Moderate to Severe Osteoarthritis: What is the Economic Burden for Patients and the Health Care System? Insights from the "PONOS" Study.

OBJECTIVE: To assess the economic burden of moderate to severe osteoarthritis (OA) management for patients and the health care system in Greece. DESIGN: A noninterventional, cross-sectional, prospective, epidemiological analysis of data from the medical records of patients with moderate to severe OA, recruited in a single visit from 9 sites in Greece. Outcomes included health care resource use (direct/indirect costs) associated with this patient population. RESULTS: A total of 164 patients were included in the analysis: mean age was 70.5 years, and the majority of participants were females (78.7%). The presence of comorbidities was reported by 87.2% of patients, with hypertension being the most frequently reported (53.7%). Paracetamol was the most commonly used analgesic treatment (96%), followed by systemic nonsteroidal anti-inflammatory drugs (NSAIDs) (75%) and opioids (50%). The mean overall annual direct costs per patient was estimated at 1,675.3€, with approximately half incurred by the National Health Insurance Fund, whereas the mean overall annual indirect cost (absenteeism of patients and informal caregivers) was estimated at 3,501.4€. Joint replacement (JR) procedures and paid care were the major drivers of annual direct costs in this patient population (4,326.3€ and 9,360.0€, respectively). CONCLUSIONS: This real-world analysis of direct and indirect costs confirmed the substantial economic burden imposed by moderate to severe OA to the health care system and the patients. Our findings emphasize the need for interventions to enhance disease management, to improve patients' health outcomes and reduce the global burden of OA on society.

The impact of moderate to severe osteoarthritis on the physical performance and quality of life: a cross-sectional study in Greek patients (PONOS study).

BACKGROUND: Osteoarthritis (OA) represents a leading cause of disability with limited data available for the Greek patients. OBJECTIVES: To evaluate the impact of moderate to severe symptomatic hip/knee OA under treatment on physical performance and quality of life. METHODS: A non-interventional, cross-sectional, epidemiological study of patients with moderate/severe OA, recruited in a single visit from 9 expert sites in Athens, Greece. Assessments were based on commonly used outcome scales: the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol-5-Dimensions 3-levels questionnaire (EQ-5D-3L). RESULTS: One hundred sixty-four patients were included in the analysis. Most of the patients were females (78.7%), with a mean age of 70.5 ± 10.2 years. Comorbidities were reported by 87.2% of patients with hypertension being the most frequently reported (53.7%), followed by dyslipidemia (31.1%), obesity (24.4%) and diabetes mellitus (23.2%). Paracetamol was the most common treatment (96%), followed by NSAIDs (75%), opioids (50%) and locally applied medications (42.7%). Both hip and knee OA patients showed substantial deterioration in health-related quality of life (QoL) and health status as reflected by the HOOS/KOOS (Function in sport and recreation was the most impaired subscale, followed by Hip- or Knee-related QoL). The mean EQ-5D-3L index score was 0.396 ± 0.319 and the mean EQ-VAS score was 52.1 ± 1.9. When compared indirectly to the local population norms our OA population had worse QoL indices. CONCLUSION: Our findings suggest the functional disability and impaired QoL of Greek patients with moderate/severe hip/knee OA under treatment emphasizing the need for novel treatments that will reduce the burden of the disease.

Relationship between obesity index and cardiovascular risk in primary care patients on Crete, Greece: a data driven sub-analysis.

BACKGROUND: The present sub-analysis aimed to examine the relationship between obesity index and cardiovascular risk among primary care attendees. STUDY DESIGN: Stratified random sampling was previously used to recruit general practitioners, practicing on Crete island, Greece, whose patients were then enrolled. METHODS: Initial sample included 815 primary care attendees (55.7% women; mean age 65.2 years; range 40-98 years). Due to missing values regarding 13 participants, data from 802 patients were included for the current analysis. Body measurements (weight, height), among other bio-clinical parameters, were recorded upon practice visit. The 10-year cardiovascular disease risk was estimated using the European Society of Cardiology (and other societies), 10-year Systematic Coronary Risk Estimation and multivariate linear regression was used to assess relationships between Obesity Index and cardiovascular disease risk. RESULTS: Higher risk is shown to be significantly related with male gender, older age, unemployed/retired status, urban area of living or smoking (p<0.05), as well as with higher levels of obesity index (stand. beta=0.048, p=0.028). CONCLUSIONS: Obesity Index may be useful for cardiovascular disease risk prediction and correction at the primary care settings, since obesity is easily addressed during the first medical contact.

