Computational modelling makes it possible to predict the onset and progression of knee osteoarthritis in overweight people, shows a new study from the University of Eastern Finland. A computational model based on the degradation of the collagen fibril network in the articular cartilage was able to predict the onset and progression of osteoarthritis in overweight people during a four-year follow-up. In normal-weight people, osteoarthritis did not develop within this time span.

The study also developed a model of the knee joint which makes it possible to evaluate the mechanical responses experienced by cartilage cells in healthy and osteoarthritic cartilage during daily activities such as walking. The model demonstrated that both menisectomy and osteoarthritic changes to the cartilage cause significant alterations in cartilage cell responses.

Osteoarthritis is a joint disease estimated to affect around 5% of the total world population. Osteoarthritis is the most common in the knee or hip joint and it often develops as a result of ageing, but it can also develop due to excessive loading or joint injury. In Europe, over 100 million people have arthritis, and in America, direct costs of arthritis were $51.1 billion in 2004. In addition, it has been predicted that the number of patients with knee osteoarthritis increases by 40% by the end of 2050.

Osteoarthritis proceeds gradually, weakening the articular cartilage and ultimately wearing it off completely from the ends of articulating bones. In these cases, the patient suffers from heavy joint pain and the joint becomes stiff, often leading to incapacity for work. Joint replacement surgery is the only effective treatment for osteoarthritis, which is why the prevention of osteoarthritis would be a cost-effective alternative both for the patient and society at large.

The study utilised a computational modelling method integrating the tissue and cellular levels of the articular cartilage in order to analyse the function of the articular cartilage during the onset and progression of osteoarthritis. The method simulated the effect of articular cartilage composition, structure and various loadings on the volume, shape and mechanical responses of cartilage cells.

Compared to healthy cartilage, the cell volume of osteoarthritic cartilage increased as a result of mechanical loading. The modelling indicated that the most important explanatory factors for the cell volume increase were the pericellular fixed charge density, i.e. the number of proteoglycan molecules, and the stiffness of the collagen fibril network.

The study also analysed the effect of menisectomy, a commonly used method in knee surgery, and simulated overweight on cell responses. Both menisectomy and simulated overweight substantially increased fluid pressures in the cell and cartilage tissue during walking, but they did not have an effect on the cell shape or volume in healthy cartilage. In osteoarthritic cartilage, however, cells were compressed and elongated more, probably due to altered cartilage integrity.

During standing, the strains were amplified more in the cell than in pericellullar tissue in healthy joint cartilages, but the opposite was observed in osteoarthritic joint cartilage. It is possible that the pericellular tissue’s function is to protect cartilage cells from sudden changes and to promote cartilage health.

The study also developed computational algorithms for the degradation of the collagen fibril network in the articular cartilage and its reorganisation in order to predict the development and progression of osteoarthritis caused by overweight and cartilage damage. The estimate obtained from the degradation algorithm was well in line with the clinically observed progression of osteoarthritis during a four-year follow-up. Furthermore, the collagen fibril network structure in the mechanically injured cartilage was observed to be disorganised in the vicinity of the injury, suggesting that a cartilage injury exposes cartilage to further damage.

In-depth understanding of the effects of abnormal loading, early osteoarthritis and mechanical injuries on cellular and tissue responses in cartilage makes it possible to develop new strategies for the recognition, prevention and slowing down the progression of the disease. The methods developed in the study may become widespread in specialised health care in the future. However, rigorous clinical validation will be necessary before they can be introduced to clinical use.

University of Eastern Finlandwww.uef.fi/-/computational-modelling-can-predict-onset-and-progression-of-knee-osteoarthritis-in-overweight-people

There is a high rate of prescription pain reliever abuse in Europe, largely accounted by opioids, according to the first comparative study of prescription drug abuse in the European Union, which was conducted by researchers at RTI International.

The study investigated nonmedical prescription drug use in five European countries – Denmark, Germany, Spain, Sweden and the United Kingdom.

‘For certain classes of medications, like opioids, we found a significant rate of prescription pain reliever abuse in the EU,’ said Scott Novak, Ph.D., lead author of the study and senior development epidemiologist at RTI. ‘While the lifetime rates were not as high as in the U.S. – 20 percent for those aged 12 years and over, compared to between 7 percent and 13 percent in the EU – the past-year rates were only slightly lower. This suggests that the EU may be catching up to the United States for some substances.’

