Can urinary CTX-II be a biomarker for knee osteoarthritis?

BACKGROUND: Early diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge. Urinary C-terminal cross-linked telopeptide of type II collagen (urinary CTX-II) is one of the potential OA biomarkers. However, conclusive evidence regarding the use of this biomarker as a tool for early diagnosis is still lacking. The purposes of this study were to compare urinary CTX-II levels in patients with knee OA and in healthy controls, to evaluate the correlation between urinary CTX-II levels, radiographic severity of OA, and patient-reported outcomes and to evaluate the effect of age and gender on urinary CTX-II levels in the Asian populations. METHODS: Two groups were studied. The OA group included 78 patients with knee OA aged > 40 years who met the diagnostic criteria for knee OA described by the American College of Rheumatology (ACR). The control group consisted of 51 healthy participants age > 40 years without clinical or radiographic evidence of knee OA. Bilateral knee radiographs were taken and classified according to the Kellgren and Lawrence (KL) grading system. Urinary CTX-II was measured using a competitive ELISA test and Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) was also recorded in all participants. RESULTS: Urinary CTX-II was significantly higher in the OA group than in the control group (p < 0.001). The severe knee OA group (KL grade 3 and 4) had higher urinary CTX-II levels than mild knee OA group (KL grade 2) but the difference did not reach statistical significance (p = 0.2). There was a moderate correlation between urinary CTX-II levels and KL grades (r = 0.405, p < 0.001) and a weak correlation between urinary CTX-II levels and WOMAC index scores (r = 0.367, p < 0.001). Multiple regression analysis showed that urinary CTX-II was independently associated with KL grades. Whereas age, gender, and WOMAC index had no statistically significant influence on the urinary CTX-II levels. CONCLUSIONS: Patients with knee OA had higher urinary CTX-II levels than healthy controls. Moreover, levels of urinary CTX-II were independently correlated with radiographic severity of knee OA. Age, gender, and patient-reported outcomes exerted no effect on the urinary CTX-II levels. LEVEL OF EVIDENCE: Diagnostic Level III.

Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement.

BACKGROUND: Despite prophylaxis, deep vein thrombosis (DVT) still occurs frequently after elective knee surgery. Hence, it would be helpful if the high-risk DVT patients could be identified before surgery so the adequate prophylaxis could be given. A normal plasma D-dimer level effectively rules out acute DVT patients who were classified as having low clinical probability. In many studies, one coagulation activation marker was measured to observe their role in preoperative prediction ofDVT after major hip or knee surgery. In this study, the preoperative plasma level of D-dimer in patients undergoing total knee arthroplasty (TKA) was collected, and correlated with the results of postoperative venography OBJECTIVE: To determine whether levels of D-dimer in plasma, taken two weeks preoperatively, predicts the development of DVT in patients undergoing TKA. MATERIAL AND METHOD: Fifty-nine consecutive patients undergoing TKA were seen in a preoperative clinic two weeks prior the surgery and had blood taken for measurement of plasma D-dimer. After surgery, they did not receive prophylaxis anticoagulant. Ascending contrast venography of both lower extremities was performed in all cases between the 6th-l0th postoperative day or earlier if clinical symptoms occurred. RESULTS: Plasma D-dimer was measured preoperatively in 59 patients undergoing TKA. DVT was detected by venography in 31 (53%) patients. At a cutoff or 500 ng/ml, the sensitivity, specificity, positive and negative predictive values of the preoperative D-dimer concentration for the development of subsequent DVT were 58%, 46%, 55%, and 50%, respectively. CONCLUSION: The results of the present study suggested that preoperative plasma measurement of D-dimer concentration is not useful for predicting DVT in patients undergoing TKA.

The prevalence of thrombophilia in idiopathic osteonecrosis of the hip.

BACKGROUND: Thrombophilia is the propensity to develop thrombosis (blood clots) within the vein or artery due to an abnormality in the system of coagulation. It is one of the pathophysiological causes of osteonecrosis of femoral head (ONFH). Previous studies showed that the prevalence of thrombophilia was 1-15% in normal population. There are two types of osteonecrosis of the femoral head, primary osteonecrosis (idiopathic osteonecrosis) and secondary osteonecrosis from other known conditions. There is no previous report of the prevalence of thrombophilia in idiopathic osteonecrosis of the femoral head in Thailand. OBJECTIVE: To study the prevalence of thrombophilia in Thai patients with idiopathic osteonecrosis of the femoral head. MATERIAL AND METHOD: Fifty-five patients with osteonecrosis of femoral head were enrolled in this study. Forty patients had idiopathic osteonecrosis and 15 patients had secondary osteonecrosis. The blood examination of Factor V Leiden mutant, Factor VIII, Protein C, Protein S and Antithrombin III were completed in all subjects. RESULTS: All patients with idiopathic ONFH had bilateral hip involvement. The prevalence of thrombophilia in idiopathic ONFH was 32.5% (13/40). The protein C, protein S deficiencies, and increased factor VIII were the common types of abnormal coagulation in idiopathic ONFH. CONCLUSION: Patients with idiopathic osteonecrosis of the femoral head had a high prevalence of thrombophilia at about 32.5% in contrast to 1-15% in the normal population. The present study suggested that thrombophilia maybe a risk factor of idiopathic osteonecrosis of the femoral head.

How we teach military medicine to medical cadets at Phramongkutklao College of Medicine.

Phramongkutklao College of Medicine has a unique curriculum for "Military Medicine." Military Medicine involves prevention, threat assessment, evacuations and clinical management of diseases and injuries resulting from military occupational exposures. The Military Medicine curriculum covers all the entities of knowledge of Military Sciences, Combat Medical Skills, Military Preventive Medicine, Military Applied Physiology and Military Contingency Medicine. The highlight of the curriculum is "Operation Petcharavut" that represents simulated battlefield operations, involving multidisciplinary clinical integration and military regulation. In this course, medical cadets review all the knowledge that they have learnt and in addition, Medical Platoon leader strategies, Advanced Cardiac Life support and Phramongkutklao Traumatic Life support, crucial medical practices. Medical cadets would experience simulated patients with minimal injuries to critical wounds and complications including combat stress syndromes in various situations, from advancing to retreating units and from Battalion Aid Station to Division Medical Operations Center, whether during day or night. Since the medical cadets experience all Military Medicine courses from the second to the sixth year class and pass all medical knowledge-based examinations, Phramongkutklao College of Medicine expects all graduates to be excellent in not only all standard requirements of the medical professional set forth by the Medical Council of Thailand but also ready to serve the nation effectively in the Royal Thai Armed Forces.