenn (MVZ-ZHZMD-Trier) with the Arthur Vick Prize 2017. With this award, scientific results with high impact on the diagnosis, therapy and pathogenetic understanding of rheumatic diseases are honored. In cooperation with pathologists and colleagues from various clinical disciplines Prof. Dr. med. Veit Krenn developed several histopathologic scoring systems which contribute to the diagnosis and pathogenetic understanding of degenerative and rheumatic diseases. These scores include the synovitis score, the meniscal degeneration score, the classification of periprosthetic tissues (SLIM classification), the arthrofibrosis score, the particle score and the CD15 focus score. Of highest relevance for orthopedic rheumatology is the synovitis score which is a semiquantitative score for evaluating immunological and inflammatory changes of synovitis in a graded manner. Based on this score, it is possible to divide results into low-grade synovitis and high-grade synovitis: a synovitis score of 1-4 is called low-grade synovitis and occurs for example in association with osteoarthritis (OA), post-trauma, with meniscal lesions and hemochromatosis. A synovitis score of 5-9 is called high-grade synovitis, e.g. rheumatoid arthritis, psoriatic arthritis, Lyme arthritis, postinfection and reactive arthritis as well as peripheral arthritis with Bechterew's disease (sensitivity 61.7%, specificity 96.1%). The first publication (2002) and an associated subsequent publication (2006) of the synovitis score has led to national and international acceptance of this score as the standard for histopathological assessment of synovitis. The synovitis score provides a diagnostic, standardized and reproducible histopathological evaluation method for joint diseases, particularly when this score is applied in the context with the joint pathology algorithm.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1007/s00393-018-0433-6

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[PMID]: 29415892
[Au] Autor:Lietman C; Wu B; Lechner S; Shinar A; Sehgal M; Rossomacha E; Datta P; Sharma A; Gandhi R; Kapoor M; Young PP
[Ad] Address:Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
[Ti] Title:Inhibition of Wnt/ß-catenin signaling ameliorates osteoarthritis in a murine model of experimental osteoarthritis.
[So] Source:JCI Insight;3(3), 2018 Feb 08.
[Is] ISSN:2379-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Osteoarthritis (OA) is a degenerative joint disease involving both cartilage and synovium. The canonical Wnt/ß-catenin pathway, which is activated in OA, is emerging as an important regulator of tissue repair and fibrosis. This study seeks to examine Wnt pathway effects on synovial fibroblasts and articular chondrocytes as well as the therapeutic effects of Wnt inhibition on OA disease severity. Mice underwent destabilization of the medial meniscus surgery and were treated by intra-articular injection with XAV-939, a small-molecule inhibitor of Wnt/ß-catenin signaling. Wnt/ß-catenin signaling was highly activated in murine synovial fibroblasts as well as in OA-derived human synovial fibroblasts. XAV-939 ameliorated OA severity associated with reduced cartilage degeneration and synovitis in vivo. Wnt inhibition using mechanistically distinct small-molecule inhibitors, XAV-939 and C113, attenuated the proliferation and type I collagen synthesis in synovial fibroblasts in vitro but did not affect human OA-derived chondrocyte proliferation. However, Wnt modulation increased COL2A1 and PRG4 transcripts, which are downregulated in chondrocytes in OA. In conclusion, therapeutic Wnt inhibition reduced disease severity in a model of traumatic OA via promoting anticatabolic effects on chondrocytes and antifibrotic effects on synovial fibroblasts and may be a promising class of drugs for the treatment of OA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  5 / 12639 MEDLINE  
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[PMID]: 29516287
[Au] Autor:Bursill D; Dalbeth N
[Ad] Address:Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
[Ti] Title:What Is the Evidence for Treat-to-Target Serum Urate in Gout?
[So] Source:Curr Rheumatol Rep;20(3):11, 2018 Mar 08.
[Is] ISSN:1534-6307
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE OF REVIEW: Most current clinical guidelines for gout management advocate a treat-to-target serum urate approach, although notable differences exist. Serum urate is a rational target for gout treatment given the central role of urate in disease causality, its association with key outcomes and its practicality of use in clinical practice. This review analyses the evidence for this strategy in gout. RECENT FINDINGS: Recent studies have confirmed the efficacy of urate-lowering therapy in achieving serum urate targets, both in trials using fixed doses and those applying a treat-to-target strategy. In a limited number of long-term studies (> 12-month duration), interventions that incorporate a treat-to-target serum urate approach have been shown to promote regression of tophi, reduce the frequency of gout flares and improve MRI-detected synovitis. A strong case can be made for a treat-to-target serum urate strategy in gout, supported by existing knowledge of disease pathophysiology, outcomes from urate-lowering therapy studies and emerging results of randomised strategy trials of sufficient duration.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1007/s11926-018-0719-3

