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Cartilage Dec 2021The aim of this systematic review was to analyze the evidence about the efficacy of the several synovial fluid (SF) biomarkers proposed for knee osteoarthritis (OA),...
OBJECTIVE
The aim of this systematic review was to analyze the evidence about the efficacy of the several synovial fluid (SF) biomarkers proposed for knee osteoarthritis (OA), categorizing them by both molecular characteristics and clinical use according to the BIPEDs criteria, to provide a comprehensive and structured overview of the current literature.
DESIGN
A systematic review was performed in May 2020 on PubMed, Cochrane Library, and Embase databases about SF biomarkers in patients with knee OA. The search was limited to articles in the last 20 years on human studies, involving patients with knee OA, reporting SF biomarkers. The evidence for each selected SF biomarker was quantified according to the 6 categories of BIPEDs classification.
RESULTS
A total of 159 articles were included in the qualitative data synthesis and 201 different SF biomarkers were identified. Among these, several were investigated multiple times in different articles, for a total of 373 analyses. The studies included 13,557 patients with knee OA. The most promising SF biomarkers were C4S, IL-6, IL-8, Leptin, MMP-1/3, TIMP-1, TNF-α, and VEGF. The "burden of disease" and "diagnostic" categories were the most represented with 132 and 106 different biomarkers, respectively.
CONCLUSIONS
The systematic review identified numerous SF biomarkers. However, despite the high number of studies on the plethora of identified molecules, the evidence about the efficacy of each biomarker is supported by limited and often conflicting findings. Further research efforts are needed to improve the understanding of SF biomarkers for a better management of patients with knee OA.
Topics: Biomarkers; Cytokines; Humans; Inflammation; Knee Injuries; Osteoarthritis, Knee; Synovial Fluid
PubMed: 32713185
DOI: 10.1177/1947603520942941 -
Cartilage Dec 2021Biomarkers in osteoarthritis (OA) could serve as objective clinical indicators for various disease parameters, and act as surrogate endpoints in clinical trials for...
OBJECTIVE
Biomarkers in osteoarthritis (OA) could serve as objective clinical indicators for various disease parameters, and act as surrogate endpoints in clinical trials for disease-modifying drugs. The aim of this systematic review was to produce a comprehensive list of candidate molecular biomarkers for knee OA after the 2013 ESCEO review and discern whether any have been studied in sufficient detail for use in clinical settings.
DESIGN
MEDLINE and Embase databases were searched between August 2013 and May 2018 using the keywords "knee osteoarthritis," "osteoarthritis," and "biomarker." Studies were screened by title, abstract, and full text. Human studies on knee OA that were published in the English language were included. Excluded were studies on genetic/imaging/cellular markers, studies on participants with secondary OA, and publications that were review/abstract-only. Study quality and bias were assessed. Statistically significant data regarding the relationship between a biomarker and a disease parameter were extracted.
RESULTS
A total of 80 studies were included in the final review and 89 statistically significant individual molecular biomarkers were identified. C-telopeptide of type II collagen (CTXII) was shown to predict progression of knee OA in urine and serum in multiple studies. Synovial fluid vascular endothelial growth factor concentration was reported by 2 studies to be predictive of knee OA progression.
CONCLUSION
Despite the clear need for biomarkers of OA, the lack of coordination in current research has led to incompatible results. As such, there is yet to be a suitable biomarker to be used in a clinical setting.
Topics: Biomarkers; Collagen Type I; Collagen Type II; Genetic Markers; Humans; Osteoarthritis, Knee; Peptides; Synovial Fluid; Vascular Endothelial Growth Factor A
PubMed: 32680434
DOI: 10.1177/1947603520941239 -
Neurosurgery Nov 2020Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated...
BACKGROUND
Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated.
OBJECTIVE
To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature.
METHODS
A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates.
CONCLUSION
The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.
Topics: Case-Control Studies; Cohort Studies; Cross-Sectional Studies; Deep Brain Stimulation; Humans; Obsessive-Compulsive Disorder; Treatment Outcome
PubMed: 32615588
DOI: 10.1093/neuros/nyaa249 -
Orthopaedic Surgery Aug 2020To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta-analysis.
