The optimal injection technique for the osteoarthritic ankle: A randomized,cross-over trial

BackgroundTo optimize the injection technique for the osteoarthritic ankle in order to enhance the effect of intra-articular injections and minimize adverse events.MethodsRandomized cross-over trial. Comparing two injection techniques in patients with symptomatic ankle osteoarthritis. Patients received an injection with hyaluronic acid using either one of the techniques. Four weeks later the second injection was given using the other technique. Primary outcome was the failure rate of the injection.ResultsSeventy patients fulfilled the study. The failure rate for both injection techniques was 24%. Forty-one patients in the traction group and thirty-nine in the group without traction experienced treatment related local adverse events. Other secondary outcomes did not show any difference between injection techniques.ConclusionsThere is no significant difference comparing the two injection methods regarding any of our formulated outcome measures. The use of contrast aided fluoroscopy for injecting the severe osteoarthritic ankle can be advised at all times.     

Developing a Reliable and Valid Scale to Measure Psychosocial Acuity

This tool is a unique comprehensive scale and methodology to measure the psychosocial acuity of patients and families across a health care continuum. Coupled with other measures, psychosocial acuity can tell a complete and compelling story of social work contributions and aid in resource alignment. Accurately conveying the full scope of social work value to anyone, especially health system leadership, requires that the psychosocial acuity of the patient and family be measured and factored into the equation, along with productivity, time spent, and services provided. The development and utilization of the Psychosocial Acuity Tool is the focus of this publication.     

Education Preferences of People With Gout: Exploring Differences Between Indigenous and Nonindigenous Peoples from Rural and Urban Locations

Objective

Gout typically responds well to medications, but adherence might be improved by education that meets individuals’ needs in a way that is inclusive of their ethnicity and rurality. The aim of this study was to compare education preferences of Māori and New Zealand European (NZEuropean) individuals with gout, and of those living in rural or urban areas.

Methods

People with gout managed in primary care were recruited from 2 rural regions and 1 city within Aotearoa/New Zealand. Focus groups were held with 26 Māori and 42 NZEuropean participants (44 rural, 24 urban). Participants discussed education preferences for diet, medication, and ways of communicating. The nominal group technique was employed, whereby the group compiled a list of ideas and then participants individually ranked the 3 most important ideas for each topic.

Results

The most frequently prioritized ideas for the 3 topics were knowing one's own food triggers, knowing side effects of medications, and communicating via a general practitioner (GP) or specialist. More Māori participants prioritized natural remedies, easy to understand information, and communicating via television. More NZEuropean participants prioritized knowing the kinds of alcohol that trigger gout, communicating via GP/specialist, and receiving written information. More urban participants prioritized knowing to stay hydrated and medication doses as important information.

Conclusion

Māori and NZEuropean individuals with gout report different understandings and education preferences around personal triggers of gout, treatment options, and ways of receiving information about gout. Further research is required to develop ethnicity‐specific gout education resources internationally.

     

3-Year Outcomes of the Edwards SAPIEN Transcatheter Heart Valve for Conduit Failure in the Pulmonary Position From the COMPASSION Multicenter Clinical Trial

Objectives

This study provides the 3-year follow-up results of the COMPASSION (Congenital Multicenter Trial of Pulmonic Valve Regurgitation Studying the SAPIEN Transcatheter Heart Valve) trial. Patients with moderate to severe pulmonary regurgitation and/or right ventricular outflow tract conduit obstruction were implanted with the SAPIEN transcatheter heart valve (THV).

Caveolar peroxynitrite formation impairs endothelial TRPV4 channels and elevates pulmonary arterial pressure in pulmonary hypertension

Recent studies have focused on the contribution of capillary endothelial TRPV4 channels to pulmonary pathologies, including lung edema and lung injury. However, in pulmonary hypertension (PH), small pulmonary arteries are the focus of the pathology, and endothelial TRPV4 channels in this crucial anatomy remain unexplored in PH. Here, we provide evidence that TRPV4 channels in endothelial cell caveolae maintain a low pulmonary arterial pressure under normal conditions. Moreover, the activity of caveolar TRPV4 channels is impaired in pulmonary arteries from mouse models of PH and PH patients. In PH, up-regulation of iNOS and NOX1 enzymes at endothelial cell caveolae results in the formation of the oxidant molecule peroxynitrite. Peroxynitrite, in turn, targets the structural protein caveolin-1 to reduce the activity of TRPV4 channels. These results suggest that endothelial caveolin-1–TRPV4 channel signaling lowers pulmonary arterial pressure, and impairment of endothelial caveolin-1–TRPV4 channel signaling contributes to elevated pulmonary arterial pressure in PH. Thus, inhibiting NOX1 or iNOS activity, or lowering endothelial peroxynitrite levels, may represent strategies for restoring vasodilation and pulmonary arterial pressure in PH.

