The effectiveness of intra-articular injections for knee osteoarthritis: a systematic review and meta-analysis

Introduction: Intra-articular (IA) injections have been used to reduce knee osteoarthritis (OA) pain. However, several side effects following the injections were reported and raised the question of whether IA injections were effective and safe. Hence, this study aimed to identify the most common type of IA injections used in treating knee OA and to determine its effectiveness, duration of pain relief and most common side effects. Methods: Online literature searches on PubMed, Wiley Online Library, and Cochrane Library were performed by using the keywords "intra-articular injection" AND "knee osteoarthritis" OR "knee OA" AND "randomised controlled trial" OR "RCT". Only randomised controlled trial studies that analysed the effects of intra-articular injections for knee OA patients and published in English were included. A total of 2823 articles were identified, 22 full-text articles were assessed, and six articles have been included in this study. National Institutes of Health (NIH) Quality Assessment Tools were used to evaluate the risk of bias in these six articles, and only four articles were included for meta-analysis. Results: The present data showed that intra-articular hyaluronic acid injection was the most common type of IA injection. However, only intra-articular corticosteroid injections (IACI) are effective for knee OA treatment. The pain relief duration provided by each intra-articular injection type varies between 1 month to 6 months. Side effects such as arthralgia and joint swelling were recorded following the administration of IA hyaluronic acid injection and IA stem cell injection, but not in the IACI therapy groups. Conclusion: Although IACI has been shown to reduce pain in patients with knee OA, the long-term consequences of IACI therapy in this population have yet to be confirmed

Subchondral bone plate changes more rapidly than trabecular bone in osteoarthritis

Osteoarthritis (OA) is the most common joint disorder, characterised by focal loss of cartilage and increased subchondral bone remodelling at early OA stages of the disease. We have investigated the temporal and the spatial relationship between bone remodelling in subchondral bone plate (Sbp) and trabecular bone (Tb) in Dunkin Hartley (DH, develop OA early) and the Bristol Strain 2 (BS2, control which develop OA late) guinea pigs. Right tibias were dissected from six male animals of each strain, at 10, 16, 24 and 30 weeks of age. Micro-computed tomography was used to quantify the growth plate thickness (GpTh), subchondral bone plate thickness (SbpTh) and trabecular bone thickness (TbTh), and bone mineral density (BMD) in both Sbp and Tb. The rate of change was calculated for 10–16 weeks, 16–24 weeks and 24–30 weeks. The rate of changes in Sbp and Tb thickness at the earliest time interval (10–16 weeks) were significantly greater in DH guinea pigs than in the growth-matched control strain (BS2). The magnitude of these differences was greater in the medial side than the lateral side (DH: 22.7 and 14.75 µm/week, BS2: 5.63 and 6.67 µm/week, respectively). Similarly, changes in the BMD at the earliest time interval was greater in the DH strain than the BS2, again more pronounced in the disease prone medial compartment (DH: 0.0698 and 0.0372 g/cm3/week, BS2: 0.00457 and 0.00772 g/cm3/week, respectively). These changes observed preceded microscopic and cellular signs of disease as previously reported. The rapid early changes in SbpTh, TbTh, Sbp BMD and Tb BMD in the disease prone DH guinea pigs compared with the BS2 control strain suggest a link to early OA pathology. This is corroborated by the greater relative changes in subchondral bone in the medial compared with the lateral compartment

Prevalence of Computer Vision Syndrome (CVS) and its associated risk factors among IIUM Kuantan Undergraduates

Introduction: Excessive computer use has increased among workers and students, particularly during the COVID-19 pandemic. Computer vision syndrome (CVS) has previously impacted many Malaysian undergraduates. However, International Islamic University Malaysia (IIUM), Kuantan has no prior or current data on CVS among their university students, raising the question of whether students are experiencing CVS symptoms when using computers, particularly during online teaching and learning. Methods: A cross-sectional study was conducted at IIUM Kuantan to determine the prevalence of CVS and its associated risk factors among undergraduates. A convenience sampling method was employed to recruit study participants, and data was collected using a self-administered questionnaire. The prevalence of CVS prevalence was calculated and its association with ergonomics and non-ergonomic risk factors was determined using statistical analysis. Results: The data showed that the CVS prevalence was 69.3%, with a higher prevalence among female and Kulliyyah of Medicine students than other Kulliyyahs. Most CVS cases were classified as mild, with tired eyes (89.9%), neck and shoulder pain (88.7%), and headache (73.4%) among the most reported symptoms. The severity of the CVS symptoms was found to be significantly inversely correlated with ergonomics practices (r= - 0.137, p= 0.034). Conclusion: Despite good ergonomics practices reported by the participants, a weak correlation between these factors raises the question of whether the participants have a correct practice of computer ergonomics. Hence, the present findings suggest that training in good computer ergonomics practices is necessary