Nonmedical prescription drug use is typically defined as either the self-treatment of a medical condition using prescription medication that was not prescribed to the user, or as the use of prescription medication to achieve euphoric states. Nonmedical prescription drug use is among the leading public health issues in the United States and previous research has suggested that it is more widespread in the United States than in Europe, where prevalence and user characteristics remain largely unknown.

‘Previously, it was thought that the prescription drug epidemic was limited to the United States,’ Novak said, ‘but this study shows that the epidemic extends well beyond the U.S.’

Examining three different classes of subscription drugs – opioids, sedatives and stimulants – the researchers found that out of the five countries examined, Germany had the lowest levels of nonmedical prescription drug use, while the U.K., Spain and Sweden had the highest levels.

The most common sources of prescription drugs for nonmedical use were family and friends – 44 percent for opioids and 62 percent for sedatives. The next most common source was taking drugs from another person without their knowledge. Internet purchases were the least common source of prescription drugs.

Nonmedical prescription drug use was more common among men relative to women, among white relative to non-white people, and among those who were unemployed compared with other levels of employment. Young people aged 12 to 17 years were at lower risk of nonmedical prescription drug use than people aged 18 years or older.

Having been prescribed a pain reliever was associated with an eight times higher risk of subsequent nonmedical use of prescription pain relievers. The risk was ten times higher for sedatives and seven times higher for stimulants.

The researchers also found that about 52 percent of nonmedical stimulant users, 32 percent of nonmedical opioid users and 28percent of nonmedical sedative users also consumed illicit drugs – this is known as poly-drug use. Rates of poly-drug use involving either sedatives or opioids were highest in the U.K. – 48 percent for sedatives and 43 percent for opioids. Women were about half as likely to engage in poly-drug use as men. Suffering from serious psychological distress, having a sexually transmitted disease and having a history of childhood arrest were also associated with a higher risk of poly-drug use.

The study suggests that international collaborations across Europe are needed to monitor prescription drug abuse, identify its scope and develop targeted interventions.

Identification of the scope and prevalence of nonmedical prescription drug use in the EU is an important first step in building a worldwide system that can be used to monitor trends, track risk and protective factors and to develop targeted interventions aimed at reducing the risk of nonmedical prescription drug use, according to the researchers.

The authors caution that their findings should not be construed as recommendation against prescribing medications to treat legitimate conditions. The cross-sectional design of this study made it impossible to resolve the question if nonmedical prescription drug use serves as a gateway to other substances or if persons using illicit drugs are at higher risk for also using prescription drugs to self-treat or to achieve euphoria.

RTI International www.rti.org/news/prescription-drug-abuse-epidemic-extends-beyond-united-states

A survey finds that consumers are enthusiastic about the future of wearables, especially in health and wellness, but they’re still having issues staying motivated. Roughly one-third of those who bought smart clothing have admitted they aren’t using them as much anymore. The drop-off rate meanwhile, is 18 percent for fitness bands, 22 percent for smart watches and 16 percent for smartglasses. According to the survey, consumers say they lose their enthusiasm for wearables after a while, finding them ineffective, uncomfortable or unstylish, or finding that they can’t synch seamlessly with a smartphone or hold battery power.
‘For consumers to commit to wearables for the long term, a device should not only be attractive and comfortable, but should also reach beyond data delivery to provide knowledge and benefits unavailable elsewhere,’ states the report, titled ‘The Wearable Life 2.0: Connected Living in a Wearable Wiorld.’
While that news is discouraging, healthcare should take note of the rising numbers of consumers investing in wearables. Of those surveyed, 45 percent own a fitness band, 27 percent now own a smartwatch and 12 percent own sensor-embedded clothing. And while the percentage of people who see a bright future for wearable has jumped 16 percent since PwC’s 2014 survey, the number of respondents who have security or privacy concerns about wearables has dropped about 8 percent in those past two years.
The survey also highlights a trust issue in healthcare. While the provider community hasn’t embraced consumer-facing wearables because they don’t think the data coming from them is reliable enough to use in clinical situations, consumers have their concerns as well.
It’s a good news-bad news issue. According to the survey, some 65 percent of consumers are excited about the possibility of using a wearable provided or endorsed by their doctor’s office, while 62 percent feel that way about wearables coming from a hospital or their insurer. On the other hand, only 41 percent would trust a wearable coming from their doctor, while only 38 percent would trust a hospital-supplied wearable and only 34 percent would place their faith in a payer-supplied device.
Farther down the list, 57 percent are excited about a wearable coming from their pharmacy, but only 29 percent would trust the device. And 25 percent of those surveyed said they wouldn’t trust their personal information to any branded wearable.
So what motivates someone to use a wearable? According to the survey, more than half say they’d be motivated by a monetary reward, while 45 percent like gaming features that allow them to compete with others. Another 45 percent would use wearables if they provided information that they’d otherwise not have, and 36 percent want it to look good.
They also want the device to synch with their smartphone – 78 percent said they’d use a wearable more frequently if it connected seamlessly to their smartphone, and 97 percent are happy with a smartphone application supporting the wearable.

