Joint lavage associated with triamcinolone hexacetonide injection in knee osteoarthritis: a randomized double-blind controlled study

Compare the medium-term effectiveness and tolerance between joint lavage (JL) in combination with triamcinolone hexacetonide (TH) intra-articular injection (IAI) and IAI with TH alone for treatment of primary osteoarthritis (OA) of the knee. A randomized, double-blind, controlled study was carried out on 60 patients with primary OA of the knee, randomized into two intervention groups: JL/TH group, joint lavage in combination with TH intra-articular injection and TH group, TH intra-articular injection. Patients were followed for 12 weeks by a blind observer using the following outcome measurements: visual analogue scale for pain at rest and in movement, goniometry, WOMAC, Lequesne’s index, timed 50-ft walk, perception of improvement, Likert scale for improvement assessment, use of nonsteroidal anti-inflammatory drugs and analgesics, and local side effects. There were no statistical differences in the inter-group analysis for any of the variables studied over the 12-week period. Although both groups demonstrated statistical improvement in the intra-group evaluation (except for Likert scale according to patient and the use of anti-inflammatory drugs). In the Kellgren–Lawrence scale (KL) 2 and 3 sub-analysis, there was a statistical difference regarding joint flexion among patients classified as KL 2, favoring the TH group (p = 0.03). For the KL 3 patients, there were statistical differences favoring the JL/TH group regarding Lequesne (p = 0.021), WOMAC pain score (p = 0.01), and Likert scale according to the patient (p = 0.028) and the physician (p = 0.034). The combination of joint lavage and IAI with TH was not more effective than IAI with TH alone in the treatment of primary OA of the knee. However, KL 3 patients may receive a major benefit from this combination.     

Assessing joint involvement in haemophilia by clinical rheumatologic scores. A pilot study on similarities with subjects with psoriatic arthritis

Because of joint haemorrhages, severe haemophilia subjects often have limitations in their daily activities. Current orthopaedic scores (OJS) in haemophilia miss mild joint impairments and only pick up severe alterations. Twelve young severe haemophiliacs (20.25 ± 1.9 years of age), were evaluated for OJS as well as for indices employed in rheumatoid arthritis [28-joint Disease Activity Score (DAS-28), Ritchie index, Health Assessment Questionnaire (HAQ), visual analogue scale (VAS)], spondyloarthritis [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), HAQ, VAS] and osteoarthritis [Knee injury and Osteoarthritis Outcome Score (KOOS), VAS]. Twenty-four matched apparently healthy subjects and 29 subjects with psoriatic arthritis (PsA) with oligoarticular involvement (one to three swollen joints) served as controls. In addition to the impairment of target joints (elbow, in five of five in those on-demand treatment; three, elbows; four, knee in those on secondary prophylaxis), HAQ (mean 0.71 ± 0.95) and VAS (3.12 ± 2.36) documented a quality of life and a perception of pain in haemophiliacs similar to that of PsA subjects (p = 0.061 and p = 0.063, respectively). Their Ritchie index did not differ from that of subjects with psoriatic arthritis (5.75 ± 8.1 vs 7.73 ± 9.22; p = 0.408), nor did the BASDAI score with respect to psoriatic arthritis patients (p = 0.105). Six of 12 haemophiliacs (50%) had KOOS values from 70 to 50 (significant function joint impairment); 3 of 12 (25%) showed DAS-28 values >3.2 (moderate disease activity), 2 of 12 (16.6%) severe disease activity (>5.1). All these indices significantly correlated with VAS and HAQ in haemophilia subjects. A rheumatologic assessment may help identify early polyarticular disease and subclinical abnormalities involving joints not usually studied (not target joint) in haemophiliacs. These pilot data provide the rationale for testing a systemic involvement in haemophiliacs by means of high-tech imaging and to start early-onset prophylaxis/treatment in this setting.     