METHODS
Pertinent studies were identified by searching Pubmed, EMBASE databases with the last search update on 16 February 2020. Studies that reported hip arthroscopy for FAI were collected. Meta-analysis was performed by the use of Review Manager 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Additionally, the I was used to assess heterogeneity among studies, and the fixed-effects model or the random-effects model was selected for the quantitative analysis. Outcomes were evaluated by forest plots. For statistical analysis, P < 0.05 was considered significant.
RESULTS
There was no significant difference among the preoperative mHHS (MD = -2.66,95% CI [-7.25, 1.92], I = 80%, P = 0.25), preoperative (MD = -4.94, 95% CI [-11.56, 1.67], I = 50%, P = 0.14) and postoperative HOS-SSS (MD = -1.00, 95% CI [-6.98, 4.98], I = 66%, P = 0.74), patient satisfaction (MD = 0.03, 95% CI [-0.25, 0.31], I = 19%, P = 0.84; OR = 0.94, 95% CI [0.59, 1.50], I = 0%, P = 0.78), complications (OR = 1.23, 95%CI [0.56, 2.67], I = 0%, P = 0.61), revisions (OR = 1.77, 95% CI [0.87, 3.60], I = 36%, P = 0.11), and surgery time (SMD = -0.38, 95% CI [-1.16, 0.40], I = 92%, P = 0.34) between the capsule closure group and the non-closure group. For the comparison of postoperative mHHS (MD = -2.66, 95% CI [-7.25, 1.92], I = 80%, P = 0.25) and HOS-ADL (MD = -4.20, 95% CI [-5.75, -2.65], I = 24%, P < 0.00001), the score of the non-closure group was significantly better than that of the closure group.
CONCLUSIONS
Remain capsule unclosed after hip arthroscopy for FAI may, to some extent, has a better postoperative functional score than the non-closure treatment.
Topics: Activities of Daily Living; Arthroscopy; Disability Evaluation; Femoracetabular Impingement; Humans; Joint Capsule; Patient Satisfaction
PubMed: 32524761
DOI: 10.1111/os.12717 -
Seminars in Arthritis and Rheumatism Aug 2020Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to...
INTRODUCTION
Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to identify domains that have been reported in prior clinical studies in CPPD, to inform the development of a core set of domains for CPPD studies.
METHODS
We performed a scoping literature review for clinical studies in CPPD, searching in Medline (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases; published from January 1, 1946 to January 7, 2020. All reported outcomes and study design data were extracted and mapped to the core areas and domains as defined by the OMERACT Filter 2.1.The protocol was registered on PROSPERO (CRD: 42019137075; 09-07-2019).
FINDINGS
There were 112 papers identified, comprising of 109 observational studies and three randomized controlled trials. Most studies reported clinical presentations of OA with CPPD or acute CPP crystal arthritis. Outcomes that mapped to 22 domains were identified; the most frequently reported measures mapped to the following domains/sub-domains: imaging (joint damage on imaging tests - 59 studies; joint calcification on imaging tests - 28 studies), joint pain (26 studies), response to treatment (23 studies), side effects of treatment (15 studies), inflammation in the joint fluid or blood (ESR or C-reactive protein - 12 studies; synovial fluid markers - 4 studies; other blood markers - 2 studies), overall function (14 studies), joint swelling (12 studies) and range of joint movement (10 studies). Very few studies mapped to domains related to life impact, societal/resource use or longevity.
CONCLUSION
There is substantial variability in outcomes reported in CPPD studies. Outcomes that map to imaging manifestations, joint pain and response to treatment domains are most often reported.
Topics: Calcinosis; Calcium Pyrophosphate; Chondrocalcinosis; Female; Humans; Male; Observational Studies as Topic; Synovial Fluid
PubMed: 32521326
DOI: 10.1016/j.semarthrit.2020.05.015 -
BMC Musculoskeletal Disorders Apr 2020Prior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule repair suggesting that the posterior capsule repair group had better clinical outcomes. However, it is still a controversy which treatment is more helpful for hip diseases. The purpose of our article is to obtain the postoperative outcomes between the 2 procedures.
