Comment on “early efficacy of intra-articular HYADD® 4 (Hymovis®) injections for symptomatic knee osteoarthritis”

We read with great interest the study by Priano titled“Early efficacy of intra-articular HYADD® 4 (Hymovis®) injections for symptomatic knee osteoarthritis.” 1 The author would like to explore the efficacy of intra-articular HYADD 4 (Hymovis) injections for symptomatic knee osteoarthritis. Results from this study are very interesting and promising from a clinical aspect; however, we believe that studying patient’sclinical status with visual analog scale and Western Ontario and McMaster Universities Arthritis Index scale should be supported by biomechanical information. From this point of view, to have more data that could influence the clinical practice, it is important to note the possible action that intraarticular injections of different kinds of hyaluronic acid could have on walking biomechanics using an objective measurement tool as gait analysis. In our opinion, the work by Priano1 is promising because it investigates the efficacy of a new formulation of hyaluronic acid. Nowadays, many hyaluronic acid formulations are approved for clinical use in Europe and the United States. Furthermore, hyaluronic acid injections’ efficacy has been demonstrated also in hip osteoarthritis. 2 However, even if these formulations differ in their chemical– physical properties, joint space half-life, rheological properties, and clinical efficacy, there are few studies that investigate hyaluronic acid’s possible action from a biomechanical point of view. 3,4 From this point of view, we believe that osteoarthritis management and rehabilitation should be prescribed after an objective analysis of functional walking alterations using gait analysis instrumentations. The use of gait analysis should be desirable during diagnosis and follow-up. In fact, it is capable to identify different walking patterns in patient with osteoarthritis of the lower limbs, whereas the radiology can evaluate the status of the joint’s structures

Assessing the cervical range of motion in infants with positional plagiocephaly

Purpose: To determine if infants with positional plagiocephaly have limitations of active and passive cervical range of motion measured with simple and reliable methods. Methods: The examiners assessed bilateral active and passive cervical rotations and passive cervical lateral flexion. Cervical assessment was performed twice by 2 different physicians to assess intertester reliability. To assess intratester reliability the first investigator performed a second examination 48 hours after the first one. Results: One-hundred nine subjects were analyzed; 70.7% of the sample had head positional preference on the right, while 29.3% had head positional preference on the left (x2 35.52, P <0.001). Cervical rotations and lateral flexion showed reliable levels of agreement for intra and intertester reliability. Conclusions: The most limited range of motion in infants with positional plagiocephaly was cervical active rotation which affected more than 90% of patients. Passive cervical rotations and lateral flexion were limited in more than 60% of patient

Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty

Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation

Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy.

OBJECTIVE: The aim of the study was to identify the main aspects concerning appropriateness and efficacy of Spa therapy for musculoskeletal pathologies. METHODS: A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. CONCLUSIONS: The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy

Polyphenon E enhances the antitumor immune response in neuroblastoma by inactivating myeloid suppressor cells

This is the author's accepted manuscript. The final published article is available from the link below. Note: In this manuscript as well as in the original published version of this article the word "Polyphenon" was incorrectly spelled in the title as "Polyphenol."Purpose: Neuroblastoma is a rare childhood cancer whose high risk, metastatic form has a dismal outcome in spite of aggressive therapeutic interventions. The toxicity of drug treatments is a major problem in this pediatric setting. In this study, we investigated whether Polyphenon E, a clinical grade mixture of green tea catechins under evaluation in multiple clinical cancer trials run by the National Cancer Institute (Bethesda, MD), has anticancer activity in mouse models of neuroblastoma. Experimental Design: We used three neuroblastoma models: (i) transgenic TH-MYCN mouse developing spontaneous neuroblastomas; (ii) nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice xenotransplanted with human SHSY5Y cells; and (iii) A/J mice transplanted with syngeneic Neuro 2A cells. Mice were randomized in control and Polyphenon E–drinking groups. Blood from patients with neuroblastoma and normal controls was used to assess the phenotype and function of myeloid cells. Results: Polyphenon E reduced the number of tumor-infiltrating myeloid cells, and inhibited the development of spontaneous neuroblastomas in TH-MYCN transgenic mice. In therapeutic models of neuroblastoma in A/J, but not in immunodeficient NOD/SCID mice, Polyphenon E inhibited tumor growth by acting on myeloid-derived suppressor cells (MDSC) and CD8 T cells. In vitro, Polyphenon E impaired the development and motility of MDSCs and promoted differentiation to more neutrophilic forms through the 67 kDa laminin receptor signaling and induction of granulocyte colony-stimulating factor. The proliferation of T cells infiltrating a patient metastasis was reactivated by Polyphenon E. Conclusions: These findings suggest that the neuroblastoma-promoting activity of MDSCs can be manipulated pharmacologically in vivo and that green tea catechins operate, at least in part, through this mechanism.SPARKS, Research in Childhood Cancer, the CGD Research Trust, and the Wellcome Trust