Additional effect of pulsed electromagnetic field therapy on knee osteoarthritis treatment: a randomized, placebo-controlled study

The aim of this study was to evaluate if pulsed electromagnetic field therapy (PEMF) has additional effect on the classical physical treatment of knee osteoarthritis (OA) composed of hot pack, therapeutic ultrasound, and terminal isometric exercises. Forty patients (29 women and 11 men), ages 44 to 78 (mean age was 61.3 ± 7.8 years) were included in our study. Patients with knee osteoarthritis [Kellgren–Lawrence criteria grade 2 and above and an average pain intensity of 40 or more on a 100-mm visual analog scale (VAS)] recruited from outpatient physical medicine and rehabilitation clinic were randomly assigned to receive PEMF or sham PEMF treatment in addition to their physical therapy. Both the PEMF and sham PEMF treatments being evaluated were 55 min/session, five sessions per week for 2 weeks. Each session comprise 20-min hot pack, 5-min therapeutic ultrasound, and 30-min PEMF or sham PEMF treatment applied to the knee of the patients. Patients were evaluated by the Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Index and VAS at the baseline and at the end of treatment. Both PEMF and sham PEMF treatment groups showed statistically significant improvement in WOMAC pain and functional scores at the end of treatment (p < 0.001 in both groups). There were no statistically significant differences between groups in WOMAC pain, stiffness, and physical function scores after treatment (p = 0.906, p = 0.855, p = 0.809, respectively). There was neither difference in concomitant used acetaminophen dose in both groups (p = 0.289). The results of this study show that PEMF does not have additional effect on the classical physical treatment in reducing symptoms of knee OA.     

Intravenous lidocaine for fibromyalgia syndrome: an open trial

Fibromyalgia is a disorder characterized by chronic widespread pain. In this study, we investigated the effect of intravenous infusions of lidocaine in pain and quality of life of patients with fibromyalgia. Twenty-three consecutive patients were included in the study, which consisted on five sequential intravenous 2% lidocaine infusions with rising dosages (2–5 mg/kg, days 1–5). Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire, and a visual analog scale (VAS) for pain were applied before the first lidocaine infusion, immediately after the fifth infusion and 30 days after the fifth infusion. A significant improvement was observed in the FIQ scores after the fifth infusion (73.52 ± 16.56 vs 63.29 ± 21.21, p = 0.02), which was maintained after 30 days (73.52 ± 16.56 vs 63.85 ± 24.59, p = 0.04). Similar results were seen concerning the VAS: 8.19 ± 1.76 vs 6.84 ± 2.44, p = 0.01 and 8.19 ± 1.76 vs 7.17 ± 2.35, p = 0.05, respectively. Intravenous lidocaine infusions are safe and effective in the management of fibromyalgia.     

Predictors of hemodynamic compromise with propofol during defibrillator implantation: a single center experience

Background  Intra-operative hypotension has been reported in cardiac resynchronization therapy defibrillator (CRT-D) clinical trials but this phenomenon is not well characterized. The purpose of this study was to understand the frequency and determinants of intra-operative hypotension in patients undergoing defibrillator implantations. Methods  We retrospectively reviewed clinical data of all CRT-D implantations over a 21-month period. We compared a randomly selected contemporaneous group undergoing implantable cardiac defibrillator (ICD) implantations as a reference group. Procedure protocol involved intra-arterial blood pressure monitoring throughout the case. Lidocaine (1%) was routinely used along with propofol for sedation in all patients. Procedure time was defined as the time from initial administration of lidocaine for arterial line access, to completion of defibrillator pocket closure. Cumulative dose of propofol was calculated in each patient. Hypotension was defined as a fall in the systolic blood pressure of ≥30% from baseline or a systolic blood pressure of ≤80 mm Hg for >3 min. CRT-D and ICD patients were divided into hypotensive and non-hypotensive subsets. Results  The incidence of hypotension in the CRT-D group (N  = 100) was 56%, as compared to 40% in the ICD group (N = 97). The mean duration of procedure in the CRT-D group was 114 ± 95 min in the hypotensive subset versus 69 ± 31.9 min in the non-hypotensive subset (p = 0.0015). The mean NYHA class in the hypotensive subset of the CRT-D group was 2.85 ± 1.2 vs 2.2 ± 1.5 in the non-hypotensive subset (p = 0.0179). Cumulative dose of propofol in the hypotensive subset of the CRT-D group was 386 ± 22 mg, while that in the non hypotensive subset was 238.3 ± 17 mg (p < 0.0001). Creatinine clearance in the hypotensive subset of the CRT-D group was 63.8 ± 12.8 ml/min, while that in the non-hypotensive subset was 78.7 ± 23.5 ml/min (p = 0.003). Patients in the CRT-D group who developed hypotension had a lower left ventricular ejection fraction of 21.1 ± 10.2% versus 29 ± 14.8% in the non-hypotensive subset (p = 0.0035). Conclusions  Hypotension is a common occurrence during defibrillator implantation under conscious sedation. Risk factors for significant hypotension include: higher NYHA class, lower left ventricular ejection fraction, lower creatinine clearance, higher doses of propofol and longer procedure times.     

