Day 2 :
Keynote Forum
Diana Hodgins
European Technology for Business
UK
Keynote: How gait is affected by joint replacement
Time : 09:00 - 09:30
Biography:
Diana obtained her degree in Mechanical Engineering and her PhD in solid state gyroscopes from the University of Hertfordshire (UH). Diana has 30 patents granted on solid state sensors and more recently on medical applications relating to the use of these sensors. In 2000 Diana was awarded an MBE for services to SMEs in the region and in 2002 she won the Women Inventor of the Year Award for Industry. In 2005 Diana was awarded an Honorary doctorate from the UH for services to innovation. In 1995 Diana and her husband established their own business, ETB and in 2009 ETB launched their sensor based gait monitoring product, GaitSmart. This is now a world leading product used in wide range of medical and sports applications around the world. One of the sectors where it is applied is orthopaedics and a number of papers have been published on this topic. Diana is currently a visiting professor at the UH and helped to establish a new MEng course in Biomedical Engineering and in 2014 was awarded Alumni of the year at the UH.
Abstract:
It is recognised and clearly visible by the human eye that subjects who have osteoarthritis of the hip or knee joint adapt their gait sub-consciously to minimise pain. This does result in abnormal joint loading and incorrect muscle usage. However, there is no objective measurement pre-operatively that identifies the type and extent of this abnormal movement, which would need to be corrected post surgery. Once the patient has received their implant, the joint pain is removed, but there is considerable pain from the surrounding muscles and ligaments. Physiotherapy is provided for the first 6 weeks and then, provided the wound has healed and the subject is walking adequately, they are left to just continue exercising, with the hope that a normal gait would eventually be resumed. No objective measurements are taken at any stage in this process to ensure that they have resumed a normal gait. Studies on hip and knee replacement patients using a sensor based tool (GaitSmart) one year post op have shown that 50% of hip patients and 60% of knee patients do not resume a normal gait one year post op. These are supported by other complementary research studies, which also show that an abnormal gait does have an effect on other joints, due to the incorrect biomechanics of the lower limbs and this can result in further surgery. It is hypothesised that individuals can be retrained to walk properly after surgery, thus reducing the likeliness of further surgery if they are provided with objective measurement to guide the rehabilitation phase. This paper will present results on hip and knee patients who have been monitored following joint replacement.
Keynote Forum
Pawel Szulc
University of Lyon
France
Keynote: Risk of sarcopenia in patients with Rheumatoid Arthritis.
Biography:
Pawel Szulc, M.D., Ph.D., graduated from the Medical Faculty in Warsaw, 1986. Degree in internal medicine, Warsaw, 1989. MD degree obtained at the Medical Center for Postgraduate Education, Warsaw, Poland. Clinical and research assistant in the Dept of Endocrinology, Medical Center for Postgraduate Education, Warsaw, Poland (1986-90, 1993-94). Degrees of PhD and DSc obtained at the University of Lyon, France. Researcher in the INSERM UMR 1033, Lyon, France. Member of the Committee of Scientific Advisors of the International Osteoporosis Foundation. Member of the Editorial Board of Osteoporosis International. Member of the Editorial Board of Journal of Bone and Mineral Research. Member of ASBMR, Member of the Thematic Network on the Osteoporosis in Male at the European Community (2001-06). Scientific interests: osteoporosis, aging and aging-related diseases in men, bone turnover markers, vertebral fracture, sarcopenia, relationship between osteoporosis and cardiovascular diseases. Author/co-author of more than 100 papers and textbook chapters on osteoporosis and related subjects.
Abstract:
Sarcopenia (low muscle mass) and dynapenia (low muscle strength) are consequences of rheumatoid arthritis (RA). However, their risk factors have been poorly studied. RA is more frequent in women who have lower muscle mass. RA starts early (fourth decade) and its negative effects accumulate over long years. Long RA duration is associated with high risk of sarcopenia. Acute inflammatory episodes and chronic inflammation are characterized by increased secretion of inflammatory cytokines stimulating muscle catabolism. Inflammatory episodes are characterized by joint stiffness, muscle weakness and pain, which are associated with low physical activity. Long-lasting RA is associated with joint deformities and reduced amplitude of joint movements. This chronic status may impose sedentary lifestyle, which increases the risk of sarcopenia. Reduced joint movements and voluntary limitation of the use of the affected limb result in local muscle loss. Furthermore, RA treatment (high doses of glucocorticoids) stimulates muscle catabolism and increases the risk of sarcopenia.rnThis risk of sarcopenia is higher in patients in RA who did not receive appropriate treatment or were not compliant. The risk of sarcopenia is higher in elderly patients who could not receive modern therapy in the initial phase of the disease. Moreover, the risk of sarcopenia in RA differs between the countries according to the availability of the up-to-date treatment. rnPatients with sarcopenia limit their physical activity, which further aggravates muscle loss. Moreover, RA is associated with higher risk of osteoporosis. In these patients, osteoporosis and higher risk of fall due to sarcopenia jointly increase the risk of fracture.rnThus, female sex, long duration of the disease, high activity of the inflammatory status, low physical activity, joint deformities and long-term glucocorticoid therapy increase the risk of sarcopenia in patients with RA. Sarcopenia is associated with further reduction of physical activity and higher risk of fall and fracture.