mHealth Intelligence http://tinyurl.com/ht3q2r3

A multicenter team of researchers led by Barbara Murphy, MD, of the Icahn School of Medicine at Mount Sinai has identified a panel of genes which can help predict whether a transplanted kidney will later develop fibrosis, an injury which can cause the organ to fail.

Researchers in the Genomics of Chronic Allograft Rejection (GoCAR) study obtained biopsy samples from transplanted kidneys three months and twelve months after transplantation. Using microarray, a method by which the expression levels of a large numbers of genes or proteins can be measured simultaneously, the researchers determined which genes were correlated with biopsy samples which had an increased Chronic Allograft Damage Index (CADI) score at the 12-month biopsy. The CADI score is a measure of the level of fibrosis in the transplanted kidney. The researchers then narrowed the genes down to a predictive gene set that identified patients at risk for decline in renal function and loss of the transplanted kidney beyond one year. The rate of correlation of the identified gene set with damage was greater than the clinico-pathological variables currently used in practice to identify kidney transplant recipients at risk of allograft damage and loss.

‘This is the first finding of its kind,’ said Barbara Murphy, System Chair of Medicine for the Mount Sinai Health System and Murray M. Rosenberg Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai, and the lead investigator on the study. ‘By helping us better understand the causes of damage to transplanted kidneys, this study has the potential to change how we monitor and manage all renal transplant patients.’

‘The study offers the potential to identify renal transplant recipients at risk for a loss of the new organ prior to the development of irreversible damage,’ said Dr. Murphy. ‘This would mean that doctors might eventually have the opportunity to change the therapeutic treatment approach in order to prevent fibrosis from progressing at all.’

Mount Sinai Health System www.mountsinai.org/about-us/newsroom/press-releases/mount-sinai-researchers-identify-way-to-predict-and-prevent-damage-in-donated-kidneys

Researchers at Lund University in Sweden have discovered a new and more accurate way to distinguish between harmful and harmless plaque in the blood vessels by using ultrasound. This can help healthcare providers determine the risk of strokes and heart attacks – which means avoiding unnecessary surgery for many patients.
In many parts of the world, atherosclerosis is one of the diseases responsible for a large number of cases of premature death.
Six years ago, a handful of researchers at Lund University in Sweden started taking an interest in how to make it easier to recognize unstable plaques that in worst case scenarios rupture and cause heart attacks or strokes.
When Tobias Erlov, who at the time was a doctoral student in biomedical engineering at the Lund Faculty of Engineering, discovered that there is a fairly simple mathematical calculation that can be used to interpret ultrasound signals and thereby figure out whether the plaque in the carotid artery is harmful or not, the researchers were somewhat surprised.
Vascular surgery is currently only performed if there is excessive blockage to the blood flow, due too large plaques. However, determining whether or not the plaque is unstable cannot be done by simply studying flow rates and plaque sizes – knowing the type of cell concerned is more important.
Simply put, harmless plaques consist of connective tissue and smooth muscle cells. Harmful plaques consist of fat (lipids) and macrophages. Unstable plaques can also involve bleeding.
‘We have shown that there is a strong correlation between changes in the centre frequency and the size of the reflecting particles. The more harmful substances, the greater the so-called centre frequency shift’, says Tobias Erlov, who is currently continuing his research at the Department of Biomedical Engineering.
The method can become useful to identify patients at risk of developing acute cardiovascular diseases, but also to follow up after surgery where plaque has already been removed.
In the future, ultrasound scans of the carotid artery will lead to the ability to perform surgery at an earlier stage in some cases, and the ability to avoid surgery completely in others.
People with cardiovascular diseases, and diabetics who risk developing them, can benefit from this new and accurate method.
‘Ultrasound enables you to screen a larger population, and that in turn means that life-threatening cardiovascular diseases can be detected at an earlier stage’, says Magnus Cinthio, senior lecturer in biomedical engineering and one of the researchers leading the work.
‘Another advantage is that the method is inexpensive and completely harmless to patients’, says Tobias Erlov.

Lund University http://tinyurl.com/jp8fbbz