An Empirical Study of Small-Area Variation for ICD-9 Surgical Procedures

Objective. Several measures of variation have been used in SAVA. One study of DRGs found that the coefficient of variation from analysis of variance (CVA) had superior performance. That work is replicated here for ICD-9 surgical procedures, and extended to age/sex-standardized rates. Results are compared with those in the literature, and recommendations are made for assessing small-area variation in future studies. Data Sources. Data were taken from Washington State\u27s Episode of Illness file of hospital discharges in the State in 1987. Up to three ICD-9 surgical procedures and a unique patient identifier were available for each discharge. Study Design. We calculated the usual small-area variation statistics for 153 different surgical procedures, among 28 counties in Washington state, with and without standardization for age and sex. We tested each variation statistic to determine whether it was correlated with the prevalence of the surgical procedure, and to see which statistic was most correlated with the true variation among counties. We used the empirical results to provide guidelines on how much of the observed variability among counties is likely to be due to chance alone. Principal Findings. As in the previous study of DRGs, the CVA was uncorrelated with the prevalence and highly related to the true variance of a procedure, whereas the other statistics performed less well. The age/sex-standardized CVA\u27s were usually smaller than CVA\u27s based on the raw data. Confidence intervals for the CVA, either crude or standardized, can be calculated from the appropriate chi-square statistic. Typical CVs were similar to those published elsewhere, in the range of .3 to .5. Conclusions. The CVA is the statistic of choice to measure small-area variation for procedures, with or without age/sex standardization. A CVA larger than .5 should be considered as high variation. In studies where fewer than 10 procedures are expected in the smallest area, the observed variation is likely to be primarily due to chance, and should be tested statistically before small-area analyses are conducted to determine the reason for the variation. The magnitude of the variation statistics here are similar to those published elsewhere, suggesting that these findings can be generalized to other settings

Oxidative Stress Promotes Peroxiredoxin Hyperoxidation and Attenuates Pro-survival Signaling in Aging Chondrocytes

Oxidative stress-mediated post-translational modifications of redox-sensitive proteins are postulated as a key mechanism underlying age-related cellular dysfunction and disease progression. Peroxiredoxins (PRX) are critical intracellular antioxidants that also regulate redox signaling events. Age-related osteoarthritis is a common form of arthritis that has been associated with mitochondrial dysfunction and oxidative stress. The objective of this study was to determine the effect of aging and oxidative stress on chondrocyte intracellular signaling, with a specific focus on oxidation of cytosolic PRX2 and mitochondrial PRX3. Menadione was used as a model to induce cellular oxidative stress. Compared with chondrocytes isolated from young adult humans, chondrocytes from older adults exhibited higher levels of PRX1–3 hyperoxidation basally and under conditions of oxidative stress. Peroxiredoxin hyperoxidation was associated with inhibition of pro-survival Akt signaling and stimulation of pro-death p38 signaling. These changes were prevented in cultured human chondrocytes by adenoviral expression of catalase targeted to the mitochondria (MCAT) and in cartilage explants from MCAT transgenic mice. Peroxiredoxin hyperoxidation was observed in situ in human cartilage sections from older adults and in osteoarthritic cartilage. MCAT transgenic mice exhibited less age-related osteoarthritis. These findings demonstrate that age-related oxidative stress can disrupt normal physiological signaling and contribute to osteoarthritis and suggest peroxiredoxin hyperoxidation as a potential mechanism

A New Compendium of Unsteady Aerodynamic Test Cases for CFD: Summary of AVT WG-003 Activities