- Track 5 Rheumatoid Arthritis
Track 9 : Pediatric Rheumatology
Track 10 :Therapies for Rheumatic Disorders
Track 12: Orthopedic trauma
Track 13 :Orthopedic Biomechanics
Location: Terra Lucis
Chair
Manuel Villanueva
Avanfi Institute, Spain
Co-Chair
Thomas Apostolou
Interbalkan Medical Center, Greece
Session Introduction
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound guided gastrocnemius recession: A new ultra-minimally invasive surgical technique
Time : 09:30 - 09:50
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Gastrocnemius equinus is defi ned as ankle dorsifl exion<10º with the knee extended. Th e equinus deformity alters foot biomechanics, predisposing to conditions such as Achilles tendinosis, fl atfoot, diabetic foot ulcer, metatarsalgia, plantar fasciitis, midfoot arthritis and nerve entrapment. In children, the deformity has been associated with equinus foot, spasticity and cerebral palsy. Th erefore, gastrocnemius recession has many well documented indications. We present an ultrasound guided ultra-minimally invasive technique for gastrocnemius recession. Materials & Methods: In 22 cadavers we checked the technique was eff ective and safe. Th en we performed gastrocnemius recession in 23 patients (25 cases), 18 males and 5 females on an outpatient regimen. Mean age was 42 years (13-61). In 11 cases the indication for the procedure was non-insertional Achilles tendinopathy. In 5 patients, the indication was gastrocnemius retraction in the presence of plantar fasciitis. US guided Achilles tenotomy, release of the paratenon or selective plantar fasciotomy were combined with gastrocnemius recession. Th e age range of patients with Achilles tendinopathy or plantar fasciitis was 37-51 years. In 3 patients (4 cases) the indication was equinus foot. Th e ages were 13, 14 and 15 years. Ultrasound guided plantar fasciotomy was performed at the same time. In 5 patients (50-61 years) the indication was metatarsalgia and forefoot overloading with no hammertoe or any other forefoot condition. All patients had at least 6 months of failed conservative management prior to surgery. Surgical Technique: Th e instrument set included long needles (a 16 gauge, 1.7 mm diameter Abbocath), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2, 3 mm) and an ultrasound device (Alpinion ECube15) with a 10-17 MHz linear transducer and the Needle Vision Plus™ soft ware package. Th e patient is placed prone, under local anesthesia plus sedation without lower limb ischemia. Recession is performed via one or two incisions (1-2–mm each) positioning the instruments beneath the sural nerve. No stitches are required, just adhesive strips and elastic bandage. Active dorsifl exion and plantar fl exion of the ankle are encouraged immediately aft er surgery. Partial weight bearing is allowed the day of surgery, aided with crutches. Results: In the clinical series, pain, function and ankle dorsifl exion increased signifi cantly for every patient in the study (mean, 14º; STD 3º). VAS score improved from 7 (6-9) to 0 (0-1) and AOFAS score improved from a mean of 30 (20-40) to 93 (85-100), at 6 months. All athletes returned to their previous sports aft er 6 months. Superfi cial hematomas were common in the series and some patients developed internal hematomas (observed by ultrasound) at the areas of the tendon and muscle surrounding the recession until the third month. Th ere were no instances of over lengthening or Achilles tendon rupture, infections, wound or nerve complications. Discussion: Open or endoscopic gastrocnemius lengthening require epidural anesthesia, lower limb ischemia and stitches. Ultrasound guided ultra-minimally invasive gastrocnemius recession allows continuous visualization of nerves and vessels without ischemia. It can be combined with other US guided ultra-minimally invasive techniques (plantar fasciotomy, Achilles tenotomies) to ensure minimal pain with excellent outcomes and no signifi cant morbidity.
Yelena Walters
University College London, UK
Title: Can task-orientated rehabilitation improve knee function in patients 12 months after knee replacement surgery for osteoarthritis?