Integrated backscatter analysis of carotid intima–media complex in patients with systemic lupus erythematosus

A number of studies based on conventional ultrasound scanning (CUS) gave contrasting results about the occurrence of early atherosclerosis in patients with systemic lupus erythematosus (SLE), while no study on early arterial sclerosis in the same patients are available. Recently, information on early arterial sclerosis can be provided by the integrated backscatter (IBS) analysis which reflects the collagen and calcium content within the vascular wall. In order to evaluate if atherosis and/or sclerosis of carotid arteries are early features of SLE, we performed carotid CUS and IBS analysis in 16 SLE patients (15 females; aged 37 ± 10 years), free from clinically evident cardiovascular diseases and cardiovascular risk factors, with the only exception of five patients who had arterial hypertension. The same investigations were performed in 16 sex- and age-matched healthy control subjects. No statistically significant difference was observed either in carotid corrected IBS values or in carotid intima–media thickness (IMT) values between SLE patients and control subjects (−17.9 ± 2.5 dB vs −19.0 ± 1.7 dB, p = 0.14; 0.66 ± 0.08 mm vs 0.62 ± 0.13 mm, p = 0.35, respectively). The little sub-group of hypertensive SLE patients exhibited a significantly higher carotid corrected IBS mean value compared to control subjects (−16.4 ± 3.1 dB vs −19.0 ± 1.7 dB, p = 0.026), while it did not significantly differ in carotid IMT value from control group (0.67 ± 0.09 mm vs 0.62 ± 0.13 mm, respectively; p = 0.86). These findings show that neither atherosis nor sclerosis of carotid arteries are early features of SLE patients free from cardiovascular risk factors. Further studies are needed to clearly demonstrate that early carotid sclerosis affects hypertensive SLE patients.     

Randomized controlled study between suture ligation and radio wave ablation and suture ligation of grade III symptomatic hemorrhoidal disease

Purpose  Suture ligation is a simple method to curb the hemorrhoids. The present study was conducted to determine the usefulness of suture ligation in third-degree hemorrhoids and to compare it with author’s procedure of suture ligation coupled with hemorrhoidal ablation through radiowave. Materials and methods  One hundred and twenty-four consecutive patients with grade III hemorrhoids requiring surgery were randomized into two groups. Half of them were treated by suture ligation, while the remaining patients underwent a radiowave ablation of hemorrhoids using a Ellman radiowave generator followed by suture ligation. A blinded observer evaluated postoperative pain scores, amount of analgesics consumed, and complications encountered. He also assessed recurrence of hemorrhoids after 1 year. Results  The postoperative pain score was significantly higher in the suture ligation group (3.4 ± 0.2 vs. 2.2 ± 0.1, p < 0.005). The mean total analgesic dose and duration of pain control using analgesics were greater and longer for suture ligation group than radiowave group (29 ± 4 vs. 23 ± 3 tablets, and 15 ± 3 days vs. 12 ± 4 days, respectively; p < 0.001). Complications were seen more frequently in radiowave group (22% vs.18%). At 1 year follow-up, the recurrence of hemorrhoids was more significant with the suture ligation group (five patients vs. one patient, p < 0.05). Conclusion  Suture ligation of hemorrhoids is a simple, cost-effective, and a convenient modality in treating third-degree hemorrhoids. The efficacy and postoperative comfort is further enhanced if the hemorrhoids are ablated with radiowave prior to ligating them.     

