Response of human engineered cartilage based on articular or nasal chondrocytes to interleukin-1? and low oxygen

Previous studies showed that human nasal chondrocytes (HNC) exhibit higher proliferation and chondrogenic capacity as compared to human articular chondrocytes (HAC). To consider HNC as a relevant alternative cell source for the repair of articular cartilage defects it is necessary to test how these cells react when exposed to environmental factors typical of an injured joint. We thus aimed this study at investigating the responses of HNC and HAC to exposure to interleukin (IL)-1? and low oxygen. For this purpose HAC and HNC harvested from the same donors (N=5) were expanded in vitro and then cultured in pellets or collagen-based scaffolds at standard (19%) or low oxygen (5%) conditions. Resulting tissues were analyzed after a short (3 days) exposure to IL-1?, mimicking the initially inflammatory implantation site, or following a recovery time (1 or 2 weeks for pellets and scaffolds, respectively). After IL-1? treatment, constructs generated by both HAC and HNC displayed a transient loss of GAG (up to 21.8% and 36.8%, respectively) and, consistently, an increased production of metalloproteases (MMP)-1 and -13. Collagen type II and the cryptic fragment of aggrecan (DIPEN), both evaluated immunohistochemically, displayed a trend consistent with GAG and MMPs production. HNC-based constructs exhibited a more efficient recovery upon IL-1? withdrawal, resulting in a higher accumulation of GAG (up to 2.6-fold) compared to the corresponding HAC-based tissues. On the other hand, HAC displayed a positive response to low oxygen culture, while HNC were only slightly affected by oxygen percentage. Collectively, under the conditions tested mimicking the postsurgery articular environment, HNC retained a tissue-forming capacity, similar or even better than HAC. These results represent a step forward in validating HNC as a cell source for cartilage tissue engineering strategies

Epidemiologie en behandeling van acute Charcot voet: prospectieve follow-up studie van 62 patiënten uit de IKED-Voet studie

&lt;p&gt;Aim:&lt;br&gt; This study aims to analyze the actual circumstances in which Charcot foot occurs and how it is managed in Belgium. Emphasis was placed on epidemiological data and data about the management.&lt;br&gt; Method:&lt;br&gt; Thirty-four diabetic foot clinics sampled the first 52 patients presenting with diabetic foot problems, resulting in a total of 1782 cases in 2014. 62 cases were registered as acute Charcot foot and followed up to a maximum of seven months in terms of treatment and outcome. Data were collected in the context of the IQED-Foot study. The data were stratified in 2 different ways, after which analysis was performed.&lt;br&gt; Results:&lt;br&gt; The prevalence of an ulcer at first visit was significantly higher in case deformation was present (58% vs. 18%, P&amp;lt;0.05). The occurrence of new wounds at the fulcrum of the deformity during follow-up was significantly higher in the group with wounds at first visit (56% vs. 11%, P&amp;lt;0.05). Considering treatment, the use of immobilization of the foot was significantly higher in the group of patients without wounds at the first visit (100% vs. 85%, P&amp;lt;0.05).&lt;br&gt; Conclusion:&lt;br&gt; The prevalence of acute Charcot foot in a population of patients with diabetic foot problems was 3.5%, which is similar to the incidence (0.1% to 8%) reported in the literature. The presence of wounds and deformation proved to be significantly and positively associated at time of the first visit. Furthermore, new wounds preferentially occurred at the fulcrum of the deformity of the acute Charcot foot.&lt;/p&gt;</p

Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Item does not contain fulltextBACKGROUND: Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found. The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity. METHODS: Patients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36. RESULTS: Twenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported. CONCLUSIONS: This randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores

Deformation at first presentation is associated with ulceration in active Charcot foot: a prospective follow-up study of 62 patients of the IQED-Foot study