With the continuous progress in hardware and numerical schemes, Computational Unsteady Aerodynamics (CUA), that is, the application of Computational Fluid Dynamics (CFD) to unsteady flowfields, is slowly finding its way as a useful and reliable tool (turbulence and transition modeling permitting) in the aircraft, helicopter, engine and missile design and development process. Before a specific code may be used with confidence it is essential to validate its capability to describe the physics of the flow correctly, or at least to the level of approximation required, for which purpose a comparison with accurate experimental data is needed. Unsteady wind tunnel testing is difficult and expensive; two factors which dramatically limit the number of organizations with the capability and/or resources to perform it. Thus, unsteady experimental data is scarce, often classified and scattered in diverse documents. Additionally, access to the reports does not necessarily assure access to the data itself. The collaborative effort described in this paper was conceived with the aim of collecting into a single easily accessible document as much quality data as possible. The idea is not new. In the early 80's NATO's AGARD (Advisory Group for Aerospace Research & Development) Structures and Material Panel (SMP) produced AGARD Report No. 702 "Compendium of Unsteady Aerodynamic Measurements", which has found and continues to find extensive use within the CUA Community. In 1995 AGARD's Fluid Dynamics Panel (FDP) decided to update and expand the former database with new geometries and physical phenomena, and launched Working Group WG-22 on "Validation Data for Computational Unsteady Aerodynamic Codes". Shortly afterwards AGARD was reorganized as the RTO (Research and Technology Organization) and the WG was renamed as AVT (Applied Vehicle Technolology) WG-003. Contributions were received from AEDC, BAe, DLR, DERA, Glasgow University, IAR, NAL, NASA, NLR, and ONERA. The final publication with the results of the exercise is expected in the second part of 1999. The aim of the present paper is to announce and present the new database to the Aeroelasticity community. It is also intended to identify, together with one of the groups of end users it targets, deficiencies in the compendium that should be addressed by means of new wind tunnel tests or by obtaining access to additionally existing data

Cartilage-specific <i>Sirt6</i> deficiency represses IGF-1 and enhances osteoarthritis severity in mice.

ObjectivesPrior studies noted that chondrocyte SIRT6 activity is repressed in older chondrocytes rendering cells susceptible to catabolic signalling events implicated in osteoarthritis (OA). This study aimed to define the effect of Sirt6 deficiency on the development of post-traumatic and age-associated OA in mice.MethodsMale cartilage-specific Sirt6-deficient mice and Sirt6 intact controls underwent destabilisation of the medial meniscus (DMM) or sham surgery at 16 weeks of age and OA severity was analysed at 6 and 10 weeks postsurgery. Age-associated OA was assessed in mice aged 12 and 18 months of age. OA severity was analysed by micro-CT, histomorphometry and scoring of articular cartilage structure, toluidine blue staining and osteophyte formation. SIRT6-regulated pathways were analysed in human chondrocytes by RNA-sequencing, qRT-PCR and immunoblotting.ResultsSirt6-deficient mice displayed enhanced DMM-induced OA severity and accelerated age-associated OA when compared with controls, characterised by increased cartilage damage, osteophyte formation and subchondral bone sclerosis. In chondrocytes, RNA-sequencing revealed that SIRT6 depletion significantly repressed cartilage extracellular matrix (eg, COL2A1) and anabolic growth factor (eg, insulin-like growth factor-1 (IGF-1)) gene expression. Gain-of-function and loss-of-function studies in chondrocytes demonstrated that SIRT6 depletion attenuated, whereas adenoviral overexpression or MDL-800-induced SIRT6 activation promoted IGF-1 signalling by increasing Aktser473 phosphorylation.ConclusionsSIRT6 deficiency increases post-traumatic and age-associated OA severity in vivo. SIRT6 profoundly regulated the pro-anabolic and pro-survival IGF-1/Akt signalling pathway and suggests that preserving the SIRT6/IGF-1/Akt axis may be necessary to protect cartilage from injury-associated or age-associated OA. Targeted therapies aimed at increasing SIRT6 function could represent a novel strategy to slow or stop OA

Proteomic Analysis Reveals Age-related Changes in Tendon Matrix Composition, with Age- and Injury-specific Matrix Fragmentation

Energy storing tendons, such as the human Achilles and equine superficial digital flexor tendon (SDFT), are highly prone to injury, the incidence of which increases with aging. The cellular and molecular mechanisms that result in increased injury in aged tendons are not well established but are thought to result in altered matrix turnover. However, little attempt has been made to fully characterize the tendon proteome nor determine how the abundance of specific tendon proteins changes with aging and/or injury. The aim of this study was, therefore, to assess the protein profile of normal SDFTs from young and old horses using label-free relative quantification to identify differentially abundant proteins and peptide fragments between age groups. The protein profile of injured SDFTs from young and old horses was also assessed. The results demonstrate distinct proteomic profiles in young and old tendon, with alterations in the levels of proteins involved in matrix organization and regulation of cell tension. Furthermore, we identified several new peptide fragments (neopeptides) present in aged tendons, suggesting that there are age-specific cleavage patterns within the SDFT. Proteomic profile also differed between young and old injured tendon, with a greater number of neopeptides identified in young injured tendon. This study has increased the knowledge of molecular events associated with tendon aging and injury, suggesting that maintenance and repair of tendon tissue may be reduced in aged individuals and may help to explain why the risk of injury increases with aging

