المؤلفون: Pierre Layrolle, Aurélie Najm, T Garraud, Frédéric Blanchard, B. Le Goff, Christelle Darrieutort-Laffite

المصدر: Poster presentations.

مصطلحات موضوعية: Pathology, medicine.medical_specialty, biology, business.industry, Acid phosphatase, medicine.disease, Chondrocyte, Staining, medicine.anatomical_structure, Proteoglycan, medicine, biology.protein, Fibrocartilage, Immunohistochemistry, business, Von Kossa stain, Calcification

الوصف: Introduction Calcific tendinopathy is a frequent cause of chronic painful shoulders. It is caused by deposits of carbonated apatite in rotator cuff tendons. Although the disease is frequent, molecular and cellular mechanisms involved in this pathological mineralization process are not currently identified. Objectives The objective of the study was to analyse calcified tendon samples to understand the organisation of the deposits and to characterise the cells potentially involved in their formation. Methods Samples were collected from cadaveric subjects. They were fixed in formalin 4%, decalcified in EDTA, dehydrated and embedded in paraffin. Some samples were not decalcified to allow a better characterisation of the calcific deposits. Hematoxylin and eosin (HE), Safranin O/Fast Green (SO/FG), Von Kossa (no decalcified samples) and Tartrate-Resistant Acid Phosphatase (TRAP) staining were performed. Immunohistochemistry using anti-Runx2, anti-Sox9, anti-Collagen II and X, anti-CD31 and CD68 antibodies has been performed. We used also used anti-TNAP (Tissue Nonspecific Alkaline Phosphatase) and ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1) antibodies. Indeed, these two enzymes are essential in the physiological mineralization: extracellular inorganic pyrophosphates are provided by ENPP1 then hydrolyzed by TNAP to promote mineralization. Results Five calcified samples were collected On HE staining, voluminous calcium deposits were encapsulated by a fibrocartilaginous tissue. In one sample, we observed an intra-tendinous osseous metaplasia. This fibrocartilaginous area presented a red coloration (proteoglycan specific) on SO/FG staining but was collagen II negative whereas the fibrocartilage at the tendon attachment was strongly positive. Within this area, cells with round nuclei and pericellular lacunae were observed as previously described (Uhthoff, 1975). These cells expressed Runx2 and Sox9 suggesting a chondrocyte differentiation but only a small number of them expressed type X collagen, hypertrophic chondrocytes-specific marker. These cells also expressed ENPP1 and TNAP. Interestingly, extracellular TNAP deposits were also present at the periphery of the deposits. We identified vessels surrounding the deposits on 4 of the 5 calcified samples. Finally, no CD68 positive cells or TRAP positive cells were detected around the deposits. Conclusions Histological analyses of whole calcified tendon tissues showed a fibrocartilaginous area surrounding the calcium deposits with chondrocyte-like cells expressing ENPP1 and TNAP suggesting their crucial role in the deposition of apatite crystals. Further analyses are necessary to understand the origin of these cells and the regulatory factors involved in their differentiation. Reference . Uhthoff HK. Calcifying tendinitis, an active cell-mediated calcification. Virchows Arch a Pathol Anat Histol1975;366(1):51–8. Disclosure of interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::311a5680f43308a19599bd8146b47d6fTest
https://doi.org/10.1136/annrheumdis-2018-ewrr2018.61Test

المؤلفون: Christelle Darrieutort-Laffite, SH Bourdaim, B. Le Goff, Y. Maugars

المصدر: Poster Presentations.

مصطلحات موضوعية: medicine.medical_specialty, Health professionals, business.industry, Educational resources, Injection site, Physical therapy, Medicine, In patient, Risks and benefits, business, Asepsis, Guided learning, Video sharing