&lt;p&gt;&lt;strong&gt;Aim:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Charcot foot is a rare but devastating complication of diabetes. We aimed to get a clear picture of the actual circumstances in which Charcot foot occurs and how it is managed. Emphasis was placed on epidemiological data (age at occurrence, diabetes duration, side of Charcot foot,…) and data about management (time to diagnosis, deformation present at diagnosis, method of immobilization).&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Thirty-four multidisciplinary diabetic foot clinics in Belgium prospectively registered 62 cases with acute Charcot foot in 2014 and followed them for up to six months in terms of treatment and outcome. Data were collected for the purpose of quality-of-care monitoring. The data set was split in 2 different ways, after which analysis was performed. In a first phase, the data set was split in a subgroup ‘acute Charcot foot with wound at presentation (N=27)’ and a subgroup ‘acute Charcot foot without wound at presentation (N=35)’. In a second phase, the data set was split in a subgroup ‘acute Charcot foot with deformation at presentation (N= 40)’ and a subgroup ‘acute Charcot foot without deformation at presentation (N=22)’&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results /Discussion:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;The prevalence of deformation at first visit was significantly higher in case a wound was already present (85,2% vs. 48,6%, P&amp;lt;0,05). The occurrence of new wounds located at the fulcrum of the deformity causing a pressure point during follow-up was significantly higher in the group of patients with wounds at the first visit (55,6% vs. 11,4%, P&amp;lt;0,05). This was also the case for the occurrence of new wounds outside the pressure point (25,9% vs. 0%, P&amp;lt;0,05). Considering treatment, the use of immobilization of the foot was significantly higher in the group of patients without wounds at the first visit (100% vs. 85,2%, P&amp;lt;0,05). Considering the split in groups with or without deformation at first visit, the only significant difference between the two groups, was the higher prevalence of wounds at the first visit in the group with deformation (57,5% vs. 18,2%, P&amp;lt;0,05).&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;The presence of wounds and deformation proved to be significantly and positively associated at time of the first visit. Furthermore, new wounds preferentially occurred at the fulcrum of the deformity of the Charcot foot by causing a pressure point. The weakness of this study is the low number of patients that is probably responsible for the lack of other significant differences between the groups.&lt;/p&gt;</p

Declining offloading rates in Belgian Recognized Diabetic Foot Clinics (RDFC): results from an audit-feedback quality improvement initiative.

&lt;p&gt;&lt;strong&gt;Aim:&lt;/strong&gt; To evaluate how DFU (Diabetic Foot Ulcer) are offloaded in RDFC and the evolution over time. RDFC receive their results after each audit for benchmarking (IQED-Foot project).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt; Comparison of offloading methods used in 2 audits (2011 and 2013/14). Audits characteristics are described in table 1. In each audit, RDFC registered the first 52 diabetic patients over a 1-year period with a “new” foot problem: DFU of Wagner grade 2 or more and/or active Charcot foot (table 2). Off-loading was categorized as follows: 1. &lt;strong&gt;knee-high device&lt;/strong&gt;, removable or not (TCC, Diabetic walkers...), 2 ankle-high &lt;strong&gt;shoe&lt;/strong&gt; or cast shoe, 3. &lt;strong&gt;other&lt;/strong&gt; off-loading techniques around the ulcer (felt, orthoses). 4. &lt;strong&gt;No off-loading&lt;/strong&gt;. In case of multiple means of off-loading, the most elaborate one was selected.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results /Discussion:&lt;/strong&gt; Population characteristics in 2013/14 are described in table 3. For plantar ulcers, the overall offloading rate diminished significantly between 2011 and 2013/14, from 84.6% to 76.3% (P=0.01). A non-significant decrease was observed in the use of shoes (42.3 and 34.7% in 2011 and 2013/14 respectively, P&amp;gt;0.05), and no decrease in knee-high off-loading (14.8 and 14.7%) and other off-loading techniques (24.8 and 23.4%). For dorsal ulcers, &amp;nbsp;the overall off-loading rates were lower and the decline between 2011 and 2013/14 more pronounced (73.1 and 53.7%, P&amp;lt;0.001), affecting both ankle-high off-loading (31.1 and 21.9%, P=0.02) and other off-loading techniques (30.4 and 19.9%, P=0.02), but not knee-high off-loading (7.0 and 8.1%).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Periodical audits in Belgian Recognized Diabetic Foot Clinics have shown a decline in offloading rates. The percentage of patients without any offloading device is increasing. Audit and feedback including non-public anonymous benchmarking has not been able to prevent this decline. Knowing that offloading is the cornerstone of DFU treatment these results are worrying, although overall off-loading rates were comparable to those reported in Eurodiale. Efforts are needed to understand and tackle the barriers towards a correct application of gold standard offloading techniques.&lt;/p&gt;</p

Diminution du taux de décharge des plaies dans les Cliniques du Pied Diabétique Reconnues Belges (CPDRB): résultats d&#039;audits réalisés dans le cadre d&#039;un programme d&#039;audit-feedback mis en place pour améliorer la qualité des soins

