Base de dados : MEDLINE
Pesquisa : A02.835.583.443.800.800 [Categoria DeCS]
Referências encontradas : 11623 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 1163 ir para página                         

  1 / 11623 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29351562
[Au] Autor:Calvet J; Orellana C; Galisteo C; García-Manrique M; Navarro N; Caixàs A; Larrosa M; Gratacós J
[Ad] Endereço:Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain.
[Ti] Título:Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion.
[So] Source:PLoS One;13(1):e0191342, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. METHODS: One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. RESULTS: One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. CONCLUSIONS: The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Osteoartrite do Joelho/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Seguimentos
Seres Humanos
Injeções Intra-Articulares
Masculino
Meia-Idade
Osteoartrite do Joelho/diagnóstico por imagem
Osteoartrite do Joelho/fisiopatologia
Dor/tratamento farmacológico
Manejo da Dor
Medição da Dor
Estudos Prospectivos
Líquido Sinovial/diagnóstico por imagem
Líquido Sinovial/efeitos dos fármacos
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191342


  2 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29437053
[Au] Autor:Tarabichi M; Shohat N; Goswami K; Parvizi J
[Ad] Endereço:The Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia PA 19107, USA.
[Ti] Título:Can next generation sequencing play a role in detecting pathogens in synovial fluid?
[So] Source:Bone Joint J;100-B(2):127-133, 2018 02.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The diagnosis of periprosthetic joint infection can be difficult due to the high rate of culture-negative infections. The aim of this study was to assess the use of next-generation sequencing for detecting organisms in synovial fluid. MATERIALS AND METHODS: In this prospective, single-blinded study, 86 anonymized samples of synovial fluid were obtained from patients undergoing aspiration of the hip or knee as part of the investigation of a periprosthetic infection. A panel of synovial fluid tests, including levels of C-reactive protein, human neutrophil elastase, total neutrophil count, alpha-defensin, and culture were performed prior to next-generation sequencing. RESULTS: Of these 86 samples, 30 were alpha-defensin-positive and culture-positive (Group I), 24 were alpha-defensin-positive and culture-negative (Group II) and 32 were alpha-defensin-negative and culture-negative (Group III). Next-generation sequencing was concordant with 25 results for Group I. In four of these, it detected antibiotic resistant bacteria whereas culture did not. In another four samples with relatively low levels of inflammatory biomarkers, culture was positive but next-generation sequencing was negative. A total of ten samples had a positive next-generation sequencing result and a negative culture. In five of these, alpha-defensin was positive and the levels of inflammatory markers were high. In the other five, alpha-defensin was negative and the levels of inflammatory markers were low. While next-generation sequencing detected several organisms in each sample, in most samples with a higher probability of infection, there was a predominant organism present, while in those presumed not to be infected, many organisms were identified with no predominant organism. CONCLUSION: Pathogens causing periprosthetic infection in both culture-positive and culture-negative samples of synovial fluid could be identified by next-generation sequencing. Cite this article: 2018;100-B:127-33.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Infecções Bacterianas/microbiologia
Micoses/microbiologia
Infecções Relacionadas à Prótese/microbiologia
Análise de Sequência de DNA/métodos
Líquido Sinovial/química
Líquido Sinovial/microbiologia
[Mh] Termos MeSH secundário: Biomarcadores/análise
Proteína C-Reativa/análise
Seres Humanos
Elastase de Leucócito/análise
Reação em Cadeia da Polimerase
Estudos Prospectivos
Sensibilidade e Especificidade
Método Simples-Cego
alfa-Defensinas/análise
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (alpha-Defensins); 9007-41-4 (C-Reactive Protein); EC 3.4.21.37 (Leukocyte Elastase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0531.R2