Time : 09:50 - 10:10
Biography:
Yelena Walters obtained degrees in Civil Engineering and Economics from Vologda University in Russia before relocating to the UK to following her passion in healthcare and rehabilitation. She graduated from the London School of Osteopathy with Honors degree in Osteopathy in 2010 and went on to obtain MSc in Musculoskeletal Science and Sports Medicine, Exercise and Health from UCL and the Diploma in Orthopedic Medicine. She is a practicing Osteopath and is currently undertaking research towards her PhD in rehabilitation techniques at the Institute of Orthopedics and Musculoskeletal Science, UCL and Royal National Orthopedic Hospital, Stanmore.
Abstract:
Osteoarthritis (OA) of the knee is a common and debilitating disease, which at the end stage requires joint replacement surgery. Total knee arthroplasty (TKA) usually results in relief from knee pain. However, even though the surgical procedure may have been successful, the patient’s gait often does not return to a normal pattern and patients are disappointed with their mobility. The importance of physiotherapy immediately following TKA is well recognized although little consensus exists regarding appropriate rehabilitation programs for the longer term. Typically prescribed rehabilitation exercises have an internal focus on a specific muscle or joint. Movement is a complex process driven by coordinated interaction between different muscles and the peripheral and central nervous systems suggesting that practicing activities that form part of everyday life (task-orientated rehabilitation) maybe more effective. This study proposes that task-orientated rehabilitation (TOR) will enhance overall performance and satisfaction for those patients who are not content with their progress. In this study we investigate patients one year after TKA. We aim to determine the relationship between patient satisfaction using the Oxford Knee Score questionnaire (OKS) and gait characteristics using inertial movement units (IMU). We are selecting a subset of patients who demonstrate abnormal gait characteristics for a 4-week program of TOR. The program is based on the daily activities of walking and stair climbing with the aim of improving gait quality. Following this, patients are re-assessed using the OKS questionnaire and IMUs. Our preliminary results suggest a beneficial effect of TOR.
Renato A. Sernik
SÃrio Libanês Hospital
Brazil
Title: Update on the use of ultrasound in the diagnostic of Carpal Tunnel Syndrome.
Time : 10:10 - 10:30
Biography:
Renato A Sernik is a Doctor and obtained his PhD from the University of Sao Paulo. He is a Radiologist at the Medical School Hospital of the University of SaoPaulo for 16 years. He is the author of some books “Ultrasound of the Musculoskeletal System (1999) and Ultrasound of the Musculoskeletal System-Correlation with MRI (2009)”, translated into Spanish and Italian. He is working as a Radiologist at the Sirio Libanes Hospital from 14 years.
Abstract:
Ultrasonography has become one of the main complementary tests for the diagnosis of carpal tunnel syndrome, especially in patients with a history of diseases that may be associated with peripheral neuropathy, such as diabetes mellitus, or in cases where the electroneuromyography is doubtful. The method has also been useful in patients with unsatisfactory results after surgical treatment, where fibrosis, adhesions and neuromas can be identified, having the advantage compared to MRI to be dynamic examination and lower cost. However, the method is operator-dependent with a longer learning curve. Between 2006 and 2014 we analyzed about 120 wrists of patients with clinical suspicion of carpal tunnel syndrome, with electroneuromyographic correlation, being part of the results published in the journal Skeletal Radiology (2008). The increase in cross-sectional area associated with the change in echotexture of the median nerve are the main criteria used for the diagnosis of carpal tunnel syndrome.
Maosheng Xia
The First Hospital of China Medical University, China
Title: Leptin improves the locomotion recovery of spinal cord injury
Time : 10:30- 10:50
Biography:
Maosheng Xia has completed his PhD and MD from China Medical University and two-year Post-doctoral studies from Medical Center of Rochester University School. Currently, he works as the Associate Professor and Associate Chief Physician in the First Hospital of China Medical University. He has published 7 papers in the fi eld of spinal cord injury.
Abstract:
Spinal cord injury (SCI) causes long-term disability and has no eff ective clinically treatment. Th e initial trauma always results in permanent functional impairment and severe disability followed by secondary injury mechanism, which is characterized by increased infl ammation, glial scarring and neuronal cell death. Leptin (a glycoprotein) could induce the activation of Janus kinase (JAK2)/signal transducers and activators of transcription-3 (Stat3) pathway via leptin receptor. In vivo, we discovered the intraperitoneal injection of leptin improved the locomotion recovery of spinal cord injury. Th en, we researched the neuro-protective and anti-infl ammatory role of leptin on the spinal cord neurons and astrocytes. In the cultured neurons, we discovered leptin administration could enhance the expression of caveolin-1, block the composition of P2X7R-Panx1 complex and reduce the damage to neurons induced by ATP or by modeling operation of SCI. Even without injury operation, the pretreatment with leptin could suppress neuronal Ca2+ imaging triggered by ATP in spinal cord of live transgenic mice. In the cultured astrocytes, we discovered that: 1) the chronic administration of leptin could suppress the release of AA and PGE2 stimulated by ATP from the cultured spinal cord astrocytes; 2) leptin could elevate the expression of caveolin-1 through JAK2/Stat3 signaling pathway; 3) the increased caveolin-1 blocked the conjunction between Src and EGFR; 4) our results highlight leptin as a promising therapeutic agent for SCI.
