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Ji Y, Chen M, Hong X, Pan L, Cheng D, Ge Y. Nocardia pseudobrasiliensis infection in a patient with arthritis. J Int Med Res 2023; 51:3000605231206959. [PMID: 38082462 PMCID: PMC10718060 DOI: 10.1177/03000605231206959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 12/18/2023] Open
Abstract
Nocardia pseudobrasiliensis is a new taxon constituting an emerging species of human pathogenic Nocardia, which shares morphological features with N. brasiliensis. However, N. pseudobrasiliensis is more invasive and more easily disseminated, and it exhibits distinctive antibiotic susceptibility. Few clinical cases related to N. pseudobrasiliensis infection have been reported, and N. pseudobrasiliensis hydrarthrosis has not been described. Here, we analyzed the case information, diagnostic process, treatment, and prognosis of a patient with N. pseudobrasiliensis hydrarthrosis who received treatment in Zhejiang Provincial People's Hospital. Magnetic resonance imaging showed joint cavity effusion and soft tissue swelling with high signal on proton density-fat saturated images and low signal on T1-weighted images. Oil microscopy revealed abundant acid-fast-positive filaments in hydrarthrosis puncture fluid. The pathogen was identified as N. pseudobrasiliensis by matrix-assisted laser desorption ionization-time of flight mass spectrometry. In contrast to the 100% ciprofloxacin resistance displayed by N. brasiliensis, this clinical isolate of N. pseudobrasiliensis was completely susceptible. In summary, this is the first report of N. pseudobrasiliensis in joint effusion from a patient with arthritis.
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Affiliation(s)
- Youqi Ji
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengyuan Chen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xin Hong
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Liya Pan
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Dongqing Cheng
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yumei Ge
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, China
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang, China
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Xu J, Wang D, Yang C, Wang F, Wang M. Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia. J Oral Rehabil 2023; 50:1202-1210. [PMID: 37391274 DOI: 10.1111/joor.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/01/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure. OBJECTIVE To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ. METHODS Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05). CONCLUSION The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.
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Affiliation(s)
- Jiali Xu
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongmei Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Chunhua Yang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Fangfang Wang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Meiqing Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of TMD, Shanghai Stomatological Disease Centre, Fudan University, Shanghai, China
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Mizuhashi F, Ogura I, Mizuhashi R, Watarai Y, Oohashi M, Suzuki T, Saegusa H. Examination for the Factors Involving to Joint Effusion in Patients with Temporomandibular Disorders Using Magnetic Resonance Imaging. J Imaging 2023; 9:jimaging9050101. [PMID: 37233320 DOI: 10.3390/jimaging9050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND This study investigated the factors involving joint effusion in patients with temporomandibular disorders. METHODS The magnetic resonance images of 131 temporomandibular joints (TMJs) of patients with temporomandibular disorders were evaluated. Gender, age, disease classification, duration of manifestation, muscle pain, TMJ pain, jaw opening disturbance, disc displacement with and without reduction, deformation of the articular disc, deformation of bone, and joint effusion were investigated. Differences in the appearance of symptoms and observations were evaluated using cross-tabulation. The differences in the amounts of synovial fluid in joint effusion vs. duration of manifestation were analyzed using the Kruskal-Wallis test. Multiple logistic regression analysis was performed to analyze the factors contributing to joint effusion. RESULTS Manifestation duration was significantly longer when joint effusion was not recognized (p < 0.05). Arthralgia and deformation of the articular disc were related to a high risk of joint effusion (p < 0.05). CONCLUSIONS The results of this study suggest that joint effusion recognized in magnetic resonance imaging was easily observed when the manifestation duration was short, and arthralgia and deformation of the articular disc were related to a higher risk of joint effusion.