  3 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29191466
[Au] Autor:Morgenstern C; Cabric S; Perka C; Trampuz A; Renz N
[Ad] Endereço:Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
[Ti] Título:Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection.
[So] Source:Diagn Microbiol Infect Dis;90(2):115-119, 2018 Feb.
[Is] ISSN:1879-0070
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Analysis of joint aspirate is the standard preoperative investigation for diagnosis of periprosthetic joint infection (PJI). We compared the diagnostic performance of culture and multiplex polymerase chain reaction (PCR) of synovial fluid for diagnosis of PJI. PATIENTS AND METHODS: Patients in whom aspiration of the prosthetic hip or knee joint was performed before revision arthroplasty were prospectively included. The performance of synovial fluid culture and multiplex PCR was compared by McNemar's chi-squared test. RESULTS: A total of 142 patients were included, 82 with knee and 60 with hip prosthesis. PJI was diagnosed in 77 patients (54%) and aseptic failure in 65 patients (46%). The sensitivity of synovial fluid culture and PCR was 52% and 60%, respectively, showing concordant results in 116 patients (82%). In patients with PJI, PCR missed 6 high-virulent pathogens (S. aureus, streptococci, E. faecalis, E. coli) which grew in synovial fluid culture, whereas synovial fluid culture missed 12 pathogens detected by multiplex PCR, predominantly low-virulent pathogens (Cutibacterium acnes and coagulase-negative staphylococci). In patients with aseptic failure, PCR detected 6 low-virulent organisms (predominantly C. acnes). CONCLUSION: While the overall performance of synovial fluid PCR was comparable to culture, PCR was superior for detection of low-virulent bacteria such as Cutibacterium spp. and coagulase-negative staphylococci. In addition, synovial fluid culture required several days for growth, whereas multiplex PCR provided results within 5hours in an automated manner.
[Mh] Termos MeSH primário: Articulações/microbiologia
Tipagem Molecular/métodos
Reação em Cadeia da Polimerase Multiplex/métodos
Infecções Relacionadas à Prótese/microbiologia
Líquido Sinovial/microbiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril/efeitos adversos
Artroplastia do Joelho/efeitos adversos
Técnicas Bacteriológicas
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Infecções Relacionadas à Prótese/diagnóstico
Infecções Estafilocócicas/diagnóstico
Infecções Estafilocócicas/microbiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


  4 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28455435
[Au] Autor:Guo Y; Walsh AM; Fearon U; Smith MD; Wechalekar MD; Yin X; Cole S; Orr C; McGarry T; Canavan M; Kelly S; Lin TA; Liu X; Proudman SM; Veale DJ; Pitzalis C; Nagpal S
[Ad] Endereço:Immunology, Janssen Research, Spring House, PA 19477; yguo49@its.jnj.com snagpal2@its.jnj.com.
[Ti] Título:CD40L-Dependent Pathway Is Active at Various Stages of Rheumatoid Arthritis Disease Progression.
[So] Source:J Immunol;198(11):4490-4501, 2017 06 01.
[Is] ISSN:1550-6606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The inflammatory CD40-CD40L pathway is implicated in various autoimmune diseases, but the activity status of this pathway in various stages of rheumatoid arthritis (RA) progression is unknown. In this study, we used gene signatures of CD40L stimulation derived from human immature dendritic cells and naive B cells to assess the expression of CD40-downstream genes in synovial tissues from anti-citrullinated protein Ab-positive arthralgia, undifferentiated arthritis (UA), early RA, and established RA cohorts in comparison with healthy donors. Interestingly, the expression of and active full-length was increased in the disease tissues, whereas that of a dominant-negative isoform was decreased. Gene set variation analysis revealed that CD40L-responsive genes in immature dendritic cells and naive B cells were significantly enriched in synovial tissues from UA, early RA, and established RA patients. Additionally, CD40L-induced naive B cell genes were also significantly enriched in synovial tissues from arthralgia patients. In our efforts to characterize downstream mediators of CD40L signaling, we have identified and as novel components of the pathway. In conclusion, our data suggest that therapeutic CD40-CD40L blocking agents may prove efficacious not only in early and established RA, but also in inhibiting the progression of the disease from arthralgia or UA to RA.
[Mh] Termos MeSH primário: Artrite Reumatoide/imunologia
Artrite/imunologia
Ligante de CD40/imunologia
Ligante de CD40/metabolismo
Progressão da Doença
Transdução de Sinais
[Mh] Termos MeSH secundário: Adulto
Idoso
Artralgia/imunologia
Artralgia/fisiopatologia
Artrite Reumatoide/fisiopatologia
Linfócitos B/efeitos dos fármacos
Linfócitos B/imunologia
Biópsia
Linfócitos T CD4-Positivos/imunologia
Antígenos CD40/deficiência
Antígenos CD40/genética
Antígenos CD40/imunologia
Antígenos CD40/metabolismo
Ligante de CD40/genética
Ligante de CD40/farmacologia
Células Dendríticas/imunologia
Células Dendríticas/fisiologia
Feminino
Voluntários Saudáveis
Seres Humanos
Ativação Linfocitária
Masculino
Meia-Idade
Líquido Sinovial/citologia
Líquido Sinovial/imunologia
Transcriptoma
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CD40 Antigens); 147205-72-9 (CD40 Ligand)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.4049/jimmunol.1601988