Thomas Apostolou
Interbalkan Medical Center, Greece
Title: Surgical treatment of osteoarthritis of the hip: The AMIS procedure
Time : 11:10 - 11:30
Biography:
Thomas Apostolou is an Orthopedic Spine Surgeon and certifi ed surgeon in AMIS procedures. He has completed his PhD from Aristotle University of Thessaloniki, Greece and Post-doctoral studies from Aristotle University of Thessaloniki, School of Medicine. He is the Director of 3rd orthopedic department of Interbalkan Medical Center of Thessaloniki and Associate Professor of Department of Physiotherapy at Alexander Technological Educational Institute of Thessaloniki. He has published more than 25 papers in reputed journals and has served as Lecturer of Orthopedics, 1st Orthopedic Department, Aristotle University of Thessaloniki, from January 2014 to May 2015.
Abstract:
Total Hip Arthroplasty (THA) is the second most common joint replacement procedure performed in the United States, aft er primary Total Knee Replacement (TKR). In 2010, more than 300,000 THA procedures were performed. Complications and revision rates, associated with THA, have declined signifi cantly, despite an increasing number of patients at risk for these outcomes. Reasons for residual pain aft er total hip replacement include malalignment of the prosthesis, infection, joint instability, trochanteric bursitis, heterotopic bone formation, and prosthesis loosening. Th e large number of approaches for (THA) had increased signifi cantly the last decades. Transgluteal approach (Hardinge, anterolateral), posterior approach and, recently, anterior approach (AMIS procedure) are the most favorable among the surgeons. Disadvantages of the transgluteal approach are painful limp due to hip abductors damage, pain and stiff ness due to heterotopic ossifi cation, blood loss and prolonged hospitalization. Th e anterior access of the hip was described more than 50 years ago by Robert Judet. Th ese past ten years, several French surgeons, familiar with this technique, have attempted to reduce the size of skin incision, while preserving the muscles in the same manner. Th e benefi ts of AMIS technique are that no muscle or tendon is cut, there is no inter-nervous plane, and is mostly direct approach with small (5-6 cm) incision (real minimal invasive approach). Most comparative studies give a post-op functional advantage to anterior approach with the benefi t of no blood loss, shorter hospital stay and quicker recovery with 2nd post-op day of full weight bearing. Literature validated best functional results with very low dislocation rate for AMIS procedure.
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound-guided ultraminimally invasive carpal tunnel release
Time : 11:30 - 11:50
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Carpal tunnel syndrome is the most surgically treated entrapment neuropathy. It aff ects 1 million adults in the United States annually. Several studies suggest smaller incisions related to lower rates of scar tenderness, pillar pain rates and earlier return to work. Ultrasound-guided ultraminimally invasive release is performed with 1 mm incision, in an ambulant regimen, with local anesthesia, without the need for ischemia. Simultaneous bilateral release is possible even in patients with diseases considered contraindications for classic techniques. Material and methods: Th e instrument set included long needles (a 16-gauge, 1.7-mm diameter Abbocath, USA), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2,3 mm), and an ultrasound device (Alpinion ECube15) with a 10-17–MHz linear transducer and the Needle Vision Plus™ soft ware package. Th e patient is placed supine, with the hand on a table and the palm up. We do not use ischemia. We delineate the midpoint between the nerve and the ulnar vessels, trying to defi ne Nakamichi zone´s midpoint. At the selected midpoint at the forearm, we insert a large spinal needle with local anesthesia and check we pierce the deepest fi bers and are beneath the transverse carpal ligament. Color-doppler function may help us to safely determine the superfi cial palmar arch and guide the distal limit of our instruments. We insert the small and medium V-shaped straight curette guided by the needle. Th e release starts 2-3 mm proximal to the superfi cial palmar arch and proximally we extend the release proximal to the pisiform. We remove the hook knife following the curve of the blade so as not to enlarge the incision. Th e mobility of fi ngers is immediately checked. No stitches are required. We use adhesive-strips and a padded dressing. Th e procedure takes 10 minutes. Results: In 20 cadavers we have checked this procedure to be safe, preserving the nerve and vessels and eff ective. We have operated on 31 hands in 20 patients (11 bilateral cases), 16 women and 4 men. Th e age ranged from 39 to 74 years. One case was a recurrence of open surgery. Patients required “pain killers” for 1-2 days and returned to activities of daily living or work aft er 3 days (1-15 days). Th e Phalen test, Tinel test, reverse Phalen test, carpal compression test, and grip strength signifi catively improved. Quick DASH score improved from 57 pre-op (25-89) to 4post-op (0-9). Th ere were no infections nor nerve damage. Minor superfi cial hematomas were common. Two patients had residual numbness and thenar atrophy despite clinical improvement. Discussion: Better outcomes (in terms of pain, strength, function, and cosmetic aspects) have been reported as dissection was reduced from classic to endoscopic to mini or ultra-minimally invasive approaches. Ultrasound-guided surgery seems to be safe, helpful and successful for carpal tunnel release. It gives the surgeon direct control of the main structures. Since they can be performed on an outpatient basis under local anesthesia and without a tourniquet, complications and contraindications are minimized. As it causes minimal pain and swelling, recovery is quicker.