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Affiliation(s)
- Fumi Mizuhashi
- Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Ryo Mizuhashi
- Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata 951-1500, Japan
| | - Yuko Watarai
- Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Makoto Oohashi
- Department of Dental Anesthesia and General Health Management, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Tatsuhiro Suzuki
- Functional Occlusal Treatment, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Hisato Saegusa
- Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata 951-1500, Japan
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Burg LC, Karakostas P, Behning C, Brossart P, Kermani TA, Schäfer VS. Prevalence and characteristics of giant cell arteritis in patients with newly diagnosed polymyalgia rheumatica - a prospective cohort study. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149963. [PMID: 36777696 PMCID: PMC9909075 DOI: 10.1177/1759720x221149963] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
Background It is known that giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) often occur together. So far, the prevalence of GCA in newly diagnosed PMR patients has not been evaluated in a prospective ultrasound study. Objective The aim of this study was to assess the prevalence of GCA using vascular ultrasound in patients with newly diagnosed PMR. Design A consecutive cohort of newly diagnosed PMR patients was prospectively evaluated for the presence of GCA with the use of systematic musculoskeletal and vascular ultrasound examination. Methods Overall, 60 patients with newly diagnosed PMR were prospectively enrolled. Symptoms and laboratory findings were collected. All patients underwent ultrasound of shoulder and hip joints, and vascular ultrasound evaluating the facial, temporal, carotid, vertebral and axillary arteries. Patients were diagnosed with GCA if they had ultrasound imaging findings of GCA. Patients with PMR (PMR-group) and patients with PMR and GCA (PMR-GCA-group) were compared, and a C-reactive protein (CRP) cut-off value was evaluated. Results GCA was diagnosed in 28 of 60 PMR patients (46%). The PMR-group consisted of 20 (62.5%) females with a mean age of 69 (±9.9) years, while the PMR-GCA-group consisted of 11 (39.3%) females with a mean age of 74 (±8.4) years. In 13 of 28 patients (46%) in the PMR-GCA-group, GCA was subclinical and only diagnosed by ultrasound. The PMR-GCA-group showed higher values of joint effusion and significantly higher CRP values. A CRP cut-off value of 26.5 mg/litre (reference range 0-5 mg/litre) yielded a sensitivity of 66% with a specificity of 73% for GCA. Conclusion GCA was found in 46% of newly diagnosed PMR patients; 22% of the patients with PMR had asymptomatic GCA. Joint effusions were higher in the PMR-GCA-group, with significant results for the hip joint. A CRP cut-off value of ⩾26.5 mg/litre in PMR can help in the identification of subclinical GCA.
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Affiliation(s)
| | - Pantelis Karakostas
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Tanaz A. Kermani
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Valentin S. Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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McCreary DJ, White A. Use Of POCUS for the Paediatric Patient with an Undifferentiated Upper Limb Injury. POCUS J 2023; 8:35-37. [PMID: 37152347 PMCID: PMC10155724 DOI: 10.24908/pocus.v8i1.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 2-year-old girl presented to the Paediatric Emergency Department following an unwitnessed injury to her left arm while playing at nursery limiting further examination. On assessment she was reluctant to use her left arm and further examination was difficult. In cases of unwitnessed and undifferentiated elbow injuries point of care ultrasound (POCUS) can be used to evaluate for elbow joint effusion, fracture, or radial head subluxation, also known as nursemaid's elbow. Pulled elbow is a commonly encountered paediatric injury but based on the history and examination findings it may not always be obvious. We present an approach to the child with an undifferentiated elbow injury incorporating POCUS as a means of increasing the reliability of findings on clinical examination.
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Affiliation(s)
- David J McCreary
- Paediatric Emergency Medicine Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation TrustUnited Kingdom
| | - Alex White
- Paediatric Emergency Medicine Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation TrustUnited Kingdom
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Schreiner JK, Recker F, Scheicht D, Karakostas P, Ziob J, Behning C, Preuss P, Brossart P, Schäfer VS. Changes in ultrasound imaging of joints, entheses, bursae and tendons 24 and 48 h after adjusted weight training. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111610. [PMID: 35898563 PMCID: PMC9310201 DOI: 10.1177/1759720x221111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Joint effusion and enthesitis are common ultrasound findings in rheumatic
diseases such as rheumatoid arthritis or spondyloarthritis. However, changes
of joints and entheses were not only observed in patients but also in
physically active individuals and athletes. Objectives: The purpose of this study was to evaluate joint, entheseal, bursal and tendon
musculoskeletal ultrasound (MSUS) findings in large and medium joints of
young healthy individuals after completing a standardised weight
training. Design: This is a prospective cohort study. Methods: MSUS examinations of large- and medium-sized joints, and related entheseal
sites, bursae and tendons were performed on young healthy individuals (ages
18–30 years). Before, 24 and 48 h after completing 1 h of standardised
weight exercise, the subjects were evaluated by MSUS. The development of the
MSUS findings and associated effects were examined using generalised linear
mixed effects models. Results: In total, 51 healthy individuals (52.9% female) with a mean age of 23.7
(±2.5) years were enrolled. The results showed an increase in the number of
individuals with at least one joint effusion from 37 (72.5%) before the
weight training to 48 (94.1%) after 48 h. Entheses with pathologies were
observed in 14 participants (27.5%) at baseline, increasing to 29
participants (56.9%) 48 h after the weight training. Biceps tendon sheath
effusion was detected in 9 individuals (17.6%) prior to training, rising to
22 individuals (43.1%) after 48 h. A significant increase in the number of
joints with effusion and abnormal entheses within 48 h after the weight
training was indicated by the generalised linear mixed effects models. Conclusion: Within 48 h after the weight training session, a significant increase in the
prevalence of joint effusion in large and medium joints and the prevalence
of abnormal entheses was observed. As a result, when performing and
interpreting an MSUS examination, the patient’s physical activities should
be taken into account.