Viability and glycosaminoglycan content in chondrocytes transfected with SRY (sex-determining region y)-BOX 9 and telomerase reverse transcriptase genes

Glycosaminoglycan (GAG) is a major component of cartilage matrix. This essential polysaccharide has the capacity to attract water molecules. Such capacity is important in cartilage primarily because it absorbs shock and provides lubrication in joint. Cartilage degeneration is often a normal ageing change. Along the process, the cartilage cell; chondrocyte may become less viable and thus, downregulate GAG production. This study evaluates cell viability and GAG content in chondrocytes using monolayer culture model. Chondrocyte usually loses its phenotype after several replications in culture. Hypothetically, replicative senescence contributes to ageing indirectly. Hence, this study compares SOX9 and/or TERT transfected and non-transfected chondrocytes to see whether or not the cells could remain viable and produce GAG after serial passages. While SOX9 is essential for chondrogenesis, TERT is responsible for cells longevity. Upon research approval (IIUM/IACUC/Approval/2015/[5]/[24]), rabbits’ articular cartilages (n=2) were harvested. Isolated chondrocytes were seeded in 6 well-plate with an initial seeding of 5,000 cells/cm2. At passage-1, the chondrocytes were transfected with SOX9 and/or TERT genes via lipofection. The four groups namely non-transfected (control), SOX9-, TERT- and SOX9/TERT-transfected chondrocytes were evaluated at passage-1, -2 and -3. It can be appreciated that the post-transfected chondrocytes have cells viability and GAG content comparable to that of the non-transfected group. They exhibited similar downregulation pattern for viability and GAG content as postulated in theory of ageing. The viability ranged from the highest 93.43% to the lowest 78.49% throughout the culture. The total GAG contents are 25.23μg/ml, 23.87μg/ml, 21.59μg/ml and 23.86μg/ml for SOX9-, TERT-, SOX9/TERT-post-transfected chondrocytes and control, respectively. While cells viability gives an indication that transfection may have non-toxic effect on cells, this study raises some significant questions whether or not SOX9 and TERT could maintain or enhance chondrocyte properties at structural and ultrastructural levels. Detailed investigations into molecular and protein levels are also needed

Effects of SRY (Sex Determining Region Y)-Box 9 (SOX9) and Telomerase Reverse Transcriptase (TERT) genes transfection in chondrocytes seeded on three-dimensional scaffolds: gross observation and cell proliferation assay

Purpose: To evaluate the formation of in vitro 3D tissue constructs engineered from the SOX9 and TERT genes post-transfected chondrocytes seeded on poly(lactic-co-glycolic acid)(PLGA) based scaffolds. Methods: With the approval of Institutional Animal Care and Use Committee (IACUC,IIUM), the post-transfected rabbits’ chondrocytes were seeded on the prefabricated PLGA with and without fibrin scaffolds. The resulting constructs were cultured for three-week. This experiment setting examined the following groups: (1) non-transfected chondrocytes (control), (2) SOX9-transfected chondrocytes, (3) TERT-transfected chondrocytes and (4) SOX9/TERT-transfected chondrocytes; each seeded on PLGA and PLGA/fibrin scaffolds. All eight groups were evaluated for gross morphology and cells proliferation activity. Results: Grossly, all constructs shrunk in size. The PLGA/fibrin constructs showed a glass-like appearance throughout the culture. The chondrocytes seeded in PLGA/fibrin number showed an increment pattern from day-1 to -21 compared to chondrocytes seeded in PLGA only. The SOX9/TERT-transfected chondrocytes seeded on PLGA/fibrin showed a steadily increased growth pattern comparable to that of control group. Both SOX9 and TERT genes may have synergistic effect in maintaining cell proliferation activity in 3D scaffolds. Overall cellular growth pattern seemed better in PLGA/fibrin than PLGA alone. Besides, PLGA/fibrin constructs exhibited a more stable macroscopic structure throughout the in vitro culture making it a suitable candidate for implantation purpose. Further in vitro study involving construct’s weight, histology analysis, genes expression, biochemical assessments and in vivo implantation are currently underway