METHODS
We performed a systematic search by browsing the MEDLINE, EMBASE, Cochrane Library. There is no restriction on the date of publication. Before we submit our manuscript, we have re-searched the literatures again, including the articles which directly compared the postoperative outcomes of the 2 procedures.
RESULTS
A total of 8 comparative studies were included in our meta-analysis. The posterior capsule repair group showed less dislocation rate, higher HHS, and even less postoperative bleeding volume. Meanwhile, there is no significant difference in ROM between 2 groups.
CONCLUSION
In conclusion, according to current evidences, repairing posterior capsule during primary THA may have better functional outcomes, less dislocation incidence, and less loss of blood.
Topics: Arthroplasty, Replacement, Hip; Connective Tissue; Hip Dislocation; Hip Joint; Humans; Incidence; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 32316961
DOI: 10.1186/s12891-020-03244-y -
Le Infezioni in Medicina Mar 2020There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic...
There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic review searching scientific articles was performed with keywords "Procalcitonin", "Total Hip Replacement", and "Total Knee Replacement" (n=123). After review of the abstract and full text for relevance, ten articles were included (n=10). Serum PCT levels for chronic Total Hip Replacement (THR) and Total Knee Replacement (TKR) have a range of mean values from 1.5 ng/ml to 14.2 ng/ml. Specificity ranges from 0.27 to 0.98, while sensitivity is from 0.33 to 0.9. On primary THR/TKR with confirmation of non-infected status, serum PCT peaks between 1-3 days post-operatively, with peak levels varying from 0.12 - 0.79 ng/ml. Based on this review, serum PCT is not a good adjunct in diagnosing Prosthetic Joint Infection (PJI). Synovial fluid PCT fluid may add better clinical support but requires further studies. There were several limitations with this review: the studies are small and heterogeneous, there was a variable definition of PJI, and there was a wide range of mean values, sensitivity and specificity.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Humans; Procalcitonin; Prosthesis-Related Infections; Reference Values; Sensitivity and Specificity; Synovial Fluid
PubMed: 32172255
DOI: No ID Found -
Advances in Therapy Apr 2020The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary...
The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary to primary inflammatory rheumatic diseases. Osteoarthritis should be carefully considered because it has potentially devastating effects on health-related quality of life. Locally injected HA seems to be an effective treatment for OA but it is not clear how to place this treatment in the context of inflammatory rheumatic disorders. To retrieve relevant articles, we conducted the search through MEDLINE, EMBASE and Cochrane Databases performing the PICO strategy. We finally selected four randomized clinical trials and six observational studies and grouped them in accordance with its main objective within three focuses: the clinical effect of HA therapy in joints without any signs of inflammation, the clinical effects of HA therapy in joints with active synovitis, and the involvement and changes of synovial fluid in the treatment of secondary OA. Our qualitative analysis clearly showed that the current literature is marked by high levels of heterogeneity and therefore difficult to interpret. Therefore, our hypothesis that viscosupplementation should be considered as a treatment for chronic moderate symptomatic OA secondary to inflammatory rheumatic diseases, and not for flares with joint swelling, cannot be definitely supported. Well-designed studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.
Topics: Humans; Hyaluronic Acid; Inflammation; Injections, Intra-Articular; Osteoarthritis; Quality of Life; Rheumatic Diseases; Synovial Fluid; Synovitis; Treatment Outcome; Viscosupplements
PubMed: 32141016
DOI: 10.1007/s12325-020-01256-7 -
PloS One 2020The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty...
Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty.
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Capsule; Joint Instability; Postoperative Complications
PubMed: 32101545
DOI: 10.1371/journal.pone.0229128 -
Journal of Orthopaedic Surgery and... Dec 2019Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI.
METHODS
We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis.
RESULTS
After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84-90%), 96% (95% CI 95-97%), and 170.09 (95% CI 97.63-296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83-90%), 97% (95% CI 96-98%), and 158.18 (95% CI 74.26-336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively.
CONCLUSION
Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.
Topics: Carboxylic Ester Hydrolases; Hip Prosthesis; Humans; Knee Prosthesis; Prosthesis-Related Infections; Reproducibility of Results; Shoulder Prosthesis; Synovial Fluid; alpha-Defensins
PubMed: 31856885
DOI: 10.1186/s13018-019-1395-3