الوصف: Background Ultrasound (US) guided injections are becoming widespread in the treatment of rheumatic articular disorders. US allows a real time assessment of the needle progression and increase the accuracy of the injection. Video sharing platforms can be sources of information and learning material for healthcare professionals as for patients. Objectives We conducted this cross-sectional study to assess the quality of educational resources on US-guided articular and periarticular injections published on video sharing platforms. Methods YouTube, Dailymotion and Vimeo were searched using predefined keywords on US-guided shoulder, elbow, wrist, hand, hip, knee, ankle, and foot injections. The videos were classified according to their source. We determined the injection site and the explanations shown for each site. We collected information on patient positioning, equipment, needle, ultrasound settings and teaching material used by the author. When demonstration was performed live in patient, the compliance with the rules of asepsis and the accuracy of the injection were evaluated. Overall, videos were evaluated for quality on a 5-point ordinal global quality scale (GQS) (from 1 = poor quality to 5 = excellent quality). Results are given as median (min-max). Results We found 69979 results with the keywords. We screened 2802 videos by titles and included 153 videos (10.05 hours). Most of videos were published on Youtube (92.2%) and 82.4% included oral explanation. 53.6% videos were published by medical advertisement or profit companies and only 9.2% videos by university, professional organization or physician group. Among the 41.2% videos showing live demonstration of injection on the patient only 25.4% followed the strict rules of asepsis. When the videos included US cineloops of injection, 10.4% of them were outside the target. Very few videos gave details about information on the pathophysiology of the disease (6.5%), the risk (0.7%), the benefice (11.2%) or the products used for the injection (58.2%). Overall, 3.3% of the videos were classified as “Excellent quality” on the GQS, 24.2% as “Good quality”, 23.5% as “Moderate quality”, 34.6% as “Generally poor quality” and 14,4% “Poor quality”. We compared the characteristics of the good quality videos (GQS score ≥4) versus the one rated ≤3. Better quality videos were longer (1.3 min ((0.07–1.05) versus 3.62 (0.32–40.43) min), had oral explanation (95% versus 77%; p=0.008). They more frequently showed the clinical and US site of injection and accurately reached their target (90% versus 68%). They were significantly more viewed (m2719 (13–80195) versus 856 (11–60174); p=0.026) and more liked (1 (0–80) versus 7 (0–58) (p=0.002)). However, some poor quality videos had more than 60000 views. Quality of the video created by medical advertisement or profit companies were not different from those coming from university but significantly better than those from individual physician or with unknown origin (p=0.011). Conclusions Our study reveals a generally a low quality of US guided learning videos available on the most popular video sharing platforms. We observed a lack of information on the treatment, its risks and benefits. Strict aseptic techniques are rarely followed and the injection can be outside the target. Finally, we identified characteristics associated with the quality of the video that can be used to improve their educational impact in the future. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::bed6b10c6d68fb2591314ed60ded55aeTest
https://doi.org/10.1136/annrheumdis-2017-eular.6396Test

المؤلفون: B. Le Goff, Christelle Darrieutort-Laffite, D Huguet

المصدر: Poster Presentations.

مصطلحات موضوعية: musculoskeletal diseases, Subluxation, Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Ultrasound, Arthroscopy, musculoskeletal system, medicine.disease, Biceps, Tendon, medicine.anatomical_structure, Bicipital groove, Medicine, Rotator cuff, Radiology, Tendinopathy, business

الوصف: Background Disorders of the long head of the biceps brachii tendon (LHBt) are commonly recognized as a source of shoulder pain. Ultrasound (US) is thought to be of limited value in the diagnosis of partial-thickness tear and non-tear abnormalities of the LHBt because of the difficulty to assess its intra-articular proximal portion. Brasseur recently described that placing the arm in extension/external rotation increased LHBt intra-articular portion visibility. Objectives The goal of this study was to determine if the systematic assessment of the intra-articular portion of the tendon, from the rotator interval to its glenoid insertion, with the arm placed in extension/external rotation could increase US sensitivity. Methods This was a cross-sectional study. All patients referred for the treatment of a rotator cuff disease (rupture, tendinopathy, calcific deposit) with an available MRI were included. US was performed blinded from the results of the clinical or MRI using a Sonosite Edge with a 6–13 MHz probe. LHBt was studied at different level: in the bicipital groove, at the rotator interval, over the upper pole of the humerus head to its insertion on the superior glenoid tubercule. To increase the visibility of the proximal portion, we placed the arm in extension/external rotation as described by Brasseur [1]. Diagnosis of tendinopathy were tendon enlargement, hypoechogenicity and an increase in the interfibrillar distance. Subluxation or dislocation of the LHBt was defined as a partial or total loss of contact between the tendon and its groove. Tearing of tendon was defined as discontinuity or absence of tendon fibers. Fluid collection was defined as an anechoic ring around the tendon >2 mm. Abnormalities of the LBHt on MRI was retrieved from the report. LBHt abnormalities detected on arthroscopy were used as the gold standard. Results We included 129 patients, 57 female (44%), and mean age 54 years (33–73). Seventy-five (58%) had a rotator cuff tear and 54 (42%) a tendinopathy. Arthroscopy found LHBt pathological changes in 39% of the case. The summary of the findings obtained with MRI, US (distal and proximal) and arthroscopy are summarised in table 1. We calculated the sensitivity/specificity of MRI and US (at the proximal and distal level) in the detection of LHBt changes using arthroscopy as gold standard (Table 2). Conclusions US has a good specificity but a poor sensitivity in the detection of LHB tendon changes even when a systematic and carreful study of the proximal part of the tendon is undertaken. If detection of distal changes of the tendon in the inter-tubercular groove seems feasible with US, the involvement of the more proximal, intra-articular part of the tendon remains challenging. MRI sensitivity remains also poor. Overall, arthroscopy still remains the gold standard to detect LHB tendon intra-articular pathology. References Brasseur, The biceps tendons: from the top and from the bottom. Journal of ultrasound (2012) 15, 29–38. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::054ead33d1d05137cd6dffd0a19438a2Test
https://doi.org/10.1136/annrheumdis-2017-eular.4468Test