Matrix production in chondrocytes transfected with sex determining region Y-Box 9 and telomerase reverse transcriptase genes: an in vitro evaluation from monolayer culture to three-dimensional culture

Background:: This study aimed to observe the cartilaginous matrix production in SRY (sex determining region Y)-box 9 (SOX9)- and/or telomerase reverse transcriptase (TERT)-transfected chondrocytes from monolayer to three-dimensional (3D) culture. Methods:: The genes were transferred into chondrocytes at passage-1 (P1) via lipofection. The post-transfected chondrocytes (SOX9-, TERT- and SOX9/TERT) were analysed at P1, P2 and P3. The non-transfected group was used as control. The 3D culture was established using the chondrocytes seeded in a disc-shaped PLGA/fibrin and PLGA scaffolds. The resulting 3D “cells-scaffolds” constructs were analysed at week-1, -2 and -3. The histoarchitecture was evaluated using haematoxylin and eosin, alcian blue and safranin o stains. The quantitative sulphated glycosaminoglycan (sGAG) content was measured using biochemical assay. The cartilage-specific markers expression were analysed via real-time polymerase chain reaction. Results:: All monolayer cultured chondrocytes showed flattened, fibroblast-like appearance throughout passages. Proteoglycan and sGAG were not detected at the pericellular matrix region of the chondrocytes. The sGAG content assay indicated the matrix production depletion in the culture. The cartilage-specific markers, COL2A1 and ACAN, were downregulated. However, the dedifferentiation marker, COL1A1 was upregulated. In 3D “cells-scaffolds” constructs, regardless of transfection groups, chondrocytes seeded in PLGA/fibrin showed a more uniform distribution and produced denser matrix than the PLGA group especially at week-3. Both sGAG and proteoglycan were clearly visualised in the constructs, supported by the increment of sGAG content, quantitatively. Both COL2A1 and ACAN were upregulated in SOX9/TERT-PLGA and SOX9/TERT-PLGA/fibrin respectively. While, COL1A1 was downregulated in SOX9/TERT-PLGA. Conclusion:: These findings indicated that the SOX9/TERT-transfected chondrocytes incorporation into 3D scaffolds facilitates the cartilage regeneration which is viable structurally and functionally. © 2019, The Korean Tissue Engineering and Regenerative Medicine Society

Virtual reality in anatomy education: advantages and challenges

Introduction: Anatomy education has evolved throughout the centuries. In the latest decade, anatomy educators encountered different challenges from limited number of cadavers, high-priced anatomical plastination and models. Recent COVID-19 pandemic has inevitably mold future anatomy pedagogy to better-adapt with the current digital-savvy generation. Despite the emergence of virtual reality (VR) in anatomy teaching & learning (T&L), there is limited comparative analysis being explored. Hence, this study aims to elucidate the advantages and challenges using VR in anatomy education. Methods: A narrative review was conducted for this study. Research question was formulated and bibliographical search performed using Scopus and Science Direct databases. Experimental studies published between 2010-2022, in English language, discussing on application, advantages or disadvantages of VR in anatomy and medical T&L were analysed. Results: A total of twenty-four research articles were retrieved. The literatures suggest VR in anatomy education is beneficial as it is more realistic, hands-on, enhances visualization and enjoyable self-learning tool that increases leaners’ engagement. This is especially in low-spatial ability learners that has difficulty to visualize the location and dimension of anatomical structures. VR may improve teaching effectiveness and level of anatomy knowledge. However, the disadvantages are high-cost equipment and risk of tools malfunction. Some experiencing extraneous cognitive load in learning new modalities, motion-sickness, and headache after using VR headgear. Conclusion: The advantages of VR in anatomy education are extensive and outweigh the challenges. As VR devices are more affordable, the current challenge has moved to exploring ways to utilize this advancement in anatomy teaching effectively

Malay medicinal knowledge on a nipah-leaf (Nypa fruiticans) manuscript: a descriptive study

Numerous Malay medical manuscripts have been discovered in the collections of libraries such as national libraries, institutions such as museums, and personal collection of old texts. These valuable resources have brought new light to the study of science and literature of the Malays particularly in the field of medicine. Amongst these collections, one medical text which belongs to the Islamic Arts Museum Malaysia in Kuala Lumpur is considered a remarkably unique text as it is written on a nipah-leaf (Nypa fruticans) material. A case as such is unusual considering the common material used in other discovered Malay medical manuscripts is paper. We present here a descriptive study of the manuscript, coded IAMM 1998.1.3370. This is a complete text that ends with a colophon supplying the name of the author, and date of writing. The manuscript contained interventions and prescriptions for numerous health problems (n=79) such as diabetes, malaria, and others. It was prepared as a book form by stitching several nipah leaves together to form several cut square pages bound with a cloth. Nasakh calligraphy was used and the text was written using black and red inks with the latter used to indicate a shift to a new topic. The manuscript is in a dilapidated condition due to several factors such as age, and material used. Considering the valuable information in the manuscript, there is a necessity for the preservation and conservation of this manuscript before the content is lost forever

The cartilaginous tissue formation using sry (Sex Determining Region Y)-BOX9 and telomerase reverse transcriptase genes transfected chondrocytes: in vivo approach

The shortage of organ supply reduces the success rate of organ transplantation. Hence, tissue regeneration has been initiated with the intention of improving the available treatment modalities. Articular cartilage is a suitable tissue for this purpose due to its limited self-heal ability. This study aims to evaluate the cartilaginous properties of in vivo constructs formed using chondrocytes transfected with the combination of sry (sex determining region y)-box9 (SOX9) and telomerase reverse transcriptase (TERT) genes (SOX9/TERT-transfected chondrocytes) seeded on a three-dimensional (3D) poly(lactic-co-glycolic) acid (PLGA)-based scaffold. The rabbit’s articular chondrocytes (n=6) were transfected with SOX9 and TERT genes via lipofection. The non-transfected chondrocyte (NTC) was used as a control. A total of 1×105 cells were seeded on a PLGA and PLGA/fibrin hybrid scaffolds to form constructs. The resulted constructs were SOX9/TERT-PLGA/fibrin, NTC-PLGA/fibrin, SOX9/TERT-PLGA and, NTC-PLGA. All constructs were cultured for three weeks prior to subcutaneous implantation into the athymic mice for two and four weeks. The constructs’ structural and functional aspects were evaluated using macroscopic observation, compression-stress analysis, histology, quantitative sulphated glycosaminoglycan (sGAG) assay and cartilage-specific genes (ACAN, COL2A1, SOX9), TERT, and MMP13 expression analysis. The constructs demonstrated a cartilage-like appearance. The constructs’ rigidity corresponded to the homogenous cells and extracellular matrix distribution in the week-4 constructs. Correspondingly, the cartilaginous matrix components were visualised at the pericellular matrix region of the construct, supported by the increment of quantitative sGAG content. The SOX9/TERT-PLGA/fibrin exhibited better genes expression and cartilaginous phenotypes than the other construct groups. The SOX9/TERT-PLGA/fibrin construct facilitated cartilaginous tissue formation

Stereological analysis of heart ventricles during the development of osteoarthritis in Dunkin Hartley Guinea Pigs

Introduction: Osteoarthritis (OA) was attributed to mobility issues which implicate an increased workload of the heart. This imposed greater stress on the ventricular wall, resulting in a maladaptive reaction known as left ventricular hypertrophy (LVH). Previous studies suggested that OA patients are susceptible to developing cardiovascular diseases, but its association with LVH is not yet established. Therefore, the present study aims to determine changes in nucleus diameter and ventricular cardiomyocytes’ density along with the morphology of the heart ventricles during the development of OA in Dunkin Hartley (DH) guinea pigs. Methods: The histological images of the DH knee joint were taken at 10, 20 and 30 weeks old and were assessed on the degree of articular cartilage degeneration using Osteoarthritis Research Society International (OARSI) scoring. The stereology method was used to determine the nucleus diameter (ND), cardiomyocytes’ density (CD), the ventricles wall’s thickness (VT) and volume of the ventricular chamber (VV). Results: The result showed that the severity of OA increased as DH grew old. Across the time points, ND, CD and VV chamber increase at the left and right ventricles, whereas VT increases only in the left ventricular chamber (p0.05). Conclusion: Since this preliminary study indicates the possibility that LVH is present in OA individuals it is suggested that further investigation should be conducted