  6 / 12639 MEDLINE  
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[PMID]: 29253286
[Au] Autor:Duetzmann S; Tas S; Seifert V; Marquardt G; Dombert T; Staub F
[Ad] Address:Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany.
[Ti] Title:Cross-sectional Area of the Median Nerve Before Revision Carpal Tunnel Release-A Cross-sectional Study.
[So] Source:Oper Neurosurg (Hagerstown);14(1):20-25, 2018 Jan 01.
[Is] ISSN:2332-4260
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: High-resolution ultrasound can be used for diagnosis of carpal tunnel syndrome with an equal accuracy to electrodiagnostic studies. Up to date there has been no investigation published that examined the median nerve in a large patient cohort with recurrent or persistent symptoms. Reference and cutoff values are lacking. OBJECTIVE: To provide reference values for detection of ongoing or recurrent compression in patients with recurring or persisting symptoms in carpal tunnel syndrome. METHODS: One hundred and sixteen patients undergoing revision decompression of the median nerve at the carpal tunnel between January 2010 and October 2015 were studied retrospectively to determine the cross-sectional area of the median nerve at the wrist by the technique of neurosonography. RESULTS: In cases of insufficient primary release, the mean cross-sectional area was 20.0 mm2 preop. In cases of scar or synovitis, the mean cross-sectional area was 17.0 mm2 (significantly less than in cases of insufficient primary release, P = .008). Compared to successfully operated patients with de novo carpal tunnel syndrome (n = 74), a cutoff value of 14.5 mm2 yielded a sensitivity of 78% and a specificity of 97% to diagnose ongoing or recurrent compression in case of a typical clinical presentation of ongoing or recurrent symptoms (tested via comparison of patients who are symptom free vs patients with symptoms). CONCLUSION: For the first time, we provide reference values in patients with recurring or persisting symptoms in carpal tunnel syndrome based on a large patient population. Ultrasound can aid in the evaluation of patients with entrapment neuropathy of the median nerve and recurring or persisting symptoms.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/ons/opx079

  7 / 12639 MEDLINE  
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[PMID]: 28471034
[Au] Autor:Hussain S; Sivakumaran P; Gill A; Dhas D; Ciurtin C
[Ad] Address:University College London Medical School, London, UK.
[Ti] Title:Ultrasonography-detected subclinical inflammation in patients with hand osteoarthritis and established rheumatoid arthritis: a comparison between two different pathologies using the same ultrasound examination protocol.
[So] Source:Musculoskeletal Care;16(1):26-31, 2018 Mar.
[Is] ISSN:1557-0681
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: A recent review of ultrasound (US) studies in osteoarthritis (OA) showed very limited data about hand OA. Previous US studies in patients with OA described a degree of overlap between the US appearance of rheumatoid arthritis (RA) and OA joints. The present study aimed to assess the US features of subclinical inflammation in RA and hand OA, using the same US examination protocol. METHODS: A retrospective, cohort study compared patients with established RA (n = 224) and hand OA (n = 73), with respect to several demographic, clinical, laboratory and US parameters. We used a 22-hand joint US examination protocol (wrists, metacarpophalangeal and proximal interphalangeal joints bilaterally - Outcome Measures in Rheumatology Clinical Trials [OMERACT] scoring system) for all patients. RESULTS: Subclinical joint inflammation in the context of equivocal clinical examination was found in 9.6% of OA patients compared with 46.4% of RA patients (p = 0.0001), despite the fact that there was no significant difference between the degree of chronic joint swelling (synovial hypertrophy grades 2 and 3; p = 0.75 and p = 0.11, respectively). The presence of osteophytes was more common in patients with hand OA, as expected (p = 0.0001). CONCLUSIONS: Our study findings reflected differences between the incidence and characteristics of subclinical inflammation in patients with RA and OA, which could be helpful in patients with an equivocal clinical examination or history of both diseases. Almost one in 10 patients with hand OA had active synovitis, while almost one in two patients with RA had uncontrolled inflammation in at least one joint.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1705
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1002/msc.1197

  8 / 12639 MEDLINE  
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[PMID]: 29510818
[Au] Autor:Danielsen MA
[Ad] Address:ammitz7@gmail.com.
[Ti] Title:Ultrasonography for diagnosis, monitoring and treatment of tenosynovitis in patients with rheumatoid arthritis.
[So] Source:Dan Med J;65(3), 2018 Mar.
[Is] ISSN:2245-1919
[Cp] Country of publication:Denmark
[La] Language:eng
[Ab] Abstract:Rheumatod arthritis is a chronic systemic autoimmune disease, characterized by inflammation in joints and tendon sheaths, which frequently leads to permanent and serious disability due to joint destruction, but also tendon and ligament ruptures. Clinical management of rheumatoid arthritis has traditionally been supported by biochemical and radiographic findings. However, imaging modalities like ultrasound and magnetic resonance imaging (MRI) have improved the possibility for better management of rheumatoid arthritis patients, due to higher sensitivity and specificity for detecting ongoing inflammation, this thesis is focusing on tenosynovitis as recent studies have shown that inflammation in tendon sheaths, i.e. tenosynovitis, is a very common manifestation of rheumatoid arthritis and may often be mistaken for synovitis. Furthermore, presence of ultrasonographic tenosynovitis may predict clinical flare and erosive progression. 
The main aim of this PhD thesis was to further develop and validate ultrasound as a tool for diagnosis, monitoring and treatment of tenosynovitis. This was investigated in four studies: 
Study I: 3D Doppler Ultrasound findings in healthy wrist and finger tendon sheaths - Can feeding vessels lead to misinterpretation in Doppler-detected tenosynovitis? 
Study II: Image fusion of Ultrasound and MRI and B-flow evaluation of tenosynovitis - A pilot study on new imaging techniques in rheumatoid arthritis patients. 
Study III: Validity and sensitivity to change of the semi-quantitative Outcome Measures in Rheumatology Clinical Trials (OMERACT) ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis and for the quantitative scoring system, pixel index. 
Study IV: Intramuscular versus ultrasound guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis - A randomised, double-blind, controlled study with ultrasound and clinical follow up at 4 and 12 weeks. 
From the studies presented in the PhD thesis the following was concluded:
 Doppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers in healthy participants. These feeding vessels may be a source of misinterpretation, i.e .wrong diagnosis of a low degree of tenosynovitis, not only due to their presence but also because they may be interpreted as being inside the tendon sheath due to blooming and reverberations artefacts.
 Ultrasound and MRI had high agreement using image fusion for assessment of tenosynovitis when MRI partial volume artefacts were taken into account. In contrast, the agreement between B-flow and ultrasound was poor, since the quality of the b-flow images and the flow sensitivity were low.
 The OMERACT ultrasound scoring system for tenosynovitis had an excellent intra- and interreader agreement between trained investigators and a high ability to detect change over time, similarly, the quantitative tenosynovitis assessment by pixel index had a very good intrareader agreement and moderate to good interreader agreement, but only a moderate ability to detect change over time. The ultrasound scores had a high responsiveness, indicating that the OMERACT ultrasound scoring system was useful for diagnosing and monitoring tenosynovitis in rheumatoid arthritis patients in clinical trials and practice. For treatment of tenosynovitis in rheumatoid arthritis patients, remission (ultrasound tenosynovitis grey scale score ≤1 and Doppler score = 0) was achieved significantly more frequently in the ultrasound guided intratenosynovial glucocorticoid injection group than in the intramuscular glucocorticoid injection group, both at 4 and 12 week follow-ups. Furthermore, tenosynovitis responded significantly better clinically and by ultrasound assessment when treated with ultrasound guided intratenosynovial glucocorticoid injection com-pared to intramuscular glucocorticoid injection, both at 4 and 12 week follow-ups.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process

  9 / 12639 MEDLINE  
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[PMID]: 29504995
[Au] Autor:Duan Y; Qian J; Chen K; Zhang Z
[Ad] Address:Dalian Medical University.
[Ti] Title:Necessity of adjuvant postoperative radiotherapy for diffuse pigmented villonodular synovitis of the knee: A case report and literature review.
[So] Source:Medicine (Baltimore);97(3):e9637, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Pigmented villonodular synovitis (PVNS) is an idiopathic, proliferative disorder lesion of synovial tissue, which is regarded as a benign disease, but has a local invasion. Up to now, these are no consensus about the etiology and pathogenesis of PVNS. Because of the lack of typical clinical features, misdiagnosis and delayed diagnosis are not uncommon, magnetic resonance imaging (MRI) can assist diagnosis and histopathological examination is recognized as the gold standard for the final diagnosis. Because this disease is so rare, there is no standard treatment. Surgical resection of the lesion is considered the preferred treatment, but postoperative recurrence is a problem that cannot be ignored. Postoperative radiotherapy is necessary, especially for patients with diffuse PVNS of the knee. PATIENT CONCERNS: A 27-year-old female teacher presented with 3 years chronic pain of the right knee, and progressive swelling aggravated for 1 week. The range of motion of the knee was limited. DIAGNOSES: Clinical and laboratory examination failed to provide definitive diagnosis. Imaging can assist in diagnosis, and pathology is the gold standard. Erythrocyte sedimentation rate (ESR), antihemolytic streptococcus O (ASO), and rheumatoid factors (RF) were all negative. Joint puncture revealed giant cell tumor of the synovial membrane. PVNS was confirmed by postoperative pathology. The characteristic T2 weighted low signal of MRI suggests the recurrence of PVNS. INTERVENTIONS: The patient underwent 2 stages of treatment: open synovectomy was performed in the first place and postoperative external radiotherapy was not considered. After 2 years of disease-free remission, she was diagnosed with a recurrence of the disease by MRI. Further, arthroscopic total synovectomy of the right knee was performed and external beam radiotherapy was carried out after the operation. OUTCOMES: Up to now, the patient was followed up for 3 years without any sign of recurrence. LESSONS: Adjuvant postoperative radiotherapy can improve the local control rate, it is a reliable treatment method for diffused PVNS.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process
[do] DOI:10.1097/MD.0000000000009637

  10 / 12639 MEDLINE  
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[PMID]: 29500484
[Au] Autor:Kalia V; Daher O; Garvin G; Chhibber S; Shepherd J
[Ad] Address:Department of Radiology, St. Joseph Hospital, London, ON, N6A 4V2, Canada. v2k1978@gmail.com.
[Ti] Title:Synchronous bilateral lipoma arborescens of bicipitoradial bursa-a rare entity.
[So] Source:Skeletal Radiol;, 2018 Mar 02.
[Is] ISSN:1432-2161
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Lipoma arborescens is a rare non-neoplastic condition that affects the synovial lining of joints and bursae accounting for less than 1% of all lipomatous lesions. Characterized by villous proliferation of the synovium, it is an uncommon cause of intra/periarticular mass presenting as a painless, slowly progressive longstanding swelling, and is sometimes accompanied by intermittent monoarticular effusions. We describe a rare case of bilateral lipoma arborescens in the bicipitoradial bursae in a young male referred for MRI evaluation of spontaneous bilateral elbow swelling. We chose to bring this case to light because of the rare simultaneous involvement of the bicipitoradial bursae bilaterally and the role of MR in providing a definite diagnosis, hence obviating the need for biopsy and avoiding consideration of other complex intra/periarticular masses.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:Publisher
[do] DOI:10.1007/s00256-018-2915-7


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