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Affiliation(s)
- Julia K Schreiner
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Dennis Scheicht
- Department of Rheumatology, Porz am Rhein Hospital, Cologne, Germany
| | - Pantelis Karakostas
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Jana Ziob
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Peter Preuss
- University Sports Division, University Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Valentin S Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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Almășan O, Kui A, Duncea I, Manea A, Buduru S. Temporomandibular Joint Disk Displacements in Class II Malocclusion and Cervical Spine Alterations: Systematic Review and Report of a Hypodivergent Case with MRI Bone and Soft Tissue Changes. Life (Basel) 2022; 12:908. [PMID: 35743939 DOI: 10.3390/life12060908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: This study aimed to perform a literature review related to disk displacement (DD) in class II malocclusion or cervical vertebrae position alterations and to report a hypodivergent case with cervical pain and right anterolateral DD with reduction, left anterolateral DD with reduction, and left joint effusion. (2) Methods: A structured electronic search was conducted between March 2022 and April 2022, without time limits, following PRISMA guidelines, in the following databases: PubMed, Scopus, Embase and Cochrane; the terms “disc displacement”, “disk displacement”, “temporomandibular joint”, “class II malocclusion” and “cervical vertebrae” are searched. (3) Results: the following thirteen publications are included in this review: two prospective studies and eleven cross-sectional studies; for evaluating disk position, eight included publications used magnetic resonance imaging (MRI), whilst six studies used lateral cephalogram to determine craniofacial morphology and relationships between the cranial base, vertical skeletal pattern, maxilla and mandible. (4) Conclusions: although the literature still shows contradictory opinions, a relationship between temporomandibular disorders and cervical posture has been shown in the presented case as well as in the literature review.
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Ogrodzka-Ciechanowicz K, Głąb G, Ciszek-Radwan E, Ślusarski J, Gądek A. The use of an alternating magnetic field in the resorption of postoperative joint effusion following anterior cruciate ligament reconstruction: A randomized double-blind controlled trial. Medicine (Baltimore) 2021; 100:e26572. [PMID: 34232202 PMCID: PMC8270597 DOI: 10.1097/md.0000000000026572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
CONTEXT There are no scientific reports unambiguously describing the efficacy of alternating magnetic field therapy in patients after anterior cruciate ligament (ACL) reconstruction in the early postoperative period. OBJECTIVE This study aims to evaluate the efficacy of using an alternating magnetic field in the resorption of postoperative joint effusion in patients after ACL reconstruction. STUDY DESIGN A randomized, double-blind placebo-controlled study. SETTING Inpatients. PARTICIPANTS Forty patients were enrolled in the trial. However, the final study group consisted of 38 patients (28 men and 10 women) after ACL reconstruction who were randomly divided into an experimental group (19 patients) and a control group (19 patients). INTERVENTION Each group received magnetic field therapy in the postoperative period, but only 1 apparatus emitted a magnetic field (the experimental group). Patients used the apparatus every day for 30 minutes for the next 11 days. The parameters in both devices were the same-3 mT and 10 Hz. MAIN OUTCOME MEASURES The measurement of the knee circumference and range of motion were made. The knee circumference measurement was performed before magnetic field therapy began and for 11 days after magnetic field treatment. The active knee range of motion was evaluated before and after magnetic field therapy was completed. RESULTS There were no statistically significant differences between the groups in the reduction of post-operative joint effusion or knee joint function. CONCLUSION In patients after ACL reconstruction, in whom an alternating magnetic field was used to treat postoperative joint effusion, there were no beneficial effects on the analyzed variables compared to the control group.