  5 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29305453
[Au] Autor:Suen K; Keeka M; Ailabouni R; Tran P
[Ad] Endereço:Western Health, 160 Gordon St, Footscray, Victoria 3011, Australia.
[Ti] Título:Synovasure 'quick test' is not as accurate as the laboratory-based α-defensin immunoassay: a systematic review and meta-analysis.
[So] Source:Bone Joint J;100-B(1):66-72, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: α-defensin is a biomarker which has been described as having a high degree of accuracy in the diagnosis of periprosthetic joint infection (PJI). Current meta-analyses are based on the α-defensin laboratory-based immunoassay rather than the quick on-table lateral flow test kit. This study is the first meta-analysis to compare the accuracy of the α-defensin laboratory-based immunoassay and the lateral flow test kit for the diagnosis of PJI. MATERIALS AND METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all clinical studies where the diagnosis of PJI was uncertain. All studies selected used the Musculoskeletal Infection Society (MSIS) or modified MSIS criteria. Two independent reviewers reviewed the studies and extracted data. A meta-analysis of results was carried out: pooled sensitivity, specificity, positive and negative likelihood ratio, heterogeneity and areas under curves are reported. RESULTS: Ten studies (759 patients) were included. Of these, seven studies (640 patients) evaluated the laboratory-based α-defensin immunoassay and three (119 patients) the lateral flow test. The pooled sensitivity and specificity of the qualitative α-defensin laboratory immunoassay was 0.953 (95% confidence interval (CI) 0.87 to 0.984) and 0.965 (95% CI 0.943 to 0.979) respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 34.86 (95% CI 19.34 to 62.85) and 0.02 (95% CI 0.00 to 0.11). The pooled sensitivity and specificity of the lateral flow test were 0.774 (95% CI 0.637 to 0.870) and 0.913 (95% CI 0.828 to 0.958), respectively. The pooled PLR and NLR were 8.675 (95% CI 4.229 to 17.794) and 0.248 (95% CI 0.147 to 0.418), respectively. CONCLUSION: The pooled sensitivity and specificity of the lateral flow test were lower than those of the α-defensin laboratory-based immunoassay test. Hence, care must be taken with interpretation of the lateral flow test when relying on its results for the intra-operative diagnosis of PJI. Cite this article: 2018;100-B:66-72.
[Mh] Termos MeSH primário: Prótese Articular/efeitos adversos
Infecções Relacionadas à Prótese/diagnóstico
Kit de Reagentes para Diagnóstico
Líquido Sinovial/química
alfa-Defensinas/análise
[Mh] Termos MeSH secundário: Biomarcadores/análise
Seres Humanos
Imunoensaio
Falha de Prótese/etiologia
Reoperação
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Reagent Kits, Diagnostic); 0 (alpha-Defensins)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0630.R1