Manuel Villanueva
Avanfi Institute, Spain
Title: Ultrasound guided ultra-minimally invasive plantar fascia release
Time : 11:50 - 12:10
Biography:
Manuel Villanueva MD, PhD, is Medical Director of Avanfi Institute Institute in Madrid, President of AECE (Spanish Association of Ecoguided Surgery) and Director of Unit for Ultrasound-guided surgery of Hospital Beata Maria, Madrid. Dr. Villanueva is the fi rst Spanish orthopedic surgeon awarded by the AAOS (American Association of Orthopedic Surgeons) for surgical techniques (currently awarded in four times, including several Certifi cate of Merit). Author of eight surgical techniques included in the Educational Media Program of the AAOS, the most prestigious institution in the fi eld of orthopedics and many international conferences and publications. Dr. Villanueva is the fi rst surgeon in the world awarded by the AAOS for Ultrasound-guided ultraminimally invasive surgery. He is involved in research and teaching of these techniques and currently performs more than 20 surgical procedures guided by ultrasound.
Abstract:
Introduction: Plantar fasciitis is the most common cause of heel pain in active working adults between the ages of 25 and 65 years. It causes more than 1 million visits per year to health professionals in the USA. It accounts for about 10% of running related injuries. Th e classic indications for surgery are 6 months of unsuccessful conservative treatment and exclusion of other causes of heel pain. Current surgical options include open surgery, endoscopic surgery and fl uoroscopy assisted surgery. We present an ultrasound guided ultra-minimally invasive technique for plantar fascia release. Material & Methods: We performed a pilot study with 20 cadavers to ensure that the technique was accurate, reproducible and safe. In a second phase, we performed US guided plantar fascia release in 24 patients (26 cases) with chronic plantar fasciitis. Th e instrument set included long needles (a 16 gauge, 1.7 mm diameter Abbocath), a V-shaped straight curette, a blunt dissector, a hook knife (Aesculap 2, 3 mm), and an ultrasound device (Alpinion ECube15) with a 10-17 MHz linear transducer and the Needle Vision Plus™ soft ware package. Th is surgical technique does not require ischemia. Using the ultrasound, we can identify the posterior tibial nerve and inject3-5 cc of 2% mepivacaine. We make a 1-2 mm incision at the selected medial entry point and position the hook in the plane between the fat pad and the fascia before releasing it, thus minimizing damage to muscle tissue. Th e procedure takes 10 minutes and is performed under an outpatient regimen. No stitches are required, just adhesive strips and a padded dressing. Patients are encouraged to walk with crutches immediately aft er surgery without orthotics. Results: We achieved the desired partial plantar fascia release in all the cadavers with no damage to the muscle, nerve or vessels. Th e clinical study population comprised 15 males and 9 females. Th ere were two bilateral cases. Mean age was 39 years (37-59). Patients had received multiple previous conservative treatments for 1-3 years. However, their symptoms failed to resolve. Preoperative plantar fascia thickness ranged 0.7-1.2 cm. Preoperative VAS averaged 9 (8-10), AOSFAS averaged 30 points. Postoperative VAS averaged 1 (0-2) and AOSFAS 91 points (74-100). Patients returned to previous daily activities or sports. Some patients developed superfi cial hematomas that resolved in 2-3 weeks. Discussion: Endoscopic release of plantar fascia have shown excellent results although some drawbacks remain including the need for ischemia, greater dissection and wound healing problems in patients with diabetes or vascular insuffi ciency. Fluoroscopy guided release does not allow us to visualize the muscle nor the fascia. Ultrasound guided ultra-minimally invasive release allows us to prevent damage to the plantar muscles and visualize the width and depth of the fascia. It is performin outpatient regimen, it does not require ischemia or stitches and allows for immediate weight bearing, thus reducing wound healing problems and classic contraindications in patients with diabetes or vascular insuffi ciency. We think that ultrasound guided plantar fascia release may be the technique of choice in the future.