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Affiliation(s)
| | - Grzegorz Głąb
- Institute of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education in Krakow, Poland
| | - Elżbieta Ciszek-Radwan
- Institute of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education in Krakow, Poland
| | - Jakub Ślusarski
- Trauma and Orthopaedics Clinical Department, University Hospital in Krakow, Poland
| | - Artur Gądek
- Trauma and Orthopaedics Clinical Department, University Hospital in Krakow, Poland
- Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Poland
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Li Z, Fu J, Cao Y, Xu C, Han X, Zhang W, Song Z, Chen J. Drug discovery in rheumatoid arthritis with joint effusion identified by text mining and biomedical databases. Ann Palliat Med 2021; 10:5218-5230. [PMID: 33977746 DOI: 10.21037/apm-20-2631b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rheumatoid arthritis is a long-term systemic disease that primarily affects multiple synovial joints throughout the body. Some patients with severe joint effusion even require repeated arthrocentesis or arthroscopic debridement to relieve symptoms, which causes them much suffering mentally and physically. This text-mining study was designed to find potential drugs that target key genes in this disease. METHODS Firstly, we performed text mining by two keywords ("rheumatoid synovitis" and "joint effusion") to get a common set of genes. Secondly, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis performed on these genes, and protein-protein interaction (PPI) network was constructed. Subsequently, the significant genes clustered in the PPI network were chose to execute gene-drug interaction analysis for potential drug discovery. RESULTS Through text mining, 68 overlapping genes were identified as an initial set of key genes. Construction of the initial gene set's PPI network showed that 25 genes clustered in a significant gene module. Ultimately, 8 out of 25 genes could be targetable by a total of 19 drugs. CONCLUSIONS The final 8 genes (PTGS2, TNF, VEGFA, IL1B, CCL2, VWF, IL6, and ESR1) and 19 drugs may provide significant therapeutic value for rheumatoid arthritis patients with joint effusion.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, China; Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Jun Fu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Yalei Cao
- Department of Urology, Peking University Third Hospital, Beijing, China; Department of Andrology, Peking University Third Hospital, Beijing, China
| | - Chi Xu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Xinli Han
- School of Medicine, Nankai University, Tianjin, China; Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Wupeng Zhang
- School of Medicine, Nankai University, Tianjin, China; Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Zelong Song
- School of Medicine, Nankai University, Tianjin, China; Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
| | - Jiying Chen
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, China;
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Abstract
Ultrasound has been described as the "stethoscope" of the radiologist; its ability to aid in clinical diagnosis with both static and dynamic imaging has allowed fast and accurate diagnosis. However, traditionally unlike a stethoscope, a large and bulky ultrasound machine made it difficult to use portably in a hospital environment where patients can be scattered across a hospital. With the development of innovative ultrasound technology, Point of Care Ultrasound (PoCUS) can readily be carried by a clinician to make a quick and timely diagnosis. In this review article we look at the uses of PoCUS within orthopaedic emergencies. Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases PoCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures. By aiding a speedy diagnosis, we can reduce unnecessary immobilisation, reduce inpatient stays, introduce early mobilisation and reduce harm to patients. With PoCUS becoming increasingly cheaper and more portable we feel this really can become the stethoscope of an orthopaedic surgeon.
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Affiliation(s)
- Jennifer Oluku
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Attila Stagl
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | | | - Karmen El-Raheb
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Richard Beese
- Clinical Radiology, Queen Elizabeth Hospital, London, GBR
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Abstract
BACKGROUND Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint effusions and guiding arthrocentesis procedures. EP-performed talonavicular joint arthrocentesis has not been previously described in the literature. We present a case in which an isolated talonavicular joint effusion was identified and then subsequently aspirated using POCUS. CASE REPORT A 65-year-old man presented with atraumatic right ankle pain. On arrival, he was noted to have diffuse warmth and edema around the ankle and midfoot. POCUS was performed to evaluate for an ankle joint effusion, which was not present. The ultrasound was then moved distally, where a talonavicular joint effusion was noted. Inflammatory markers were found to be elevated. A magnetic resonance imaging scan revealed an isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crystals consistent with an initial episode of gouty arthritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS provides the EP with an efficient tool to diagnose joint effusions and guide arthrocentesis procedures. The foot is composed of several small joints where ultrasound can be particularly helpful. Similar to the ankle joint, these joints can be afflicted with pyogenic infections and crystalline arthropathies. To our knowledge, we present the first report of EP-performed talonavicular arthrocentesis guided by POCUS. The approach to this joint and technique for arthrocentesis are presented.
