Morphological study of cartilage cell death in patients affected by osteoarthritis and chondrocalcinosis

The role of chondrocyte death in the pathogenesis of osteoarthritis (OA) has been largely discussed in literature, but its relative contribution is difficult to assess (1). Chondrocyte death, be it apoptotic, necrotic or chondroptotic, has been clearly documented in OA and a certain correlation between the degree of cartilage damage and chondrocyte apoptosis has been demonstrated (2;3). Conversely, the relationship between the different types of cell death and chondrocalcinosis (CC) is still little known, as well as the presence and role of chondroptotic cells. The aim of this research was to compare chondrocyte behavior in the cartilage of osteoarthritic and chondrocalcinotic knees, evaluating the different types of cell death by means of optical and electron microscopy. During total knee replacement surgeries, cartilage specimens of femoral condyle have been withdrawn and their transversal semithin sections, stained with toluidine blue and alizarin solutions, have been investigated by optical microscopy. From the same samples, thin sections were obtained for transmission electron microscopy to evaluate, at high magnification, the specific ultrastructural features of different types of cell death. Cartilage specimens from both conditions revealed a thickness reduction of superficial layer and a high number of empty lacunae in the middle layer. Calcium pyrophosphate crystals appeared in the samples of patients affected by CC. In osteoarthritic cartilage, numerous chondrocytes revealed necrotic features, whereas, in chondrocalcinotic tissue, the middle zone was characterized by morphological patterns suggestive of chondroptosis, such as chromatin condensation mostly localized at the nuclear periphery, mitochondria alterations, a marked increase in endoplasmic reticulum, the presence of a diffuse autophagic component and the extrusion of cellular material into the lacunae. In conclusion, a different distribution of cell death types seems to characterize the intermediate layers of cartilage specimens from patients affected by CC compared to OA

Feasibility, Adherence and Efficacy of Liraglutide Treatment in a Sample of Individuals With Mood Disorders and Obesity

Background: Liraglutide is a once-daily injectable medication approved for the treatment of obesity. Hereby we report the feasibility, adherence and efficacy of liraglutide treatment in a sample of individuals with mood disorders and obesity.Methods and Sample: Twenty-nine patients with Bipolar or Major Depressive Disorder received liraglutide once daily subcutaneously at a dose gradually titrated from 0.6 to 3 mg. All patients were obese and had previously failed multiple healthy lifestyle interventions, including exercise and diet programs. Patients' weight was recorded before liraglutide treatment (T0) and then 1 (T1), 3 (T3), and 6 months (T6) following T0.Results: Mean baseline (T0) weight was 110.54 Kg (±24.95). Compared to baseline, the percentage of weight loss was 3.37% at T1, 7.85% at T3, and 10.20% at T6. Thirty-one percent (n = 9) of patients had no side effects, 34.48% (n = 10) had one, 24.14% (n = 7) had two, and 10.34% (n = 3) had three side effects. All 29 subjects were still on liraglutide at T1; 79.31 and 48.28% were on liraglutide at T3 and T6. No significant relationship was found between liraglutide dose and likelihood to continue the medication. No patient showed a worsening of the psychiatric condition due to liraglutide treatment. Acceptability and satisfaction with treatment were good for the 48% that completed the study.Conclusions: Liraglutide treatment was efficacious, accepted and tolerated by ~50% of our sample, followed up for a period of 180 days. Larger, longer, controlled, prospective studies are warranted

Prevalence and Correlates of Vitamin D Deficiency in a Sample of 290 Inpatients With Mental Illness

Introduction: Vitamin D inadequacy or deficiency (VDID) has been reported in a high percentage of otherwise healthy individuals. Factors that may contribute to the high prevalence of VDID in people with mental disorders include diet low in vitamin D, poor sunlight exposure, decrease in cutaneous vitamin D synthesis, intake of certain medications, poor mobility, excessive alcohol intake, and tobacco smoking. VDID has been correlated to a host of adverse conditions, including rickets, osteoporosis, osteomalacia, muscle diseases, depression, cognitive dysfunction, and even certain cancers.Objectives: The purpose of this study was to report the prevalence and correlates of vitamin D inadequacy in a sample of 290 psychiatric patients admitted to inpatient or day hospital treatment at the University of Siena Medical Center.Methods: We retrospectively evaluated the prevalence of VDID in 290 psychiatric inpatients' medical records during the year 2017 and evaluated the correlates of VDID in patients with mental illness.Results: Two hundred and seventy two out of two hundred and ninety patients (94%) showed VDID. Physical activity and regular diet were positively correlated with vitamin D levels whereas age, tobacco smoking, PTH, alkaline phosphatase levels were negatively correlated. Statistically significant differences were found among smokers and non-smokers in all study groups.Conclusions: VDID was highly prevalent in our sample. In addition to vitamin D supplementation, psychosocial intervention able to promote and help sustain physical activity, appropriate diet, quitting smoking and sensible sun exposure to prevent and treat VDID in patients with mental health should be implemented, tested, and introduced in our clinical practice

The Microbiome: A New Target for Research and Treatment of Schizophrenia and its Resistant Presentations? A Systematic Literature Search and Review

