The effect of glucosamine sulphate on osteoarthritis: design of a long-term randomised clinical trial [ISRCTN54513166]

BACKGROUND: Pharmacological treatment for osteoarthritis (OA) can be divided into two groups: symptom-modifying drugs and disease-modifying drugs. Symptom-modifying drugs are currently the prescription of choice for patients with OA, as disease-modifying drugs are not yet available in usual care. However, there has recently been a lot of debate about glucosamine sulphate (GS), a biological agent that is thought to have both symptom-modifying and disease-modifying properties. This assumption has yet to be proved. The objective of this article is to present the design of a blind randomised clinical trial that examines the long-term symptom-modifying and disease-modifying effectiveness of GS in patients with hip OA. This trial is ongoing and will finish in March 2006. METHODS/DESIGN: Patients with hip OA meeting the ACR-criteria are randomly allocated to either 1500 mg of oral GS or placebo for the duration of two years. The primary outcome measures, which are joint space narrowing (JSN), and change in the pain and function score of the Western Ontario McMaster Universities Osteoarthritis index (WOMAC), are determined at baseline and after two years of follow-up during the final assessment. Intermediate measures at three-month intervals throughout the trial are used to study secondary outcome measures. Secondary outcome measures are changes in WOMAC stiffness score, quality of life, medical consumption, side effects and differences in biomarker CTX-II

Costs and effectiveness of a brief MRI examination of patients with acute knee injury

The aim of this study was to assess the costs and effectiveness of selective short magnetic resonance imaging (MRI) in patients with acute knee injury. A model was developed to evaluate the selective use of MRI in patients with acute knee injury and no fracture on radiography based on the results of a trial in which 208 patients were randomized between radiography only and radiography plus MRI. We analyzed medical (diagnostic and therapeutic) costs, quality of life, duration of diagnostic workup, number of additional diagnostic examinations, time absent from work, and time to convalescence during a 6-month follow-up period. Quality of life was lowest (EuroQol at 6 weeks 0.61 (95% CI 0.54–0.67)); duration of diagnostic workup, absence from work, and time to convalescence were longest; and the number of diagnostic examinations was largest with radiography only. These outcomes were more favorable for both MRI strategies (EuroQol at 6 weeks 0.72 (95% CI 0.67–0.77) for both). Mean total costs were 2,593 euros (95% CI 1,815–3,372) with radiography only, 2,116 euros (95% CI 1,488–2,743) with radiography plus MRI, and 1,973 euros (95% CI 1,401–2,543) with selective MRI. The results suggest that selective use of a short MRI examination saves costs and potentially increases effectiveness in patients with acute knee injury without a fracture on radiography

Assessment of a failed (Painful?) total joint arthroplasty

Total joint arthroplasty (TJA) has provided, to patients with end stage major joint arthritis, reliable painless range of movement and functional recovery which can last for more than 15 years [1]. However, the majority of these artificial joints will eventually fail for various reasons, in a variety of failure patterns [2], and revision surgery becomes necessary. The lifetime of a TJA can be divided into three phases: the initial months during which the implant must become rigidly fixed (early stable phase) and the remainder of the implant's life, during which fixation may either be maintained (late stable phase) or lost (late unstable phase). An early unstable phase may also be seen, although infrequently these days, due mainly to errors of surgical technique. Orthopedic surgeons often face the question of how they can diagnose early loss of interface integrity, material structural failures, and how they can diagnose and treat other painful arthroplasty conditions. It should be realized that certain patterns of TJA failures can remain silent for a long period of time (Fig. 10.1). Regular follow-up examination of even painless and well-functioning TJAs should be organized at dedicated orthopedic centers in order to diagnose problems and failures as early as possible. © 2014 Springer-Verlag London. All rights are reserved

Polymeric hollow fiber membranes for bioartificial organs and tissue engineering applications

Polymeric hollow fiber (HF) membranes are commercially available, i.e. microfiltration and ultrafiltration cartridges or reverse osmosis and gas separation modules, to be applied for separation purposes in industry, for instance to recover valuable raw materials or products, or for the treatment of end-of-pipe wastes to avoid environmental impacts, to regenerate or treat waters for reuse and for the separation of key components or clarification in food and beverage industries. They have also shown important benefits as hemodialyzers, hemodiafiltration or plasma purification devices in patients with liver or kidney damage. The good mass transport properties characterizing the polymeric HFs have opened new research areas of application in the biomedical field, such as the tissue engineering (TE) and the construction of bioartificial organs (BAO). In TE, the HFs act as scaffolds or supports and/or allow high permeance of nutrients and waste removal for cell proliferation and differentiation. In BAO, HFs are used for the fabrication of bio-hybrid constructs that replace the damaged organs of the patient or can be used as in vitro models for therapeutic studies. This review presents the state-of-the-art concerning preparation and application of HFs for TE and BAO and discusses the challenges and future perspectives of the HFs in both field