A 'Cut-Down-To-Stop' intervention for smokers who find it hard to quit: a qualitative evaluation.

BACKGROUND: English Stop Smoking Services primarily deliver behavioural interventions to support abrupt quit attempts. Recent evidence suggests an alternative approach could be offered to clients involving a more gradual reduction of cigarettes smoked leading to complete abstinence, known as 'Cut Down To Stop' (CDTS). The purpose of this study was to explore the experiences of stop smoking practitioners and service users who participated in a pilot study of a CDTS service. METHODS: The CDTS intervention was pilot tested in a Stop Smoking Service in London, England. As part of the CDTS intervention clients who were still smoking 2 weeks after their quit date were offered tailored advice, medication and support to reduce their current smoking by half, with the aim to stop smoking altogether within a six-month period. A qualitative evaluation was conducted involving a focus group discussion with nine practitioners involved in the delivery of the CDTS intervention and telephone interviews with 18 CDTS service users. Thematic analysis was performed. RESULTS: Service users and practitioners were very positive about their experience with the CDTS intervention. The intervention was found to be an effective way of keeping clients engaged with the service and was felt to increase the likelihood they might quit and/or re-engage in service for future quit attempts. Elements that contributed to the attractiveness of the CDTS intervention included: 1) the trust and empathetic relationship developed between service users, practitioners and their referring primary care provider; 2) time and flexibility for service users to engage in the quitting process at their own pace; 3) setting progressive goals and building service user confidence; 4) the opportunity to experiment with quit smoking medications; and, 5) the on-going contact with the practitioner/service. CONCLUSIONS: Service users who are not successful with quitting abruptly may benefit from a CDTS intervention. This study highlights the important role of 'relationships', time and 'flexible' service delivery models in engaging service users who are not initially successful with quitting. The findings of this study have the potential to inform decision-making regarding the value of the CDTS approach for the English Stop Smoking Service and cessation services worldwide.

Microsecond-resolved SDR-based cavity ring down ellipsometry.

We present an experimental apparatus that allows microsecond-resolved ellipsometric and absorption measurements. The apparatus is based on an optical cavity containing a Dove prism, in which light undergoes total internal reflection (TIR), while the data acquisition is based on software defined radio technology and custom-built drivers. We demonstrate the ability to sense rapid variations in the refractive index above the TIR interface for arbitrarily long times with a temporal resolution of at least 2 µs.

A novel surgical tool for the revision hip arthroplasty due to neck stem's fracture.

During revision surgery of total hip arthroplasties, surgeons may come across the challenging complication of a proximally fractured femoral stem, which however maintains sufficient distal fixation. Such cases, although rare, are extremely demanding due to lack of available attachments that would assist surgical explantation of the broken implant. It is herein presented a metal sterilisable surgical tool designed for the removal of the femoral stem broken at the level of the "neck". Hippokratia 2015; 19 (4): 352-355.

Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site.

OBJECTIVE: The use of peripherally inserted central venous catheters (PICC lines) has reduced the mortality and morbidity of premature newborns. The usual sites of insertion are the veins in the upper arms but other locations are being used as well. STUDY DESIGN: To examine whether using the axillary vein as a site of insertion of a PICC line affects the frequency of complications. Our study has a clinical trial design. A total of 62 neonates that had a PICC line inserted were recruited and randomly divided equally in two groups: in Group A (mean birth weight, standard deviation (s.d.)=1353 (142) g), the PICC line was inserted through the axillary vein, and in Group B (birth weight=1308 (112) g), the PICC line was inserted in other sites further from the axillary vein. The outcomes measured were the total PICC line-related complications, the reason for removing the catheter, the number of total attempts until successful insertion and the mean duration of stay of the catheter. The likelihood of having an adverse outcome was assessed with Mantel-Haenszel odds ratio (OR). RESULTS: Premature neonates with axillary PICC lines were 12 times less likely to have line-related complications (inflammation, blockage, edema, infection) as compared with any other site of insertion (OR= 95%, confidence interval (CI)=0.10 (0.01 to 0.8)) and they were seven times more likely to have the PICC line removed because they achieved full enteral nutrition as compared with the other causes (OR 95%, confidence interval (CI)=10.35 (4.88 to 21.96)). There was no statistical difference between the two groups in the number of attempts until successful PICC line insertion (P=0.667) and the mean duration of stay of the PICC line (P=0.97). CONCLUSION: The use of the axillary vein as a site of insertion of a PICC line was correlated with significantly less complications in premature newborns as opposed to the other sites of insertion.