Pulmonary hypertension (PH) is a degenerative disease characterized by increased pulmonary arterial pressure (PAP) (1). Current therapeutic options for PH patients are aimed at dilating pulmonary arteries (PAs) to lower PAP. However, treatments that target the mechanisms for impaired vasodilation are not available. Endothelial cells (ECs) promote vasodilation of PAs under normal conditions. Loss of endothelium-dependent vasodilation of resistance-sized PAs is a significant contributor to elevated PAP in PH (2). Therefore, a detailed understanding of the pathological signatures of arterial ECs is necessary for designing therapeutic options capable of rescuing endothelium-dependent vasodilation in PH.Intracellular Ca²⁺ is an essential regulator of EC function in the pulmonary circulation. Recent studies show that Ca²⁺ influx through EC transient receptor potential vanilloid 4 (TRPV4_EC) channels dilates resistance PAs via activation of endothelial nitric oxide synthase (eNOS) (3, 4). However, the physiological role of TRPV4_EC channels in regulating PAP remains unknown, largely due to the lack of studies in cell-specific knockout mice. In this regard, activation of smooth muscle cell TRPV4 (TRPV4_SMC) channels can induce PA constriction (5), whereas activation of TRPV4_EC channels induces PA dilation (4). We hypothesized that TRPV4_EC channel dysfunction contributes to the loss of vasodilation and elevation of PAP in PH.Caveolin-1 (Cav-1) is an important scaffolding protein that interacts with and stabilizes several other proteins in the pulmonary circulation, including eNOS (6). Global Cav-1^−/− mice show elevated PAP, and endothelial Cav-1 (Cav-1_EC)–dependent signaling is altered in PH (7–11). Studies on pulmonary EC culture showed that the TRPV4_EC channel coimmunoprecipitates with Cav-1 (12); however, direct functional evidence for the effect of Cav-1 on TRPV4_EC channel activity is lacking. We postulated that Cav-1_EC enhances TRPV4_EC channel activity in PAs and that impaired Cav-1_EC–TRPV4_EC signaling contributes to the loss of vasodilation and elevated PAP in PH.The generation of reactive oxygen species (ROS) appears to be central to vascular dysfunction in PH (13, 14). In this regard, NADPH oxidase 1 (NOX1) has emerged as a crucial source of endothelial superoxide radicals in PH (15–17). Interestingly, superoxide radicals were shown to augment TRPV4 channel-induced increases in global Ca²⁺ in pulmonary EC culture (18). Additionally, superoxide radicals can quickly react with NO to form the oxidant molecule peroxynitrite (PN) (19). PN is elevated in the lungs of PH patients (20) and is known to have deleterious effects on EC function (21). Importantly, inducible NOS (iNOS), which generates NO, is also up-regulated in mouse models of PH and in PH patients (22, 23). Therefore, we hypothesized that NOX1 and iNOS contribute to ROS-dependent inhibition of Cav-1_EC–TRPV4_EC channel signaling in PH.In the current study, we used inducible, EC-specific TRPV4 channel knockout (TRPV4_EC^−/−) and endothelium-specific Cav-1–knockout (Cav-1_EC^−/−) mice to confirm a vital role for Cav-1_EC–TRPV4_EC signaling in lowering resting PAP. Cav-1_EC–TRPV4_EC signaling was impaired in resistance PAs from mouse models of PH and those from pulmonary arterial hypertension (PAH) patients. NADPH oxidase enzyme 1 (NOX1^−/−) and inducible nitric oxide synthase (iNOS^−/−) mice were protected against the impairment of Cav-1_EC–TRPV4_EC signaling in PH, and NOX1/iNOS/PN inhibitors rescued Cav-1_EC–TRPV4_EC signaling in PH. Collectively, our findings provide evidence that pathological signaling made possible by the colocalization of NOX1 and iNOS with Cav-1 underlies the loss of TRPV4_EC channel activity and vasodilation in PH. Therefore, inhibiting NOX1/iNOS or suppressing PN formation may be a viable strategy for rescuing endothelial function and PAP in PH.     

Contained rupture of patched right ventricular outflow tracts during balloon sizing for percutaneous pulmonary valve implantation

Transcatheter pulmonary valves are being used off‐label to treat pulmonary insufficiency in patched right ventricular outflow tracts (RVOTs). We describe the first reported cases of patched RVOT rupture, during balloon sizing for percutaneous pulmonary valve implantation, in two patients with tetralogy of Fallot status post repair. Both RVOTs were too large for subsequent catheter‐based intervention. The ruptures remained stable over time, and both patients were managed conservatively with follow‐up imaging. © 2015 Wiley Periodicals, Inc.     

Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral Treatment

AIDS and Behavior - This study explored factors associated with durable viral suppression (DVS) among two groups of people living with HIV (PLWH) and problem substance use in the context of...