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Affiliation(s)
- Christopher Thom
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Jonathan Pozner
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Matthew Kongkatong
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - James Moak
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
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Thom C, Ahmed A, Kongkatong M, Moak J. Point-of-care hip ultrasound leads to expedited results in emergency department patients with suspected septic arthritis. J Am Coll Emerg Physicians Open 2020; 1:512-520. [PMID: 33000078 PMCID: PMC7493574 DOI: 10.1002/emp2.12167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The evaluation of septic hip arthritis often incorporates the utilization of hip ultrasonography to determine the presence of a hip joint effusion, as well as to guide arthrocentesis. Point-of-care (POC) hip ultrasound has previously been demonstrated to be accurate when performed by the emergency physician. Time to diagnosis and subsequent intervention in septic arthritis (SA) is critical to favorable outcomes. METHODS Retrospective single-center study of all emergency department (ED) patients who had a POC or radiology hip ultrasound or arthrocentesis as part of their ED evaluation for SA in a 3-year period. We investigated the difference in time to obtain hip ultrasonography results and the time to arthrocentesis between radiology and emergency physician-performed studies in cases of suspected septic hip arthritis. RESULTS Seventy-four patients met inclusion criteria. The median time to hip ultrasound completion was 68 (interquartile range [IQR], 38.8-132) minutes in the emergency physician-performed ultrasound group versus 208.5 (IQR, 163.8-301.3) minutes for the radiology group (P < 0.001). A total of 17 patients had a hip arthrocentesis performed. Time to arthrocentesis was 211 (IQR 141.3-321.5) minutes in the emergency physician-performed arthrocentesis group and 602 (IQR 500-692) minutes in the radiology arthrocentesis (P < 0.001). CONCLUSION There was a statistically shorter time to ultrasound result and arthrocentesis when POC hip ultrasound was utilized by the emergency physician. Given that unfavorable outcomes in SA are associated with delay in treatment, further study is warranted to determine if emergency physician-performed hip ultrasound and arthrocentesis could lead to improved patient-centered clinical end points.
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Affiliation(s)
- Christopher Thom
- Emergency Medicine University of Virginia Health System Charlottesville Virginia USA
| | - Azhar Ahmed
- Emergency Medicine University of Virginia Health System Charlottesville Virginia USA
| | - Matthew Kongkatong
- Emergency Medicine University of Virginia Health System Charlottesville Virginia USA
| | - James Moak
- Emergency Medicine University of Virginia Health System Charlottesville Virginia USA
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Fielder SE, Meinkoth JH, Rizzi TE, Hanzlicek AS, Hallman RM. Feline histoplasmosis presenting with bone and joint involvement: clinical and diagnostic findings in 25 cats. J Feline Med Surg 2018; 21:887-892. [PMID: 30407138 DOI: 10.1177/1098612x18806706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to describe clinical and diagnostic findings in cats with bone and joint disease associated with histoplasmosis. METHODS Medical records from between 2011 and 2017 were reviewed. Inclusion criteria required: (1) diagnosis of histoplasmosis by cytology, histology, urine or serum Histoplasma antigen testing, or culture; and (2) lameness or joint effusion as a presenting complaint or physical examination finding. RESULTS Twenty-five cases met the inclusion criteria. Four had incomplete records, but available data were included when applicable. Lameness was a presenting complaint in 17/21 cats and was the only complaint in 9/21 cats. Initial diagnosis was made by cytology in 22/25 cats and by culture, urine antigen and necropsy in one case each. Diagnostic cytology samples included synovial fluid (n = 13), lymph node (n = 5), skin (n = 2), lung (n = 1) and bone (n = 1). Two additional cases had synovial fluid examined but no organisms present. Inflammation was present in all synovial fluid samples examined. Biopsy was obtained in two cats and histologic diagnoses included osteomyelitis with no infectious organisms identified and severe lymphoplasmacytic synovitis suggestive of feline periosteal proliferative polyarthritis. Histoplasma urine antigen test was positive in 7/12 cats. CONCLUSIONS AND RELEVANCE Inflammatory arthritis is common in cats with histoplasmosis, with lameness a common presenting complaint. Organisms are found in synovial fluid cytology in most cases. If not, appropriate additional diagnostics must be pursued.