Kathy Kane
Director of Business Development
PharmaLegacy, China
Title: Preclinical development of animal models for Rheumatoid Arthritis that are more clinically relevant and more focused on targeted therapeutics.
Time : 12:10 - 12:30
Biography:
Kathy Kane is the Director of Business Development for PharmaLegacy. She is a Management Executive with over 14 years’ experience in the Biotech Industry in Sales Management and Business Development.
Abstract:
In the past two decades, antibody drugs have achieved great success in the treatment of many human diseases, due to their superior efficacies and pharmacokinetic characteristics. Antibody drugs bind to human disease target molecules with great specificity, and do not cross-react with most rodent targets. This has posted a big challenge to the traditional preclinical efficacy evaluation systems, which are mainly based on rodent models. However, antibody drugs can cross-react with most target molecules in Non-human Primate (NHP) models due to the high homology of these NHP targets with their human counterparts. This makes NHP models an ideal system for preclinical efficacy evaluation of antibody therapies. Since 2009, PharmaLegacy has been dedicated to developing a preclinical evaluation system for antibody therapies based on NHP. Now, PharmaLegacy has established a range of NHP models in inflammation/autoimmune and bone disease areas and has successfully evaluated many candidate mAb drugs binding to important disease targets like TNFα/IL-6/IL-1β and RANKL/Sclerostin. Our experiences have fully demonstrated that NHP models form an ideal preclinical efficacy evaluation system for antibody drugs.
Mohamed Albarouni
Bonn University
Germany
Title: Predictors of response to methotrexate in juvenile idiopathic arthritis
Time : 13:35 - 13:55
Biography:
Dr. Mohamed Albarouni works as a pediatrician since 2007, he has completed his MBBCh from Tripoli University in Libya, he earned his MD degree from University of Bonn in Germany. 2010-2014 he worked in the Centre of Pediatric Rheumatology in Asklepios Clinic Sankt Augustin, Germany. In 2014 he has won the Poster Award of the German Society for Pediatric Rheumatology. Since 2015 he works in the Department of Pediatrics in St. Elisabeth Hospital in Wittlich, Germany.
Abstract:
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic illness in children and it is responsible for short and long-term disability. In the recent years an increased number of disease-modifying anti-rheumatic drugs (DMARDs) have been developed for treatment of juvenile idiopathic arthritis, but methotrexate still the most common second line therapeutic agent used in treatment of JIA worldwide, either as mono-therapy or in combination with biologic agents. However, there is variation in the clinical response to methotrexate among the patients. The main goal of juvenile idiopathic arthritis treatment is the achievement of wellbeing with minimal risk of side effects. Prediction of response can prevent further exposing of patients to side effects of methotrexate and also saving the time by progressing to the treatment with an alternative therapy (e.g. biological drugs) as soon as possible to prevent irreversible complications. Identification of predictors of response might also be helpful to develop recommendations for methotrexate use, especially starting of methotrexate as well as further continuation or early discontinuation and starting use of an alternative therapy. The aim of this study is to determine whether demographic, clinical, articular and laboratory variables at baseline predict methotrexate response in patients with juvenile idiopathic arthritis.
Khalid Masood
Combined Military Hospital Lahore, Pakistan
Title: An easy technique of corrective osteotomy for distal radial deformities
Time : 13:55 - 14:15
Biography:
Khalid Masood obtained his MBBS from Nishtar Medical College Multan, Pakistan in 1988. He initially obtained his fellowship in General Surgery from College of Physicians and Surgeons Pakistan, followed by completion of training in Orthopedic Surgery from Armed forces Post Graduate Medical Institute, Rawalpindi in 2001. He completed his Fellowship in Hand surgery from UK in 2010. Since then, he is practicing exclusively in upper extremity and currently serving as head of department in hand and upper limb surgery centre, Lahore, Pakistan.