Background: The gastrointestinal system hosts roughly 1,800 distinct phyla and about 40,000 bacterial classes, which are known as microbiota, and which are able to influence the brain. For instance, microbiota can also influence the immune response through the activation of the immune system or through the release of mediators that are able to cross the brain blood barrier or that can interact with other substances that have free access to the brain, such as tryptophan and kynurenic acid, which is a metabolite of tryptophan and which has been involved in the pathogenesis of schizophrenia. Objectives: This paper reviews the possible relationships between microbiome, schizophrenia and treatment resistance. Given the possibility of a role of immune activation and alterations, we also describe the relationship between schizophrenia and immune inflammatory response. Finally, we report on the studies about the use of probiotic and prebiotics in schizophrenia. Methods: Cochrane library and PubMed were searched from the year 2000 to 2018 for publications about microbiome, immune-mediated pathology, schizophrenia and neurodevelopmental disorders. The following search string was used: (microbiome or immune mediated) AND (schizophrenia OR neurodevelopmental disorder). Associated publications were hand-searched from the list of references of the identified papers. A narrative review was also conducted about the use of probiotics and prebiotics in schizophrenia. Results: There exists a close relationship between the central nervous system and the gastrointestinal tract, which makes it likely that there is a relationship between schizophrenia, including its resistant forms, and microbiota. This paper provides a summary of the most important studies that we identified on the topic. Conclusions: Schizophrenia in particular, remain a challenge for researchers and practitioners and the possibility of a role of the microbiome and of immune-mediated pathology should be better explored, not only in animal models but also in clinical trials of agents that are able to alter gut microbiota and possibly influence the mechanisms of gastrointestinal inflammation. Microbiome targeted treatments have not been well-studied yet in patients with mental illness in general, and with schizophrenia in particular. Nonetheless, the field is well worth of being appropriately investigated. Copyright © 2018 Cuomo, Maina, Rosso, Beccarini Crescenzi, Bolognesi, Di Muro, Giordano, Goracci, Neal, Nitti, Pieraccini and Fagiolini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms

Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

Purpose: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. Conclusions: painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. Level of evidence: level I, validating cohort study with good reference standards

Morphological study of cartilage cell death in patients affected by osteoarthritis and chondrocalcinosis.

The role of chondrocyte death in the pathogenesis of osteoarthritis (OA) has been largely discussed in literature, but its relative contribution is difficult to assess (1). Chondrocyte death, be it apoptotic, necrotic or chondroptotic, has been clearly documented in OA and a certain correlation between the degree of cartilage damage and chondrocyte apoptosis has been demonstrated (2;3). Conversely, the relationship between the different types of cell death and chondrocalcinosis (CC) is still little known, as well as the presence and role of chondroptotic cells. The aim of this research was to compare chondrocyte behavior in the cartilage of osteoarthritic and chondrocalcinotic knees, evaluating the different types of cell death by means of optical and electron microscopy. During total knee replacement surgeries, cartilage specimens of femoral condyle have been withdrawn and their transversal semithin sections, stained with toluidine blue and alizarin solutions, have been investigated by optical microscopy. From the same samples, thin sections were obtained for transmission electron microscopy to evaluate, at high magnification, the specific ultrastructural features of different types of cell death. Cartilage specimens from both conditions revealed a thickness reduction of superficial layer and a high number of empty lacunae in the middle layer. Calcium pyrophosphate crystals appeared in the samples of patients affected by CC. In osteoarthritic cartilage, numerous chondrocytes revealed necrotic features, whereas, in chondrocalcinotic tissue, the middle zone was characterized by morphological patterns suggestive of chondroptosis, such as chromatin condensation mostly localized at the nuclear periphery, mitochondria alterations, a marked increase in endoplasmic reticulum, the presence of a diffuse autophagic component and the extrusion of cellular material into the lacunae. In conclusion, a different distribution of cell death types seems to characterize the intermediate layers of cartilage specimens from patients affected by CC compared to OA

Functional treatment in rotator cuff tears: Is it safe and effective? a retrospective comparison with surgical treatment

Background: The aim of this study was to compare rehabilitation protocol and operative treatment in a population of patients with a diagnosis of small to medium rotator cuff tears (≤3 cm), the null hypothesis being that there would been no difference in terms of clinical outcomes and patient’s satisfaction between the rehabilitation protocol and the surgical treatment. Methods: Patients with small to medium supraspinatus tears were retrospectively enrolled in this study and divided in 2 groups: arthroscopic repair (group A, 20 patients) and reinstated (group B, 18 patients). At a mean follow-up of 18 months, both groups underwent clinical (Constant, QuickDash, VAS), dynamometric and ultrasonographic evaluation. Results: In both groups a significant clinical improvement was registered compared to baseline. However, surgical treatment yielded better results in Constant (p=0.004), Quick-Dash (p=0.0012), VAS (p=0.048) and strength evaluation (p=0.0014). In group A the re-tear rate was 10%, while in group B only 11% of increased tear size was registered. Conclusion: At a short term follow-up, the surgical treatment of small to medium supraspinatus tears yielded better clinical outcomes compared to the rehabilitation protocol, with better strength outcomes and 10% re-tear rate. Nevertheless, physiotherapy still offers acceptable results and could be a valuable option in patients not undergoing surgery. Level of evidence: III

Chondroptotic chondrocytes in the loaded area of chondrocalcinotic cartilage: A clinical proposal?

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