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Affiliation(s)
- Susan E Fielder
- Veterinary Pathobiology, Oklahoma State University Center for Veterinary Sciences, Stillwater, OK, USA
| | - James H Meinkoth
- Veterinary Pathobiology, Oklahoma State University Center for Veterinary Sciences, Stillwater, OK, USA
| | - Theresa E Rizzi
- Veterinary Pathobiology, Oklahoma State University Center for Veterinary Sciences, Stillwater, OK, USA
| | - Andrew S Hanzlicek
- Veterinary Clinical Sciences, Oklahoma State University Center for Veterinary Sciences, Stillwater, OK, USA
| | - Ruth Mackenzie Hallman
- Veterinary Clinical Sciences, Oklahoma State University Center for Veterinary Sciences, Stillwater, OK, USA
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14
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Noureldine MHA, Taher AT, Haydar AA, Berjawi A, Khamashta MA, Uthman I. Rheumatological complications of beta-thalassaemia: an overview. Rheumatology (Oxford) 2017; 57:19-27. [PMID: 28371817 DOI: 10.1093/rheumatology/kex058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Indexed: 01/19/2023] Open
Abstract
Beta-thalassaemia, an autosomal recessive haemoglobinopathy, ranks among the most frequent monogenetic diseases globally. The severe form of the disease, beta-thalassaemia major, is accompanied by progressive involvement of multiple organ systems as a result of the disease pathophysiology as well as iron overload from blood transfusions on a regular basis. Some of the manifestations might also be caused by medications used to manage iron overload. The purpose of this review is to highlight the rheumatological complications of beta-thalassaemia, which include musculoskeletal manifestations, such as arthritis and arthropathies, joint effusions, osteoporosis, bone fractures and myalgias, in addition to CTDs, such as pseudoxanthoma elasticum. Rheumatologists are strongly encouraged to take part in a multidisciplinary approach to the management of this debilitating disease.
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Affiliation(s)
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Ali A Haydar
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Ahmad Berjawi
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, Division of Women's Health, St Thomas Hospital, London, UK.,Department of Rheumatology, Dubai Hospital, Dubai, UAE
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Peters MJ, Ramos YFM, den Hollander W, Schiphof D, Hofman A, Uitterlinden AG, Oei EHG, Slagboom PE, Kloppenburg M, Bloem JL, Bierma-Zeinstra SMA, Meulenbelt I, van Meurs JBJ. Associations between joint effusion in the knee and gene expression levels in the circulation: a meta-analysis. F1000Res 2016; 5:109. [PMID: 27134727 PMCID: PMC4837985 DOI: 10.12688/f1000research.7763.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/16/2023] Open
Abstract
Objective: To identify molecular biomarkers for early knee osteoarthritis (OA), we examined whether joint effusion in the knee associated with different gene expression levels in the circulation. Materials and Methods: Joint effusion grades measured with magnetic resonance (MR) imaging and gene expression levels in blood were determined in women of the Rotterdam Study (N=135) and GARP (N=98). Associations were examined using linear regression analyses, adjusted for age, fasting status, RNA quality, technical batch effects, blood cell counts, and BMI. To investigate enriched pathways and protein-protein interactions, we used the DAVID and STRING webtools. Results: In a meta-analysis, we identified 257 probes mapping to 189 unique genes in blood that were nominally significantly associated with joint effusion grades in the knee. Several compelling genes were identified such as
C1orf38 and
NFATC1. Significantly enriched biological pathways were: response to stress, gene expression, negative regulation of intracellular signal transduction, and antigen processing and presentation of exogenous pathways. Conclusion: Meta-analyses and subsequent enriched biological pathways resulted in interesting candidate genes associated with joint effusion that require further characterization. Associations were not transcriptome-wide significant most likely due to limited power. Additional studies are required to replicate our findings in more samples, which will greatly help in understanding the pathophysiology of OA and its relation to inflammation, and may result in biomarkers urgently needed to diagnose OA at an early stage.