Abstract:
Distal radial malunion is being treated by traditional techniques with unpredictable results. Purpose is to report our experience of special technique of corrective osteotomy followed by fixation with locking volar plate to restore best possible anatomy. 34 patients with different types of malunion were operated during last two years. Preoperative evaluation required clinical, radiological or CT-scan assessment followed by preparation of preoperative template. Under C-arm control, open wedge osteotomy was performed by directing the oscillating saw under guidance of two K-wires passed parallel to the articulating surface through two different planes (sagittal and horizontal). Additionally, cortico-cancellous iliac bone graft was used and fixed with 2.7 mm titanium fixed angle locking volar plate. Post-operative results were evaluated by radiological and clinical parameters. This technique significantly improved radiological parameters. Radial height, Radial inclination and Volar tilt improved from 7.9 mm (SD ±2.4), 17.63º (SD±3.5), -1.42º (SD±7.50) to 10.33 mm (SD±1.7), 20.39º (SD±3.7) and 10.53º (SD ±10.53) respectively. Clinically there was eminent improvement in wrist and forearm function, finger movements and grip strength. Anatomical restitution is the hall mark of this surgery which can be achieved by correct way of osteotomy. Rigid peculiarities of volar plates provide the best fixation allowing early post-operative motion with credible outcome.
Bita Anvari
Imam Khomeini Hospital-Kermanshah University of Medical Science, Iran
Title: Methotrexate hepatotoxicity in rheumatoid arthritis - An analysis of the physician's policy
Time : 14:15 - 14:35
Biography:
Anvari B did her Medical education and Internship, from Shiraz University of medical science, in the year 1990-1997, and in 2004-2008, Internal medicine residency and Board (2008), from Tehran University of Medical science. Her previous related work experiences include: from 1997-2004, she worked as a emergency, primary care, and trustworthy physician, from 2008-2009, she worked as a Internist of Internal medicine ward of GHods Hospital, Paveh, Kermanshah, and from 2009 to present, she is working as an Assistant Professor, in Internal medicine department, at Imam Khomeini Hospital, Kermanshah.
Abstract:
Background: Rheumatoid Arthritis is a common chronic disease and concern about the adverse eff ect of methotrexate especially hepatotoxicity could be a reason for discontinuation or reducing dose but the result of multiple policy in this situation is unclear and the physicians need to know what would be happened aft er each decision. Aim of the work: To demonstrate the result of multiple approaches to transaminitis in patients with Rheumatoid Arthritis who received methotrexate. Patients & Methods: Th e data has been collected from the previous work (since 2006) on 295 patients with Rheumatoid Arthritis who received at least 7.5 mg methotrexate for one month in a referral rheumatology clinic. Th e patients who developed transaminitis at least one time were selected for this study (N=102). At this point, physicians’ decision on discontinuing, decreasing, increasing or fi xed dose of methotrexate in approach to patients was collected and the result of the next liver enzyme was evaluated. Results: Decreased dose or discontinuation was happened among 32 patients (31.4%) and fi xed dose or rising dose in 53.9% and 8.8% respectively. Th e result of next enzyme in each group was normal in 93%, 65% and 67% respectively. Among 30 patients who had two consecutive elevated liver enzymes, 30% discontinued or decreased MTX dose. Th e next enzyme became normal in all of them however it was seen in 67% of the others with fi xed or rising dose. Conclusion: Obvious improvement in liver enzymes aft er decreased dose or discontinuation of methotrexate could be seen that makes this policy the best of action in approach to transaminitis of methotrexate, however trend to improvement despite of physicians’ decision were observed. If this natural course may be due to adjustment of hepatocyte activity or renal clearance, it needs to be further investigated.
Cesare Chemello
Asiago Hospital, Italy
Title: PSI: new instruments for a new generation of knee arthroplasty
Biography:
Cesare Chemello has completed his PhD from Padua University (Italy) and Post-doctoral studies from Padua University School of Medicine. From 2009 to 2010, he was a fellow of PhD Confalonieri Roberto in the Teaching Center of Milan where he improved his technique about computer assisted surgery and Total Knee replacement. In 2012, he was a fellow of PhD Alecci where he learned anterior approach and minimally surgery of total hip replacement. From 2013 he is consultant for Microport about Total Knee Replacement. He has published more than 10 papers in reputed journals. He is the winner of the Caos Scholarship in 2010 and SICOT Lester Lowe Award in 2012.
Abstract:
Introduction: Custom Made Surgery seems to be the future of total knee replacement (TKR). “Patients specific instrument” (PSI) helps the surgeon to perform a real tissue sparing surgery (TSS) and it allows to customize the technique and to standardize the results. Usually rheumatologic knees have important axial deviation and important bone loss, for this reason it is difficult to use a traditional prosthesis. The aim of our study was to illustrate the advantages and disadvantages of PSI in a prospective study of 100 pre-navigated total knee replacements.
