Presse Med
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Osteogenesis imparfecta (OI) comprises a group of disorders principally affecting type I collagen, which result in increased bone fragility. Lethal forms are rare and are characterised by micromelia with malformation of the limbs. ⋯ Molecular biology and genetic studies offer new possibilities of prenatal diagnosis, but ultrasonography remains the investigation of choice. It confirms the diagnosis by revealing an increase in bone transparency.
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RADIOLOGICAL EVALUATION CRITERIA: To date, outcome of therapeutic trials examining structure modifying treatments has been basically assessed with repeated measurement of joint spaces on plain x-rays. In the ECHODIAH study, these measurements demonstrated an advantage in favor of treatment with diacerein. ⋯ The PHARE study on the epidemiology of osteoarthritis includes three types of patients referred to orthopedic surgeons for degenerative hip disease and undergoing total hip replacement within three Months. Analysis of data collected should provide a better understanding of the factors leading to implantation of total hip prosthesis in daily practice and help determine the validity of total hip replacement or its indication as the main outcome assessment criterion for therapeutic trials.
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GREAT PROGRESS: The use of purified insulins obtained by genetics has dramatically lowered the frequency of insulin hypersensitivity. This frequency has decreased from 1 to 55% with non purified insulins and to 0.1 to 2% with newly generated insulins.
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DEGRADATION AND REPAIR: Osteoarthritis generally occurs in a context of an overloaded normal cartilage matrix or normal loading of a vulnerable cartilage matrix. Interleukin-1 appears to be principally indicated in degradation phenomena while transforming growth factor (TGFbeta) is mainly implicated in phenomena of excessive synovial and chondrocyte repair observed at the same time as degradation. ⋯ Two mechanisms of action have been validated: in vitro inhibition of interleukin-1 (IL-1) synthesis, the main cytokine involved in cartilage destruction, and activity on the synthesis of proteoglycans, and hyaluronic acid, the principal component of cartilage. Other studies presented here have provided further details concerning other mechanisms of action of diacerein.