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Affiliation(s)
| | - Yolande F M Ramos
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Wouter den Hollander
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - P Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Margreet Kloppenburg
- Department of Clinical Epidemiology and Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands; Department of Orthopedics, Erasmus MC, Rotterdam, Netherlands
| | - Ingrid Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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Avcu S, Altun E, Akpinar I, Bulut MD, Eresov K, Biren T. Knee joint examinations by magnetic resonance imaging: The correlation of pathology, age, and sex. N Am J Med Sci 2012; 2:202-4. [PMID: 22624141 PMCID: PMC3354411 DOI: 10.4297/najms.2010.2202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims: The aim of our study was to investigate the incidence and coexistence of multiple knee joint pathologies and the distribution of knee joint pathologies according to age and sex. Patients and Methods: A retrospective analysis was performed using the clinical data of patients evaluated with magnetic resonance imaging (MRI) of the knee joint. Data from 308 patients examined between August 2002 and July 2003 were included into this study. A Pearson correlation analysis was performed to examine the relationship between the pathological findings and the age and sex of the patients. Results: The ages of the patients ranged between 1 and 74 years (mean: 43.3 years). Age was significantly correlated with meniscal degeneration and tears, medial collateral ligament degeneration, parameniscal cyst, and chondromalacia patellae. There was a significant correlation between male gender and anterior cruciate ligament injury. Meniscal injury was significantly correlated with bursitis, as well as medial collateral ligament injury. Bone bruise was significantly correlated with medial collateral ligament injury, lateral collateral ligament injury, Baker's cyst, and anterior cruciate ligament injury. Chondromalacia patellae was significantly correlated with anterior cruciate ligament injury, patellae alta, and osteochondral lesion. Bursitis (in 53.2% of the patients) followed by grade-II meniscal degeneration (in 43% of the patients) were the most common knee pathologies observed by MRI. Conclusions: MRI findings of select knee pathologies are significantly correlated with each other and the age and sex of the patient.
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Affiliation(s)
- Serhat Avcu
- Department of Radiology, Yuzuncu Yil University School of Medicine, Van, Turkey
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Hopkins JT, Ingersoll CD, Edwards J, Klootwyk TE. Cryotherapy and Transcutaneous Electric Neuromuscular Stimulation Decrease Arthrogenic Muscle Inhibition of the Vastus Medialis After Knee Joint Effusion. J Athl Train 2002; 37:25-31. [PMID: 12937440 PMCID: PMC164304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE: Arthrogenic muscle inhibition (AMI) is a presynaptic, ongoing reflex inhibition of joint musculature after distension or damage to the joint. The extent to which therapeutic interventions affect AMI is unknown. The purpose of this study was to verify that the vastus medialis (VM) is inhibited using the knee joint effusion model and to investigate the effects of cryotherapy and transcutaneous electric nerve stimulation (TENS) on AMI using this model. DESIGN AND SETTING: A 3 x 6 analysis of variance was used to compare Hoffmann-reflex data for treatment groups (cryotherapy, TENS, and control) across time (preinjection, postinjection, and 15, 30, 45, and 60 minutes after injection). SUBJECTS: Thirty neurologically sound volunteers (age = 21.8 +/- 2.4 years; height = 175.6 +/- 9.6 cm; mass = 71.5 +/- 13.3 kg) participated in this study. MEASUREMENTS: Hoffmann-reflex measurements were collected using a percutaneous stimulus to the femoral nerve and surface electromyography of the VM. RESULTS: Hoffmann-reflex measurements from the cryotherapy and TENS groups were greater than measurements from the control group at 15 and 30 minutes after injection. Measurements from the cryotherapy group were greater than for the TENS group, and measurements for the TENS group were greater than those for the control group at 45 minutes. At 60 minutes, the cryotherapy group measurements were greater than the TENS and control group measures. Measurements at 15, 30, 45, and 60 minutes after injection were reduced compared with the preinjection and postinjection measurements in the control group. Measurements in the cryotherapy group at 30, 45, and 60 minutes were greater than the preinjection, postinjection, and 15-minute data. No differences between time intervals existed in the TENS group. CONCLUSIONS: Artificial knee joint effusion results in VM inhibition. Cryotherapy and TENS both disinhibit the quadriceps after knee joint effusion, and cryotherapy further facilitates the quadriceps motoneuron pool. Cryotherapy treatment resulted in facilitation of the VM motoneuron pool during the post-treatment phase. The TENS treatment failed to disinhibit the VM motoneuron pool by 30 minutes postinjection.
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