Effects of external qigong therapy on osteoarthritis of the knee

The objective of our study was to assess the efficacy of external qigong therapy (EQT), a traditional Chinese medicine practice, in reducing pain and improving functionality of patients with knee osteoarthritis (OA). One hundred twelve adults with knee OA were randomized to EQT or sham treatment (control); 106 completed treatment and were analyzed. Two therapists performed EQT individually, five to six sessions in 3 weeks. The sham healer mimicked EQT for the same number of sessions and duration. Patients and examining physician were blinded. Primary outcomes were Western Ontario MacMaster (WOMAC) pain and function; other outcomes included McGill Pain Questionnaire, time to walk 15 m, and range of motion squatting. Results of patients treated by the two healers were analyzed separately. Both treatment groups reported significant reduction in WOMAC scores after intervention. Patients treated by healer 2 reported greater reduction in pain (mean improvement −25.7 ± 6.6 vs. −13.1 ± 3.0; p < 0.01) and more improvement in functionality (−28.1 ± 9.7 vs. −13.2 ± 3.4; p < 0.01) than those in sham control and reduction in negative mood but not in anxiety or depression. Patients treated by healer 1 experienced improvement similar to control. The results of therapy persisted at 3 months follow-up for all groups. Mixed-effect models confirmed these findings with controlling for possible confounders. EQT might have a role in the treatment of OA, but our data indicate that all EQT healers are not equivalent. The apparent efficacy of EQT appears to be dependent on some quality of the healer. Further study on a larger scale with multiple EQT healers is necessary to determine the role (if any) of EQT in the treatment of OA and to identify differences in EQT techniques. Trial registration: clinicaltrials.gov identifier: NCT00104156     

The relationship between physical activity level,anxiety, depression,and functional ability in children and adolescents with juvenile idiopathic arthritis

The aim of this study was to assess the relationships between physical activity level and anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis (JIA). Cross-sectional study design including patients with JIA aged between 8 and 17 years and healthy controls was used. Sociodemographic data and clinical features were assessed. Physical activity level and energy expenditure were assessed with a 1-day activity diary. Anxiety was screened by The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. Depressive symptoms were assessed by the Children’s Depression Inventory (CDI). Functional ability was assessed with the Childhood Health Assessment Questionnaire (CHAQ). Pain and overall well-being were measured using a visual analog scale (VAS). Fifty-two patients and 48 controls were included with a mean age of 12.13 ± 2.92 and 11.27 ± 1.59 years, respectively. The mean disease duration was 64 months. The JIA group had significantly less time in physical activity (p = 0.000), decrease in energy expenditure (p = 0.04), and higher CHAQ scores (p = 0.000) compared with the control group. In the JIA group, significant relationships were found between the number of active joint and disease duration (r = 0.44, p = 0.000) and VAS pain (r = 0.30, p = 0.02), between SCARED and CDI (r = 0.54, p = 0.000). Significant relationships were found between VAS overall well-being and CDI (r = 0.29, p = 0.03), CHAQ (r = 0.37, p = 0.000), and VAS pain (r = 0.41, p = 0.000). Correlation between CHAQ and CDI (r = 0.34, p = 0.01) was significant. The result of our study suggested that only depression was related to anxiety, functional ability, and well-being in children and adolescents with JIA.     