Aspectos microbiológicos de la actinomicosis periapical: revisión de la literatura / Microbiological aspect of periapical actinomycosis

La Actinomicosis Periapical es una lesión asociada con infecciones producidas por especies de Actinomyces y se ha considerado un factor en la perpetuación de las radiolucencias periapicales después de los tratamientos endodóncicos. El objetivo de esta revisión es dar a conocer la frecuencia de especies de Actinomices en la Actinomicosis Periapical...

Periapical Actinomycosis is a periapical lesion associated with infections caused by Actinomyces species and has been considered a contributing factor in the perpetuation of periapical radiolucencies after root canals. The objective of this review is to present frequency of Actinomyces species in Periapical Actinomycosis...

The effect of radial osteotomy on the position of the posterior interosseous nerve.

The purpose of this study was to determine whether a radial shaft fracture would decrease the protection provided to the posterior interosseous nerve by the pronation maneuver during posterolateral exploration. The position of the nerve in 14 cadaveric elbows, before and after a radial osteotomy, was determined using CT scans in full supination and full pronation after injection of the nerve with radio-opaque dye. The angle formed by the olecranon, radial head and posterior interosseous nerve, and the distance between the nerve and the most lateral aspect of the radial head were measured.Pronation increased the distance between the lateral radial head and the nerve by a mean of 6.5 mm (range 3.6-10.7). After radial osteotomy, the mean increase was 4.2 mm (range 1.0-8.3), difference 2.3 mm (p = 0.044, 95% CI 0.10 to 3.33). The posterolateral approach requires additional care in the presence of a radial shaft fracture, but pronation is still beneficial.

The long-term results of a two-stage protocol for revision of an infected total knee replacement.

We report the long-term results of the management of neglected chronically infected total knee replacements with a two-stage re-implantation protocol. In 18 of 34 patients (53%) a resistant organism was isolated. All cases were treated by the same surgical team in a specialist centre and had a mean follow-up of 12.1 years (10 to 14). They were evaluated clinically and radiologically using the Knee Society Score (KSS) and the American Knee Society Roentgenographic scoring system, respectively. One patient died after eight years from an unrelated cause and two were lost to follow-up. Three patients (8.8%) developed a recurrent infection for which further surgery was required. The infection was eradicated successfully in 31 patients (91.1%). There was one case of aseptic loosening after 13 years. We found a significant improvement in the KSS at final follow-up (p < 0.001).

The Trabecular Metal Monoblock acetabular component in patients with high congenital hip dislocation: a prospective study.

Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up. The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.

Encapsulation of nutraceutical monoterpenes in beta-cyclodextrin and modified starch.

The encapsulation of thymol and geraniol in beta-cyclodextrin (beta-CD) and modified starch (MS) by spray- and freeze-drying was studied. The formation of thymol/beta-CD and geraniol/beta-CD inclusion complexes was confirmed by differential scanning calorimetry (DSC). Oxidative DSC revealed that the monoterpenes enclosed in the beta-CD cavity were protected against oxidation, remaining intact in temperatures at which free monoterpenes were oxidized. Phase solubility studies showed that the inclusion complexes of thymol and geraniol with beta-CD are more soluble in water than the free molecules themselves. Furthermore, in order to evaluate the fraction of monoterpenes that can be released from their complexes with MS in aqueous media, a series of release experiments were conducted.

Wafer-level assembly of carbon nanotube networks using dielectrophoresis.