  6 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29246219
[Au] Autor:Jessberger S; Högger P; Genest F; Salter DM; Seefried L
[Ad] Endereço:Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Am Hubland C7, 97074, Würzburg, Germany.
[Ti] Título:Cellular pharmacodynamic effects of Pycnogenol® in patients with severe osteoarthritis: a randomized controlled pilot study.
[So] Source:BMC Complement Altern Med;17(1):537, 2017 Dec 16.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The standardized maritime pine bark extract (Pycnogenol®) has previously shown symptom alleviating effects in patients suffering from moderate forms of knee osteoarthritis (OA). The cellular mechanisms for this positive impact are so far unknown. The purpose of the present randomized pilot controlled study was to span the knowledge gap between the reported clinical effects of Pycnogenol® and its in vivo mechanism of action in OA patients. METHODS: Thirty three patients with severe OA scheduled for a knee arthroplasty either received 100 mg of Pycnogenol® twice daily or no treatment (control group) three weeks before surgery. Cartilage, synovial fluid and serum samples were collected during surgical intervention. Relative gene expression of cartilage homeostasis markers were analyzed in the patients' chondrocytes. Inflammatory and cartilage metabolism mediators were investigated in serum and synovial fluid samples. RESULTS: The oral intake of Pycnogenol® downregulated the gene expression of various cartilage degradation markers in the patients' chondrocytes, the decrease of MMP3, MMP13 and the pro-inflammatory cytokine IL1B were statistically significant (p ≤ 0.05). Additionally, protein concentrations of ADAMTS-5 in serum were reduced significantly (p ≤ 0.05) after three weeks intake of the pine bark extract. CONCLUSIONS: This is the first report about positive cellular effects of a dietary supplement on key catabolic and inflammatory markers in patients with severe OA. The results provide a rational basis for understanding previously reported clinical effects of Pycnogenol® on symptom scores of patients suffering from OA. TRIAL REGISTRATION: ISRCTN10754119 . Retrospectively registered 08/10/2015.
[Mh] Termos MeSH primário: Cartilagem/efeitos dos fármacos
Flavonoides/farmacologia
Osteoartrite do Joelho/tratamento farmacológico
Osteoartrite do Joelho/metabolismo
Líquido Sinovial/efeitos dos fármacos
[Mh] Termos MeSH secundário: Idoso
Biomarcadores/análise
Cartilagem/química
Colagenases/sangue
Feminino
Flavonoides/administração & dosagem
Flavonoides/uso terapêutico
Seres Humanos
Interleucina-1beta/sangue
Masculino
Meia-Idade
Projetos Piloto
Líquido Sinovial/química
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Biomarkers); 0 (Flavonoids); 0 (IL1B protein, human); 0 (Interleukin-1beta); 0 (pycnogenols); EC 3.4.24.- (Collagenases)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-017-2044-1


  7 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29220376
[Au] Autor:Hornum L; Hansen AJ; Tornehave D; Fjording MS; Colmenero P; Wätjen IF; Søe Nielsen NH; Bliddal H; Bartels EM
[Ad] Endereço:Novo Nordisk A/S, Måløv, Denmark.
[Ti] Título:C5a and C5aR are elevated in joints of rheumatoid and psoriatic arthritis patients, and C5aR blockade attenuates leukocyte migration to synovial fluid.
[So] Source:PLoS One;12(12):e0189017, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Complement activation correlates to rheumatoid arthritis disease activity, and increased amounts of the complement split product C5a is observed in synovial fluids from rheumatoid arthritis patients. Blockade of C5a or its receptor (C5aR) is efficacious in several arthritis models. The aim of this study was to investigate the role of C5a and C5aR in human rheumatoid arthritis and psoriatic arthritis-both with respect to expression and function. Synovial fluid, blood and synovial samples were obtained from rheumatoid arthritis, psoriatic arthritis and osteoarthritis patients as a less inflammatory arthritis type, and blood from healthy subjects. Cells infiltrating synovial tissue were analysed by immunohistochemistry and flow cytometry. SF and blood were analysed for biomarkers by flow cytometry or ELISA. The effect of a blocking anti-human C5aR mAb on leukocyte migration was determined using a Boyden chamber. Appropriate statistical tests were applied for comparisons. C5aR+ cells were detected in most rheumatoid arthritis, in all psoriatic arthritis, but not in non-inflammatory control synovia. C5aR+ cells were primarily neutrophils and macrophages. C5aR+ macrophages were mainly found in lymphoid aggregates in close contact with T cells. C5a levels were increased in both rheumatoid arthritis and psoriatic arthritis synovial fluid compared to osteoarthritis, and in blood from rheumatoid arthritis compared to healthy subjects. Neutrophil and monocyte migration to rheumatoid arthritis synovial fluid was significantly inhibited by anti-C5aR. The data support that the C5a-C5aR axis may be driving the infiltration of inflammatory cells into the synovial fluid and synovium in both rheumatoid and psoriatic arthritis, and suggest that C5a or C5aR may be a promising treatment target in both diseases.
[Mh] Termos MeSH primário: Artrite Psoriásica/metabolismo
Artrite Reumatoide/metabolismo
Quimiotaxia de Leucócito
Complemento C5a/metabolismo
Leucócitos/patologia
Receptor da Anafilatoxina C5a/metabolismo
Líquido Sinovial/metabolismo
[Mh] Termos MeSH secundário: Ensaio de Imunoadsorção Enzimática
Citometria de Fluxo
Seres Humanos
Imuno-Histoquímica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Receptor, Anaphylatoxin C5a); 80295-54-1 (Complement C5a)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171209
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189017