Long-term Follow-up of Patients Undergoing Postconditioning During ST-Elevation Myocardial Infarction

Reperfusion injury may offset the optimal salvage of myocardium achieved during primary coronary angioplasty. Thus, coronary reperfusion must be combined with cardioprotective adjunctive therapies in order to optimize myocardial salvage and minimize infarct size. Forty-three patients with their first ST-elevation myocardial infarction were randomized to myocardial postconditioning or standard of care at the time of primary coronary angioplasty. Postconditioning was performed immediately upon crossing the lesion with the guide wire and consisted of four cycles of 30 s occlusion followed by 30 s of reperfusion. End-points included infarct size, myocardial perfusion grade (MPG), left-ventricular ejection fraction (LVEF), and long-term clinical events (death and heart failure). Despite similar ischemic times (≅4.5 h) (p = 0.9) a reduction in infarct size was observed among patients treated with the postconditioning protocol. Peak creatine phosphokinase (CPK), as well as its myocardial band (MB) fraction, was significantly lower in the postconditioning group when compared with the control group (CPK—control, 2,444 ± 1,928 IU/L vs. PC, 2,182 ± 1,717 IU/L; CPK-MB—control, 242 ± 40 IU/L vs. PC, 195 ± 33 IU/L; p = 0.64 and p < 0.01, respectively). EF in the postconditioning group was improved when compared with the control group (control, 43% ± 15 vs. PC, 52% ± 9; p = 0.05). After a mean follow-up of 3.4 years, a 6-point absolute difference in LVEF was still evident in the postconditioning group (p = 0.18). MPG was better among patients treated with the postconditioning protocol compared with control (2.5 ± 0.5 vs. 2.1 ± 0.6; p = 0.02). Due to the small sample size no significant differences in clinical events were detected (p value for death = 0.9; p value for heart failure = 0.2). A simple postconditioning protocol applied at the onset of mechanical reperfusion, resulted in reduction of infarct size, better epicardial and myocardial flow, and improvement in left ventricular function. The beneficial effects of postconditioning on cardiac function persist beyond 3 years.     

A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter

Purpose  Although radiofrequency (RF) energy is routinely used for tricuspid isthmus (TI) ablation, it is often associated with discomfort. The paucity of studies comparing the feasibility and efficacy of cryo- versus RF energy for TI-ablation urged us to conduct a prospective, randomised trial. Methods  Forty patients with atrial flutter (AFl) were randomised to RF- or cryoenergy for TI-ablation. Perceived pain was scored from 1 to 10 on a Visual Analogue Scale. Results  Significantly lower pain scores were recorded for cryoablation versus RF ablation (0.96 ± 0.73 versus 4.2 ± 2.4, p = 0.00004). Cryoablation was associated with significantly longer procedure duration and ablation time (137 ± 35 versus 111 ± 29 min, p = 0.016 and 81 ± 40 versus 48 ± 30 min, p = 0.007) and lower acute success rate (56% versus 100%, p = 0.001) than RF ablation. The recurrence of AFl was 20% (cryo) versus 15% (RF; p = 0.45) after a mean of 15.1 months follow-up. Conclusion  Cryoablation results in significantly less pain and discomfort compared to RF ablation of AFl, which is offset by the significantly lower acute success rate.     

Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study

The objective was to determine the relationship between symptoms of fibromyalgia (FM) and early menopause and hysterectomy. We included 115 postmenopausal patients with FM (mean age 54.6 ± 7.6) and 67 rheumatoid arthritis (RA) patients (mean age 55.5 ± 9) into our study. All patients were questioned about the severity of their symptoms of FM, anxiety, and depression by using a visual analog scale and FM impact questionnaire. Patients’ history of menopause and hysterectomy were recorded. Menopause (≤45 years) was accepted to be early. The frequencies of early menopause (38.3% vs. 13.4%, p = 0.001) and hysterectomy (16.5% vs. 6%, p = 0.039) in FM patients were significantly higher than in RA patients. While chronic widespread pain and other FM-related symptoms started after menopause in 58.3% of FM patients, the disease started after menopause in 64.2% of RA patients (p > 0.05). FM-related symptoms started in 30 patients (26.1%) with FM with menopause or within the first postmenopausal year. When the clinical features of FM patients whose symptoms started within the first menopausal year were compared to other FM patients; it was observed that the frequency of early menopause was higher in the former group (p = 0.048). Duke anxiety and depression score was higher in patients with hysterectomy whose FM symptoms started within the first year of post-hysterectomy than other FM patients (9.1 ± 2.7 vs. 6.7 ± 2.7, p = 0.022). Early menopause and hysterectomy may be one of the factors contributing to the development of FM.     