Scientific Evidence and Rationale for the Development of Curcumin and Resveratrol as Nutraceutricals for Joint Health

Interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) are key cytokines that drive the production of inflammatory mediators and matrix-degrading enzymes in osteoarthritis (OA). These proinflammatory cytokines bind to their respective cell surface receptors and activate inflammatory signaling pathways culminating with the activation of nuclear factor κB (NF-κB), a transcription factor that can be triggered by a host of stress-related stimuli including, excessive mechanical stress and ECM degradation products. Once activated, NF-κB regulates the expression of many cytokines, chemokines, adhesion molecules, inflammatory mediators, and several matrix-degrading enzymes. Therefore, proinflammatory cytokines, their cell surface receptors, NF-κB and downstream signaling pathways are therapeutic targets in OA. This paper critically reviews the recent literature and outlines the potential prophylactic properties of plant-derived phytochemicals such as curcumin and resveratrol for targeting NF-κB signaling and inflammation in OA to determine whether these phytochemicals can be used as functional foods

The Potential of N-Rich Plasma-Polymerized Ethylene (PPE:N) Films for Regulating the Phenotype of the Nucleus Pulposus

We recently developed a nitrogen-rich plasma-polymerized biomaterial, designated “PPE:N” (N-doped plasma-polymerized ethylene) that is capable of suppressing cellular hypertrophy while promoting type I collagen and aggrecan expression in mesenchymal stem cells from osteoarthritis patients. We then hypothesized that these surfaces would form an ideal substrate on which the nucleus pulposus (NP) phenotype would be maintained. Recent evidence using microarrays showed that in young rats, the relative mRNA levels of glypican-3 (GPC3) and pleiotrophin binding factor (PTN) were significantly higher in nucleus pulposus (NP) compared to annulus fibrosus (AF) and articular cartilage. Furthermore, vimentin (VIM) mRNA levels were higher in NP versus articular cartilage. In contrast, the levels of expression of cartilage oligomeric matrix protein (COMP) and matrix gla protein precursor (MGP) were lower in NP compared to articular cartilage. The objective of this study was to compare the expression profiles of these genes in NP cells from fetal bovine lumbar discs when cultured on either commercial polystyrene (PS) tissue culture dishes or on PPE:N with time. We found that the expression of these genes varies with the concentration of N ([N]). More specifically, the expression of several genes of NP was sensitive to [N], with a decrease of GPC3, VIM, PTN, and MGP in function of decreasing [N]. The expression of aggrecan, collagen type I, and collagen type II was also studied: no significant differences were observed in the cells on different surfaces with different culture time. The results support the concept that PPE:N may be a suitable scaffold for the culture of NP cells. Further studies are however necessary to better understand their effects on cellular phenotypes

Inflammation-Associated Nitrotyrosination Affects TCR Recognition through Reduced Stability and Alteration of the Molecular Surface of the MHC Complex

Nitrotyrosination of proteins, a hallmark of inflammation, may result in the production of MHC-restricted neoantigens that can be recognized by T cells and bypass the constraints of immunological self-tolerance. Here we biochemically and structurally assessed how nitrotyrosination of the lymphocytic choriomeningitis virus (LCMV)-associated immunodominant MHC class I-restricted epitopes gp33 and gp34 alters T cell recognition in the context of both H-2Db and H-2Kb. Comparative analysis of the crystal structures of H-2Kb/gp34 and H-2Kb/NY-gp34 demonstrated that nitrotyrosination of p3Y in gp34 abrogates a hydrogen bond interaction formed with the H-2Kb residue E152. As a consequence the conformation of the TCR-interacting E152 was profoundly altered in H-2Kb/NY-gp34 when compared to H-2Kb/gp34, thereby modifying the surface of the nitrotyrosinated MHC complex. Furthermore, nitrotyrosination of gp34 resulted in structural over-packing, straining the overall conformation and considerably reducing the stability of the H-2Kb/NY-gp34 MHC complex when compared to H-2Kb/gp34. Our structural analysis also indicates that nitrotyrosination of the main TCR-interacting residue p4Y in gp33 abrogates recognition of H-2Db/gp33-NY complexes by H-2Db/gp33-specific T cells through sterical hindrance. In conclusion, this study provides the first structural and biochemical evidence for how MHC class I-restricted nitrotyrosinated neoantigens may enable viral escape and break immune tolerance