We use dielectrophoresis (DEP) to controllably and simultaneously assemble multiple carbon nanotube (CNT) networks at the wafer level. By an appropriate choice of electrode dimensions and geometry, an electric field is generated that captures CNTs from a sizable volume of suspension, resulting in good CNT network uniformity and alignment. During the DEP process, the electrical characteristics of the CNT network are measured and correlated with the network morphology. These experiments give novel insight into the physics of DEP assembly of CNT networks, and demonstrate the scalability of DEP for future device applications.

Neurological outcome following early versus delayed lower cervical spine surgery.

PURPOSE: To determine whether the timing of surgery affects neurological outcome in patients with lower cervical spine trauma. METHODS: 29 patients with a fracture and 38 with a fracture-dislocation of C3 to C7 cervical vertebrae were treated operatively during the inclusive period January 1987 to December 2000. Surgery was performed as soon as the patient's medical condition allowed, within 72 hours in 31 and more than 72 hours after the injury in 36. RESULTS: Only patients with incomplete spinal cord injury had neurological improvement after surgery. There was no statistically significant difference in final neurological outcomes in patients having early as opposed to delayed surgery. CONCLUSION: Surgical intervention for cervical injuries is safe, as no postoperative neurological deterioration was recorded. Timing of surgery does not affect neurological outcome.

Granular self-organizing map (grSOM) for structure identification.

This work presents a useful extension of Kohonen's Self-Organizing Map (KSOM) for structure identification in linguistic (fuzzy) system modeling applications. More specifically the granular SOM neural model is presented for inducing a distribution of nonparametric fuzzy interval numbers (FINs) from the data. A FIN can represent a local probability distribution function and/or a conventional fuzzy set; moreover, a FIN is interpreted as an information granule. Learning is based on a novel metric distance d(K)(.,.) between FINs. The metric d(K)(.,.) can be tuned nonlinearly by a mass function m(x), the latter attaches a weight of significance to a real number 'x' in a data dimension. Rigorous analysis is based on mathematical lattice theory. A grSOM can cope with ambiguity by processing linguistic (fuzzy) input data and/or intervals. This work presents a simple grSOM variant, namely greedy grSOM, for classification. A genetic algorithm (GA) introduces tunable nonlinearities during training. Extensive comparisons are shown with related work from the literature. The practical effectiveness of the greedy grSOM is demonstrated comparatively in three benchmark classification problems. Statistical evidence strongly suggests that the proposed techniques improve classification performance. In addition, the greedy grSOM induces descriptive decision-making knowledge (fuzzy rules) from the training data.

Resonant oscillators with carbon-nanotube torsion springs.

We report on the characterization of nanometer-scale resonators. Each device incorporates one multiwalled carbon nanotube (MWNT) as a torsional spring. The devices are actuated electrostatically, and their deflections, both low frequency and on resonance, are detected optically. These are some of the smallest electromechanical devices ever created and are a demonstration of practical integrated MWNT-based oscillators. The results also show surprising intershell mechanical coupling behavior in the MWNTs.

The development of bone metastases as the first sign of metastatic spread in patients with primary solid tumours.

The purpose of this retrospective study was to investigate the incidence of bone metastases as the first sign of metastatic spread in patients with primary solid malignant tumours. Between January 1987 and December 1998, we treated 867 patients suffering from primary solid malignant tumours. Their average age was 67 (range: 30-96) years and all were thoroughly investigated with a complete physical examination and laboratory tests as well as imaging studies and bone scans. No bone metastases were found at the time of the initial diagnosis, and the patients were then re-assessed every 6 months for the first 5 years and then once a year. We found that, regardless of treatment, bone metastases appeared in a certain number of patients and that after excluding patients with prostate cancer a bone metastasis was the first sign of "recurrence" in 1.3% of the patients with a known primary solid malignant tumour.

Laterally modulated 2D electron system in the extreme quantum limit.

We report on magnetotransport of a two-dimensional electron system (2DES), located 32 nm below the surface, with a surface superlattice gate structure of periodicity 39 nm imposing a periodic modulation of its potential. For low Landau level fillings nu, the diagonal resistivity displays a rich pattern of fluctuations, even though the disorder dominates over the periodic modulation. Theoretical arguments based on the combined effects of the long-wavelength, strong disorder and the short-wavelength, weak periodic modulation present in the 2DES qualitatively explain the data.