BMP2 and TGF-β Cooperate Differently during Synovial-Derived Stem-Cell Chondrogenesis in a Dexamethasone-Dependent Manner

Recent studies highlighting mesenchymal stem cell (MSC) epigenetic memory suggest that a different differentiation medium may be required depending on the tissue of origin. As synovial-derived stem cells (SDSCs) attract interest we aimed to investigate the influence of TGF-β1, BMP-2 and dexamethasone on SDSC chondrogenesis in vitro. We demonstrate that dexamethasone-free medium led to enhanced chondrogenic differentiation at both the mRNA and matrix level. The greatest COL2A1/COL10A1 ratio was detected in cells exposed to a combination medium containing 10 ng/mL BMP-2 and 1 ng/mL TGF-β1 in the absence of dexamethasone, and this was reflected in the total amount of glycosaminoglycans produced. In summary, dexamethasone-free medium containing BMP-2 and TGF-β1 may be the most suitable when using SDSCs for cartilage tissue regeneration

Validation of the Patient Health Questionnaire‐4 for longitudinal mental health evaluation in elite Para athletes

Background Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented. Objective Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes. Design A 43-week prospective observational cohort study. Setting Online questionnaire, provided weekly via web browser and mobile app. Participants Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games. Interventions Not applicable. Main Outcome Measures Weekly PHQ-4 scores, stress level, and mood. Results With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1–1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p < .001). Internal consistency of the PHQ-4 was satisfying, Cronbach's α being 0.839. There were significant cross-sectional as well as longitudinal correlations of PHQ-4 and stress level as well as mood values (p < .001). 39.7% of all athletes (n = 31) had at least one positive screen for mental health symptoms. Conclusions The PHQ-4 was shown to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ-4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow-up

Prospective Clinical Trial for Septic Arthritis:Cartilage Degradation and Inflammation Are Associated with Upregulation of Cartilage Metabolites

Background. Intra-articular infections can rapidly lead to osteoarthritic degradation. The aim of this clinical biomarker analysis was to investigate the influence of inflammation on cartilage destruction and metabolism. Methods. Patients with acute joint infections were enrolled in a prospective clinical trial and the cytokine composition of effusions (n=76) was analyzed. Characteristics of epidemiology and disease severity were correlated with levels of cytokines with known roles in cartilage turnover and degradation. Results. Higher synovial IL-1β concentrations were associated with clinical parameters indicating a higher disease severity (p<0.03) excluding the incidence of sepsis. Additionally, intra-articular IL-1β levels correlated with inflammatory serum parameters as leucocyte counts (LC) and C-reactive protein concentrations (p<0.05) but not with age or comorbidity. Both higher LC and synovial IL-1β levels were associated with increased intra-articular collagen type II cleavage products (C2C) indicating cartilage degradation. Joints with preinfectious lesions had higher C2C levels. Intra-articular inflammation led to increased concentrations of typical cartilage metabolites as bFGF, BMP-2, and BMP-7. Infections with Staphylococcus species induced higher IL-1β expression but less cartilage destruction than other bacteria. Conclusion. Articular infections have bacteria-specific implications on cartilage metabolism. Collagen type II cleavage products reliably mark destruction, which is associated with upregulation of typical cartilage turnover cytokines. This trial is registered with DRKS00003536, MISSinG

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p < 0.0001; 0.39 < r < 0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and Mental Health in Para-Athletes During COVID-19 a stress level, respectively. Reduced physical activity was significantly (p < 0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population

Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration

Abstract Background Glenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients. Methods One hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded. Results One hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via “squeeze-and-stir-technique” assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1). Conclusions Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies

Quantitative work demands, emotional demands and cognitive stress symptoms in surgery nurses

In surgery, cognitive stress symptoms, including problems in concentrating, deciding, memorising, and reflecting are risks to patient safety. Recent evidence points to social stressors as antecedents of cognitive stress symptoms in surgery personnel. The current study tests whether cognitive stress symptoms are positively associated with emotional abuse, emotional- and task-related demands and resources in surgery work. Forty-eight surgery nurses from two hospitals filled out the Copenhagen Psychosocial Questionnaire in its German version. Task-related and emotional demands were positively related to cognitive stress symptoms. In a stepwise, multiple, linear regression of cognitive stress symptoms on task-related and emotional demands, emotional abuse and emotional demands were unique predictors (p < .05). Efforts to increase patient safety should address emotional abuse, emotional demands, and, therefore, communication and cooperation team climate in surgery personnel