The effect of religious practice on the prevalence of knee osteoarthritis

The aim of this study is to evaluate the effect of religious practice on the prevalence, severity, and patterns of knee osteoarthritis (OA) in a Thai elderly population with the same ethnicity and culture but different religions. A house-to-house survey was conducted in two subdistricts of Phranakhon Sri Ayutthaya province where inhabitants are a mixture of Buddhists and Muslims. One hundred fifty-three Buddhists and 150 Muslims aged ≥ 50 years were evaluated demographically, physically, and radiographically. Those suffering knee pains were questioned about severity using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and examined for their range of knee motion. Radiographic knee OA (ROA) was defined as Kellgren–Lawrence radiographic grade ≥2 while symptomatic knee OA (SOA) was defined as knee symptoms of at least 1 month in a knee with ROA. Muslims had on average a higher number of daily religious practices than their Buddhist neighbors (p < 0.001). The prevalence of knee pain and ROA was significantly higher in Buddhists than in Muslims (67.11 vs. 55.80, p = 0.02 for knee pain; 85.62 vs. 70.67, p = 0.02 for ROA). For SOA, Buddhists showed a trend towards higher prevalence than Muslims (47.71 vs. 37.32, p = 0.068). No significant difference was found when the range of motion and WOMAC scores were compared between the two groups. Muslims had a lower prevalence of OA than their Buddhists counterparts with the same ethnicity but different religious practice. The Muslim way of praying since childhood, forcing the knees into deep flexion, may stretch the soft tissue surrounding the knee and decrease stiffness and contact pressure of the articular cartilage.     

Serum and synovial fluid levels of interleukin-17 in correlation with disease activity in patients with RA

The aim of this study was to evaluate serum and synovial levels of IL-17A by ELISA in rheumatoid arthritis (RA) and find out the correlations between IL-17A levels and various clinical, laboratory parameters and RA disease activity and severity indices. Group I consists of 30 adult active RA patients fulfilling the ARA 1987 revised criteria, with knee effusion and receiving basic therapy, and with a mean age of 41.47 ± 11.49 years and mean disease duration of 9.5 ± 4.16 years. Group II consisted of 13 healthy volunteers, age- and sex-matched, with a mean age of 39.08 ± 14.19 years. RA patients showed significantly higher mean serum IL-17A levels than controls (11.25 ± 9.67 vs. 0.6 ± 1.4 pg/mL, respectively, p = 0.0002). Synovial IL-17A levels showed a significant positive correlation with serum IL-17A levels (r = 0.5 and p = 0.005). RA patients with negative rheumatoid factor (RF) had non-significantly higher mean serum IL-17A levels (12 ± 9.86 pg/mL) compared to those with positive RF (10.82 ± 9.81 pg/mL); however, the mean synovial IL-17A levels were nearly the same. Significant positive correlations were found between both serum and synovial IL-17A levels and DAS-28 scores (r = 0.556, 0.392 and p = 0.001, 0.032, respectively). RA patients with class III functional status showed significantly higher mean serum IL-17A levels (17.53 ± 13.43 pg/mL) than classes I and II (8.97 ± 6.97 pg/mL, p = 0.009). These led us to conclude that the elevated serum and synovial IL-17A levels in RA patients parallel the degree of disease activity and severity. This may highlight the usefulness of IL-17 (especially serum level) as a possible marker for more aggressive joint involvement and damage.     