Materials & Methods: 100 patients, affected by knee advance osteoarthritis and by axial deviation exceeding 3°, underwent to TKR (Advance Prophecy Wright). In the pre-operative examination, a TC was performed following strict protocols. We used a strict radiological protocol Post operative axes were compared to the planed ones and the following angles were examined: between anatomical and mechanical femoral axis (α-AAM), femoral flexion shield (FSF), tibial slope (ST) and frontal angle of the tibial component (α-CT). Negative outcome was considered as axial deviations ± 2 for FSF, ST and ±3 for α-CT e α-AAM.
Results: All patients achieved an excellent clinical and functional result according to KSS. Unplanned gender prosthesis was implanted in two patients. In only 1 case we changed the component size (femoral). In two cases, a 17 mm insert was necessary. Final knee flexion was necessary always more than 105°. Only 2 errors of the final α-AAM
Conclusion: This technique allows performing a TSS surgery, to reduce surgical time, to obtain optimal alignments. This technique also allows converting a challenging knee in a normal knee.
Sameer Naranje
Helena Regional Medical Center, USA
Title: An update on lower limb joint replacement in rheumatoid arthritis
Biography:
Sameer Naranje has completed his fellowship in joint replacement and adult reconstructive surgery from University of Minnesota after completing his M.R.C.S from Royal College of Physicians and Surgeons, Glasgow and Orthopaedic Residency from prestigious All India Institute of Medical Sciences, New Delhi, India. He is currently Chief of Surgery and Orthopaedics at Helena Regional Medical Center, AR, USA and Consultant Orthopaedic Surgeon at East Arkansas Orthopaedic Associates, AR, USA. He has extensive research background, numerous conference presentations, has published more than 30 papers in reputed journals and has been serving as an editorial board member and reviewer of number of reputed Orthopaedic journals.
Abstract:
More than 2/3rd of patients of Rheumatoid arthritis (RA) become disabled 20 years from primary diagnosis. RA is one of the most common indications for lower limb joint replacement in Northern Europe and North America. Though improved medical treatment of RA over last 2 decades have decreased the rate of hip and knee surgery, over a third of patients will need a major joint replacement, of which the majority will receive a total hip or knee replacement (THR and TKR). This paper summarizes an update on the major lower limb arthroplasty surgery for patients with RA. A multidisciplinary approach is needed for preoperative optimization. RA patients may need joint replacement at relatively younger age when compared to the patients with osteoarthritis and may need mutilple revision surgeries over their lifespan. Patients should be made aware of this and increased risk of infection and periprosthetic fracture rates associated with their disease. Biologic agents should be stopped pre-operatively due the increased infection rate. However, continued use of methotrexate does not increase infection risk, and may infact be helpful in recovery. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. Achieving ligamentous balance may be challenging in knee replacements in these patients and more constrained implants may be needed in patients with poor ligaments and severe deformities. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. The results of total ankle replacement remain inferior to THR and TKR though the science of ankle replacement continues to evolve. RA patients achieve equivalent pain relief after joint replacement, but their rehabilitation is slower and their functional outcome may not be optimum due to continued presence or worsening of the disease. Again, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimize their outcome.
Kimihiko Okazaki
Okazaki Medical Clinic, Japan
Title: A case report of Atopic Dermatitis that healed completely
Biography:
Dr. Kimihiko Okazaki was born in Osaka on March 23, 1933. Graduated from Kyoto University Faculty of Medicine in March, 1959. Engaged in medical chemical research work from April, 1960 through July, 1981. Started working as an internist in July, 1981. Started running a private medical clinic in September, 1989.
Abstract:
It has long been taken for granted that every antibody molecule rigidly adheres to its receptor on cell surfaces. Needless to say, to take something for granted is not very scientific. Indeed, another concept that an equilibrium state exists among antibody molecules in the vicinity of their receptors has been established since a half century ago. These two concepts obviously disagree with each other. Needless to say, again, the latter concept is more scientific and relevant than the former. It follows that every receptor of antibodies keeps changing antibodies. It still follows that the ratio of certain kind of antibody occupying receptors equals the ratio of that kind of antibody existing in the vicinity of the receptors. Accordingly, antibodies’ substitution should take place immediately after a new type of antibody appears. Hence, pathogenic antibodies could be detached from their receptors by producing non-pathogenic antibodies in the patients’ bodies. In order to let the patients produce non-pathogenic antibodies, the patients need to receive intra-dermal injections with non-pathogenic antigens. In conclusion, sufficient time of repetition of intra-dermal injections with non-pathogenic antigens should bring about complete cures of all of immunological diseases, i.e. diseases which are caused by pathogenic antibodies.