Effect of perches on morphology, welfare and behaviour of captive reared pheasants

This study investigated the effect of providing elevated perches in growing pens on the morphology and behaviour of young pheasants. Pheasants reared with perches from one week old were observed roosting off the ground significantly more frequently when moved into a pen containing trees at five weeks old than pheasants reared without perches (roosting pheasants: 24.3% vs. 6.7%; p < .01). The presence of perches reduced the level of plumage damage caused by feather pecking (damage scores: 2.3% vs. 2.1%; p < .05). Pheasants reared in huts with perching were larger overall than those from control huts, in particular were heavier (weights: 356.9 g vs. 345.2 g) and had longer and thicker tarsi than control pheasants (60.61 mm vs. 59.35 mm and 4.715–6.571 mm vs. 4.705–6.412 mm, respectively). Since roosting on tree branches is an important anti-predator behaviour, providing perches at an early stage of life in the captive rearing environment may be helpful in order to improve survival of the captive reared pheasant after release in the wild. Furthermore, the study suggests that a simple and easy husbandry technique, providing elevated perches, may improve the welfare and fitness of farm-reared game birds

Winter habitat selection by the European hare (Lepus europaeus) during feeding activity in a farmland area of southern Tuscany (Italy)

We investigated the winter habitat use by the European hare (Lepus europaeus) at the macro-habitat level in a farmland area of southern Tuscany during feeding activity using spot-light counts. Olive tree groves, cereal stubbles and winter cereals were used more than their availability, whereas ploughed fields, alfalfa and fallow fields were used less than their availability. Olive tree groves were the most used, followed by cereal stubbles. Since approximately 50% of over-wintering cereal stubbles were the result of economic agreements between the hunting district and local farmers, the study confirms the importance of this kind of agro-environmental measure for hare conservation

Evaluation of some habitat improvement actions in a Mediterranean area through observation of reared pheasant and red-legged partridge land uses

Red-legged partridge (Alectoris rufa) and pheasant (Phasianus colchicus) have suffered population decline in the last decades. Research suggested that decline is mainly related to the intensification of agricultural techniques and land abandonment. We evaluated habitat use and distribution of reared red-legged partridge pairs and cock pheasants in an estate representative of most of the agricultural Mediterranean areas from 2007 to 2012. Particular attention has been addressed to the effect of artificial habitat improvement actions (HIAs) and other management options such as supplemental feeding and hedgerows maintenance. We compared habitat use with its availability and analyzed spatial distribution by comparing points with pheasant cocks and partridge pairs with random ones. HIAs were used more than their availability by both species and resulted to have an important role in their distribution like hedgerows. Feeders resulted to have a strong effect on pheasant distribution, but not on pairs of red-legged partridges. Our results show that habitat management could be a fundamental tool for game-bird conservation, though the effects of feeders on red-legged partridge distribution need to be further investigated

Relationship between Anti-European Brown Hare Syndrome Serological Titers and Brown Hare (Lepus europaeus Pallas) Densities

Thirty-three protected wild game reproduction areas, located in the province of Florence (Central Italy), were monitored for habitat characteristics and hare census over a period of 2 years. A total of 172 hares was captured, checked for sex, and age, and blood samples were taken. Serum samples were analyzed by competitive ELISA test for detection and titration of anti-European brown hare syndrome virus (EBHSV) antibodies. Results showed that EBHSV seropositive hares from areas with high and medium population densities had higher antibody titers than those coming from low-density areas and that adults showed lower values than young animals. Anti-EBHSV antibody levels were inversely related to the distances between protected areas and private hunting areas while a high density of protected areas was not associated with any similarity in the values or prevalence of EBHSV

Therapeutic DNA vaccination of vertically HIV-infected children: Report of the first pediatric randomised trial (PEDVAC)

Subjects: Twenty vertically HIV-infected children, 6–16 years of age, with stable viral load control and CD4+ values above 400 cells/mm³. Intervention: Ten subjects continued their ongoing antiretroviral treatment (ART, Group A) and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B). The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. Results: Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047), whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031). No increased CD8+ perforin levels were observed in control Group A. Conclusions: The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population. Trial registration: clinicaltrialsregister.eu 2007-002359-18; 2007-002359-18/I