&lt;p&gt;&lt;strong&gt;But: &lt;/strong&gt;Evaluer comment les (Ulcères du Pied Diabétique) UPD sont déchargés dans les CPDRB et l’évolution de la décharge au cours du temps. Les CPDRB reçoivent leurs résultats après chaque audit pour analyse comparative (IQED-Foot projet).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Méthode:&lt;/strong&gt; Comparer les méthodes de décharge utilisées lors de 2 audits (2011et 2013/14). Les caractéristiques des audits sont décrites dans le tableau 1. Pour chaque audit, la CPDRB enregistre les 52 premiers patients diabétiques souffrant d’un “nouveau” problème au pied vus sur un an: les UPD de grade Wagner 2 ou supérieur et/ou les pieds de Charcot actif (tableau 2). La décharge est définie comme suit: 1. &lt;strong&gt;Appareillage remontant jusqu’au genou&lt;/strong&gt;, amovible ou non (TCC, Diabétique Walker...), 2 Les chaussures ou plâtres montant jusqu’à la cheville, 3. Les autres techniques de décharge autour de l’ulcère (feutre, orthoplasties...). 4. &lt;strong&gt;L’absence de décharge.&lt;/strong&gt; Si plusieurs moyens de décharge sont utilisés, le plus sophistiqué est sélectionné.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Résultats /Discussion:&lt;/strong&gt; Les caractéristiques de la population de l’audit 2013/14 sont décrites dans le tableau 3. Pour les ulcères plantaires, le taux de décharge diminue significativement entre 2011 et 2013/14, de 84.6% à 76.3% (P=0.01). Une diminution non significative est observée pour l’utilisation des chaussures (42.3 et 34.7% en 2011 et 2013/14 respectivement, P&amp;gt;0.05), aucune diminution n’est notée pour les appareillages remontant jusqu’au genou (14.8 et 14.7%) ni pour les autres techniques de décharge (24.8 et 23.4%). Pour les ulcères dorsaux, &amp;nbsp;le taux global de décharge est inférieur et la diminution entre 2011 et 2013/14 plus nette (73.1 et 53.7%, P&amp;lt;0.001), touchant les chaussures ou plâtres montant jusqu’à la cheville (31.1 et 21.9%, P=0.02) et les autres techniques de décharge (30.4 et 19.9%, P=0.02), mais pas les &lt;strong&gt;appareillages remontant jusqu’au genou&lt;/strong&gt; (7.0 et 8.1%).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Les audits réguliers des Cliniques du Pied Diabétique Reconnues Belges montrent une diminution du taux d’utilisation de la décharge. Le pourcentage de patients ne recevant aucun moyen de décharge augmente. Les audits et les feedback comprenant une analyse comparative anonymes n’ont pas pu prévenir ce déclin. Sachant que la décharge est la pierre angulaire du traitement des UPD ces résultats sont inquiétants, même si les taux globaux de décharge sont comparables à ceux de l’étude Eurodiale. Des efforts sont nécessaires pour comprendre et dépasser les barrières qui empêchent l&#039;application correcte des « gold standard » des techniques de décharge.&lt;/p&gt;</p

Management and 6-month outcome of patients with diabetic foot problems: results from a nationwide quality improvement initiative between 2005 and 2014

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; We describe the implementation and results of an audit-feedback quality improvement (QI) initiative in Belgian diabetic foot clinics (DFCs).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Using self-developed software and questionnaires, DFCs (N=35) collected data in 2005, 2008, 2011 and 2014, covering characteristics, history, and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥2 diabetic foot ulcer (DFU) or acute Charcot foot that year. QI was encouraged by meetings and by anonymous benchmarking of DFCs.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness.&lt;/p&gt; &lt;p&gt;In total, 5,510 episodes were sampled between 2005 and 2014 (5,407 DFUs and 183 acute Charcot feet). Median age was 69 years, median diabetes duration was 14 years, 91% had type 2 diabetes, 65% were male and 48% had renal insufficiency, end-stage renal disease or a prior major cardiovascular event. Fifty-two percent of DFUs were plantar and 26% were both ischemic and deeply infected. Management of DFUs varied between DFCs: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%) and 42% of ischemic limbs were revascularized (P10-P90: 22-69%) in 2011. Ulcer healing rate at 6 months was 50% and did not change significantly over time. Major amputation as a first event during the 6-month follow-up declined from 3.5% in 2008 to 2.6% in 2014, but this was paralleled by an increase in death as a first event from 3.3% to 5.2%.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A unique, nationwide QI initiative was established among DFCs, covering ulcer healing, lower-limb amputation and many other aspects of diabetic foot care. The cyclical audits and feedback allow DFCs to focus their QI efforts. Clear nationwide gains in care quality have not been documented between 2005 and 2014, although the short-term outcomes are good for a population with deep DFUs and high comorbidity burden.&lt;/p&gt;</p