  8 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29257013
[Au] Autor:Lee YS; Koo KH; Kim HJ; Tian S; Kim TY; Maltenfort MG; Chen AF
[Ad] Endereço:Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
[Ti] Título:Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis.
[So] Source:J Bone Joint Surg Am;99(24):2077-2084, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The search for a single standard reference test for determining periprosthetic joint infection (PJI) through analysis of synovial fluid has yielded numerous biomarkers as potential candidates. The purpose of the present systematic review and meta-analysis was to evaluate the diagnostic accuracy of synovial fluid biomarkers and to determine which test has the highest diagnostic odds ratio (DOR) for the diagnosis of PJI. METHODS: An online literature search of the MEDLINE, Embase, and Cochrane databases identified 33 articles reporting a total of 13 major parameters for diagnosing PJI through analysis of synovial fluid. Each of the included articles was independently analyzed for risk of bias and for concerns regarding applicability utilizing the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. The mada (meta-analysis of diagnostic accuracy) tool was used to generate forest plots for sensitivity, specificity, and the log of the DOR, as well as summary statistics. RESULTS: In this analysis, 13 index tests (leukocyte count; measurement of the percentage of polymorphonucleocytes [PMN%] and the levels of C-reactive protein [CRP], α-defensin, leukocyte esterase [LE], interleukin [IL]-6, IL-8, IL-10, IL-1ß, vascular endothelial growth factor [VEGF], and granulocyte-colony stimulating factor [G-CSF]; culture; and polymerase chain reaction [PCR] analysis) were evaluated on the basis of ≥2 articles. Of these tests, 8 (leukocyte count, PMN%, CRP, α-defensin, LE, IL-6, IL-8, and culture) were appropriate for pooled analysis. The overall sensitivity of these 8 markers was 0.85, and all but culture showed a sensitivity of ≥0.8. All markers showed a specificity of ≥0.9. Of the 8 tests, measurement of the α-defensin level showed the highest log DOR. CONCLUSIONS: Synovial fluid leukocyte count, PMN%, CRP, α-defensin, LE, IL-6, and IL-8 all demonstrated high sensitivity for diagnosing PJI, with α-defensin being the best synovial marker based on the highest log DOR. However, other synovial fluid tests that demonstrate good diagnostic performance can also be used in combination for the diagnosis of PJI. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Artroplastia de Substituição/efeitos adversos
Infecções Relacionadas à Prótese/diagnóstico
Líquido Sinovial/metabolismo
alfa-Defensinas/metabolismo
[Mh] Termos MeSH secundário: Artroplastia de Substituição/métodos
Biomarcadores/análise
Proteína C-Reativa/metabolismo
Feminino
Seres Humanos
Masculino
Sensibilidade e Especificidade
Fator A de Crescimento do Endotélio Vascular/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Vascular Endothelial Growth Factor A); 0 (alpha-Defensins); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.17.00123