Effects of chondroitin sulfate and glucosamine in adult patients with Kaschin–Beck disease

The purpose is to investigate the effects of chondroitin sulfate and glucosamine on adult patients with Kaschin–Beck disease (KBD). A total of 80 patients, aged over 40 years, were randomized into two groups receiving either 1,600 mg oral mixture of chondroitin sulfate and glucosamine or placebo twice daily for 8 months. Posteroanterior radiographs of bilateral knee in full extension were taken at enrollment and after 8 months. Mean joint-space width of the assigned six points on the tibiofemoral joint compartment was measured by a graduated magnifying lens. The mean joint space decreased significantly in the placebo group (4.3 ± 1.09 versus 4.1 ± 1.07 mm, P < 0.0001) after 8 months and was unchanged in the experimental group (P = 0.51). There was no statistical significance in the mean joint space between two groups at baseline and follow-up (P = 0.65 and P = 0.84, respectively). But the overall mean change in joint space was significant between the two groups (P < 0.0001). Knee joint space of the experimental group narrowed slowly compared to the control group. Therefore, chondroitin sulfate and glucosamine might play a protective role in preserving articular cartilage and provide evidence for therapeutic drugs in adult patients with KBD.     

Risk factors for cardiovascular disease and endothelin-1 levels in Takayasu arteritis patients

The objective of this study was to evaluate traditional risk factors for cardiovascular disease (CVD) and endothelin-1 (ET-1) levels in Takayasu arteritis (TA) patients. Twenty-two TA patients and 37 controls were evaluated. TA patients had a higher prevalence of hypertension (63.6% vs. 21.6%, p = 0.001) and higher levels of triglycerides (129.5 mg/dL ± 70.8 vs. 88.4 mg/dL ± 60.8, p = 0.017) than controls. Mean number of CVD risk factors was 1.64 ± 1.22 in TA patients and 1.03 ± 1.44 among controls, p = 0.030. More TA patients presented at least one CVD risk factor when compared to controls (77.2% vs. 51.3%, p = 0.048). ET-1 levels were higher in patients than in controls (1.49 pg/mL ± 0.45 vs. 1.27 pg/mL ± 0.32, p = 0.034), however no significant difference was found between patients with active and inactive disease. In this study, TA patients presented a higher prevalence of hypertension, higher levels of triglycerides, and ET-1 than controls.     

The evaluation of efficacy and tolerability of Hylan G-F 20 in bilateral thumb base osteoarthritis: 6?months follow-up

The aims of this randomized controlled trial were to evaluate the efficacy of intra-articular Hylan G-F 20 on the pain, pinch strength, and functional status in patients with thumb base osteoarthritis (OA). Sixty-six hands of 33 female patients (mean age, 62.6 ± 6.4 years) with bilateral clinical and radiological thumb base OA were included into this study. Hands of the same patient were divided to Hylan G-F 20 and saline-injection groups. VAS pain 100 mm, pinch strength (key, tripod and pulp to pulp pinch) and functionality (Dreiser functional index) were assessed at baseline, at sixth and 24th weeks. Statistically significant improvements were detected in function (p = 0.001), VAS pain (p = 0.002), and pinch strength (p = 0.004) at the 24th week in the Hylan G-F 20 group. However, only VAS pain scores decreased temporarily in control hands at the 6th week (p = 0.02). Although short-term placebo analgesic effect could not be ignored, intra-articular hylan was effective on pain, pinch strength, and function at the 24th week.     

Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: a prospective study

Background  Pulmonary vein antral isolation (PVAI) is an effective treatment for atrial fibrillation and involves prolonged procedure and fluoroscopy times. This study assesses the impact of a comprehensive radiation safety program on patient and operator radiation exposure during PVAI. Methods and Results  We evaluated a comprehensive radiation safety program including: (1) verbal reinforcement of previous fluoroscopy times (2) effective collimation (3) minimizing source-intensifier distance and (4) effective lead shield use. Exposure doses in 41 consecutive patients without (group-I, n = 21) and with (group-II, n = 20) the use of radiation safety program were assessed. PVAI was done using intracardiac echo (ICE) guided roving circular mapping catheter. A 3-dimensional mapping system was used in 27% cases for additional guidance. Operator and patient exposure was measured during the PVAI. The age, gender, body mass index and AF duration were similar in both of the groups. The total procedure (166 ± 56 vs 178 ± 38 min, p = 0.54) and fluoroscopy times (74 ± 24 vs 70 ± 20 min, p = 0.72) were comparable. Group-II had significantly lower dose area product (234 ± 120 vs 548 ± 363 Gy cm², p = 0.03) compared to group-I. The mean operator exposure was reduced by half and mean patient peak skin dose by three to ten times with comprehensive radiation safety program. None of the patients were noted to have radiation related skin injuries. Additional lifetime cancer risk was significantly lower in group-II patients (0.08 vs 0.2%, p < 0.001) than group-I. Conclusions  Implementation of a comprehensive radiation safety program described above significantly decreases the radiation exposure to the patient as well as the operator.     

Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation—from Chinese report

Background and aims  Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is recommended widely for the patients with severe, refractory slow transit constipation (STC). Subtotal colectomy with end-to-end antiperistaltic cecorectal anastomosis (Sarli procedure), an alternative for STC, has been paid particular attention. The purpose of this study was to retrospectively compare alterations of clinical functions and qualities of life between TAC-IRA and Sarli procedure. Methods  Seventeen patients with STC who underwent Sarli procedure and 20 patients with STC who underwent TAC-IRA were chosen for this study. Patient characteristics, operative data, postoperative data, alterations of clinical function, and quality of life were compared. The gastrointestinal quality of life index (GIQLI) survey was used to evaluate postoperative qualities of life. Results  At the mean 4-year follow-up (range 2–6 years), the frequency of daily bowel movement in the Sarli group was significantly less than that in the TAC-IRA group (2.4 ± 0.9 vs. 3.4 ± 0.8; P = 0.0014), and the Wexner continence scores were significantly lower in the Sarli group compared to the TAC-IRA group (4.3 ± 1.8 vs. 5.8 ± 1.9; P = 0.0223). However, the GIQLI score in Sarli group was higher than the TAC-IRA group (119.8 ± 7.5 vs. 111.1 ± 12.0, P = 0.0455). Post subtotal colectomy barium enema showed a sign of “reservoir” at the residual ascending colon and cecum. Conclusions  Compared to the TAC-IRA, subtotal colectomy with end-to-end antiperistaltic cecoproctostomy for appropriately selected patients with STC resulted in relief of constipation, satisfactory functional outcome, and improved qualities of life.     

Risk factors of vertebral fractures in women with systemic lupus erythematosus

The aim of the current study was to analyze the role of traditional and systemic lupus erythematosus (SLE)-related risk factors in the development of vertebral fractures. A cross-sectional study was performed in women with SLE attending a single center. A vertebral fracture was defined as a reduction of at least 20% of vertebral body height. Two hundred ten patients were studied, with median age of 43 years and median disease duration of 72 months. Osteopenia was present in 50.3% of patients and osteoporosis in 17.4%. At least one vertebral fracture was detected in 26.1%. Patients with vertebral fractures had a higher mean age (50 ± 14 vs. 41 ± 13.2 years, p = 0.001), disease damage (57.1% vs. 34.4%, p = 0.001), lower bone mineral density (BMD) at the total hip (0.902 ± 0.160 vs. 982 ± 0.137 g/cm², p = 0.002), and postmenopausal status (61.9% vs. 45.3%, p = 0.048). Stepwise logistic regression analysis revealed that only age (p = 0.001) and low BMD at the total hip (p = 0.007) remained as significant factors for the presence of vertebral fracture. The high prevalence of vertebral fractures in the relatively young population implies that more attention must be paid to detect and treat vertebral fractures.