  9 / 11623 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29212683
[Au] Autor:Dattilo J; Gittings D; Sloan M; Charette R; Hume E; Lee GC
[Ad] Endereço:University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
[Ti] Título:'Hot Joints' infection protocol reduces unnecessary post-operative re-admissions following total hip and knee arthroplasty.
[So] Source:Bone Joint J;99-B(12):1603-1610, 2017 Dec.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: To evaluate the effectiveness of an institutionally developed algorithm for evaluation and diagnosis of prosthetic joint injection and to determine the impact of this protocol on overall hospital re-admissions.p PATIENTS AND METHODS: We retrospectively evaluated 2685 total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients prior to (1263) and following (1422) the introduction of an infection detection protocol. The protocol used conservative thresholds for C-reactive protein to direct the medical attendant to aspirate the joint. The protocol incorporated a clear set of laboratory and clinical criteria that allowed a patient to be discharged home if all were met. Patients were included if they presented to our emergency department within 120 days post-operatively with concerns for swelling, pain or infection and were excluded if they had an unambiguous infection or if their chief complaint was non-orthopaedic in nature. RESULTS: Concern for infection was the single most common (32%) reason for presentation. A total of 296 patients made an emergency visit and were included following THA or TKA. In the pre-protocol cohort, 11 of 27 patients were formally re-admitted to the hospital with concern for infection but only five (45%) patients had actual infections and received additional treatment. In comparison, in the post-protocol cohort, 11 patients were admitted for suspected infection, nine (82%) of whom were truly infected (p = 0.04). Sensitivity increased from 83% to 100% and specificity increased from 71% to 96%. Implementation of this protocol did not miss any infections. CONCLUSION: A standardised protocol for evaluation of THA and TKA infections significantly reduced unnecessary hospital re-admissions. The protocol was both sensitive and specific and did not compromise quality of care. Cite this article: 2017;99-B:1603-10.
[Mh] Termos MeSH primário: Artroplastia de Quadril/efeitos adversos
Artroplastia do Joelho/efeitos adversos
Protocolos Clínicos/normas
Readmissão do Paciente/estatística & dados numéricos
Infecções Relacionadas à Prótese/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Algoritmos
Proteína C-Reativa/análise
Feminino
Seres Humanos
Articulação do Joelho/cirurgia
Masculino
Meia-Idade
Período Pós-Operatório
Infecções Relacionadas à Prótese/etiologia
Estudos Retrospectivos
Líquido Sinovial/química
Líquido Sinovial/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171213
[Lr] Data última revisão:
171213
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B12-BJJ-2017-0566.R1


  10 / 11623 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28460426
[Au] Autor:Schoonover MJ; Moser DK; Young JM; Payton ME; Holbrook TC
[Ad] Endereço:Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma.
[Ti] Título:Effects of tourniquet number and exsanguination on amikacin concentrations in the radiocarpal and distal interphalangeal joints after low volume intravenous regional limb perfusion in horses.
[So] Source:Vet Surg;46(5):675-682, 2017 Jul.
[Is] ISSN:1532-950X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the influence of a dual tourniquet technique and limb exsanguination on amikacin concentrations in the synovial fluid of the radiocarpal joint (RCJ) and distal interphalangeal joint (DIPJ) after low volume, cephalic intravenous regional limb perfusion (IVRLP). STUDY DESIGN: Randomized cross-over design. ANIMALS: Six healthy adult horses. METHODS: One gram of amikacin in 6 mL of 0.9% NaCl was infused via cephalic IVRLP in 6 standing, sedated horses using 4 techniques: proximal pneumatic tourniquet (P), proximal pneumatic tourniquet with exsanguination (PE), proximal pneumatic and distal Esmarch tourniquet (PD), and proximal pneumatic with distal Esmarch tourniquet and exsanguination (PDE). Amikacin concentrations were measured in RCJ and DIPJ synovial fluid samples, collected just before perfusion (time 0), and at 15 and 30 minutes (before tourniquet release) after perfusion. RESULTS: Synovial fluid amikacin concentrations achieved in the RCJ were higher with techniques PD and PDE than those achieved with techniques P and PE 15 and 30 minutes after perfusion (P < .0001). Synovial fluid amikacin concentrations in the DIPJ were higher with techniques P and PE than those achieved with techniques PD and PDE at 15 minutes (P = .0002) and were higher than technique PDE at 30 minutes after perfusion (P < .0001). CONCLUSION: Low volume (10 mL) cephalic IVRLP should be combined with the placement of 2 tourniquets (proximal and distal to the carpus) to achieve therapeutic amikacin concentrations in the RCJ. Exsanguination prior to low volume IVRLP does not alter synovial fluid amikacin concentrations.
[Mh] Termos MeSH primário: Amicacina/química
Amicacina/farmacocinética
Antibacterianos/farmacocinética
Cavalos
Líquido Sinovial/química
Torniquetes/veterinária
[Mh] Termos MeSH secundário: Amicacina/administração & dosagem
Animais
Antibacterianos/administração & dosagem
Estudos Cross-Over
Membro Anterior
Perfusão
Procedimentos Cirúrgicos Vasculares
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 84319SGC3C (Amikacin)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1111/vsu.12662



página 1 de 1163 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde