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Spinal cord injury (SCI) is a devasting neurological condition producing physical dependency, morbidity, psychological stress, and financial burden. During the last 30 years, its global prevalence has increased from 236 to 1298 cases per million populations. Two types of spinal cord injury are primary and secondary injury. Primary injury is mechanical damage to the cord itself whereas secondary injury results from one or more biochemical and cellular processes that are triggered by the primary lesion. In 1700 BC, in an Egyptian surgical papyrus, they describe the frustration of health care professionals in treating a severe spinal cord injury, the Papyrus reported spinal fractures as a “disease that should not be treated”. Most of these studies approach a patient with acute spinal cord injury (ASCI) in one of four manners: corrective surgery or a physical, biological, or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at a minimum, allow for partial functional recoveries for these patients, which could improve their quality of life. More studies were done on spinalized animals that indicate that most of these pharmacological agents may act on receptors present in the spinal cord, thus facilitate to produce coordinated locomotor movement, whereas some other drugs used to improve the neuropathological changes caused because of spinal cord injury (SCI), such as spasticity or demyelination, to improve walking.

Ankylosing spondylitis is a chronic inflammatory arthropathy of young adults which primarily affects the axial skeleton. The pathogenesis of AS is unclear, but it is thought to be caused by an early inflammatory phase followed by ossification that may induce local osteitis. It has also been linked to an increase in morbidity and mortality and is known to have a debilitating impact on QoL of the patients. Whereby, CRP and ESR are used for assessment of the disease activity and determination of treatment efficacy, HLA-B27 is considered the best biomarker for AS diagnosis. The conventional therapeutic regimen like NSAIDs and DMARDs alone are not effective in controlling symptoms and indicators of disease; however, when combined with the physical therapy, great improvement in the QoL of the patients has been observed. The outlook for AS has improved remarkably with the advent of biologics that blocks key inflammatory cytokines such as TNF inhibitors. Biologics aids in halting disease progression, and can be used concomitantly with other medications for pain management. In this chapter, barring surgical interventions, we will discuss about the non-pharmacological and pharmacological therapies routinely employed for the treatment of AS, as well as the novel therapeutics currently under study.

Osteoarthritis (OA) is a debilitating joint disorder with a complex pathogeny wherein diverse factors interact, causing a process of deterioration of the articular cartilage and the subchondral bone. It can be primary or secondary but has common clinical, radiological, and pathological manifestations. Unfortunately, there are no curative or preventive options available for this disease. The knee is the most common site to develop OA among all synovial joints. Both environmental and genetic factors play an essential role in the initiation of the disease. Identifying the genes underlying the genetic background could give new insights into the pathophysiology of knee osteoarthritis (KOA) and could potentially lead to new drug targets. Several genes involving developmental processes or maintenance of cartilage and bone are found to be associated with KOA susceptibility and progression. Understanding the gene functions has improved the knowledge towards the disease pathogenesis. So, it will be of interest to investigate the role of gene-gene interaction in the disease.

BACKGROUND CONTEXT Pressure ulcers (PUs) are wounds initiated by pressure on the skin that blocks circulation, causing the skin and underlying tissues to die. PUs are a major health problem for bedridden patients or persons with reduced mobility; individuals with spinal cord injury (SCI) are especially more prone to developing pressure ulcers. Chronic wounds such as PUs are difficult to treat with available standard medical therapy and represent a burden on health care professionals and drain on resources and developing more effective treatments is therefore a necessity. Recent interest in the treatment of chronic wounds has shifted from a primary focus on the selection of topical dressings augmented by pharmaceutical agents to a focus on therapies designed to enhance various aspects of the wound healing cascade. Negative pressure wound therapy includes mechanical, vacuum-assisted methods that exert negative pressure of 60 to 125 mm Hg on the wound bed. Commercially available devices are typically rented and require costly consumables. This study focuses on a novel, bellows-powered negative pressure device (NPD) that is easy to apply and does not require electricity. PURPOSE The purpose of this study was to find the efficacy of negative pressure wound therapy by a novel negative pressure device for the treatment of PUs. STUDY DESIGN/SETTING This study was done at the Spinal Cord Injury Unit, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, India. PATIENT SAMPLE Thirty-four spinal cord injury (SCI) cases resulting paraplegia with PUs of grade 4 were recruited in the study. All cases were equally divided in two treatment groups: 17 cases managed by negative pressure wound therapy by a novel NPD and & 17 were received wet to moist gauze dressing as standard wound care. OUTCOME MEASURES Reduction of length, width and depth of PUs, reduction of exudate and formation of healthy granulation tissue. METHODS Application of the novel NPD and all subsequent dressing-related procedures occurred at the patient's bedside. The perforated end of the drainage tube was placed on the wound surface, and its other end was extended approximately 10 cm away from the wound margin and connected to the bellows. Sterilized foam was trimmed according to the size and geometry of the wound and placed on top as a cover. The transparent film dressing was used to cover the wound and the border of adjoining healthy skin in order to achieve an airtight seal. The bellows of the NPD was charged to attain appropriate cyclical/ intermittent negative pressure. Patients and caregivers were taught how to charge the NPD and advised to charge it after every 5 to 6 hours. Standard wound care was done by wet to moist dressing with normal saline. RESULTS Wound healing outcome measures were compared at 3, 6 and 9 weeks. There were no significant changes in the length and width of PUs between the groups until week 3. Significantly reduced length and width of NPD treated PUs were found at week 6 (p=0.04) which further reduced at week 9 (p=0.001) as compared to standard wound care group cases. Similarly, significant reduction in the depth of PUs was found in the NPD treated group at week 9 (P CONCLUSIONS Negative pressure wound therapy may be the future of wound healing. Our novel negative pressure device is safe, easy to apply and efficacious in treating the pressure ulcer. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Background Osteoarthritis (OA) is a common cause of musculoskeletal disability among elders and is characterized by late-onset degeneration of articular cartilage. OA affects various joints, commonly hand, knee, and hip, with clinical features that are unique to each joint. This study was initiated to identify and evaluate the role of the ASPN and COMP genes in the development of knee OA. Methods A case–control study was carried out involving 500 cases with knee OA (diagnosed by the American College of Rheumatology) and an equal number of healthy controls. Blood was drawn for genomic DNA isolation. PCR-RFLP and TaqMan assay methods were used to identify the SNPs. mRNA and protein expression of genes were carried out in peripheral blood lymphocytes (PBLs) by RT-PCR and Western immunoblotting. The data obtained were analyzed for the statistical significance between control and case groups. Results The variant genotype of ASPN and COMP genes was found to be present at a relatively higher frequency in cases than controls. RT-PCR and immunochemical studies revealed increased mRNA and protein expression of such gene in PBLs isolated from cases of knee OA as compared to healthy control. Conclusion The allelic alteration in ASPN and COMP genes in knee OA cases points to the role of these genes in the development of knee OA. Further, increased mRNA and protein expression of ASPN and COMP in peripheral blood samples of patients with the disease suggest that expression profile of candidate gene could be used as a biomarker for predicting the development and progression of knee OA.

Background: Osteoarthritis (OA) is one of the most depleting chronic disorders and its pathogenesis is yet to be unfold. It is characterized by pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs. Knee Osteoarthritis (KOA) is multifactorial and remains largely understudied at molecular level. The available literature suggested that the development, onset and progression of OA is significantly affected by genetic factors. Chemokines are small, secreted proteins that released from chondrocytes and/or synovial fibroblasts of KOA patients. In this case control study, we investigated the possible association between promoter polymorphisms rs1024611 and the polymorphism rs4586 in exon 2 of the chemokine (C–C motif) ligand 2 (CCL2) gene and knee OA. Objectives: To investigate the possible association between promoter polymorphisms rs1024611 and the polymorphism rs4586 in exon 2 of the CCL2 gene and KOA. Methods: DNA was obtained from 300 primary knee OA patients and 300 healthy controls. CCL2 genomic variants (rs1024611 and rs4586 polymorphisms) were detected by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). In additional, the effect of serum levels of rs1024611 and rs4586 on cases and controls were examined by enzyme-linked immunosorbent assay (ELISA). Results: The rs1024611 A/G promoter polymorphism was associated with KOA [genotype frequency, p= 0.007; allele frequency, p= 0.01]. Significant association was observed between the G carrier of the rs1024611 A/G promoter polymorphism and primary knee OA patients (p=0.01). However, no significant difference was found in the rs4586 polymorphism. Haplotype frequency analysis revealed a significant difference (x2= 8.01, p= 0.02). The CCL2 serum level of subjects with the G carrier (285.0 ± 86.5 pg/mL) of the rs1024611 A/G promoter polymorphism was statistically higher than that of subjects with the non-G carrier (160.5±47.8 pg/mL). Further in relation with clinical severity of KOA, we observed signification association of the G carrier of the rs1024611 A/G promoter polymorphism with both Visual analogue scale (VAS) (p Conclusion: The G carrier of the rs1024611 A/G promoter polymorphism was found to be associated with primary knee OA, and could be a susceptibility factor in the development of primary knee OA in the North Indian population. References [1] Hulin-Curtis SL, Bidwell JL & Perry MJ. Association between CCL2 haplotypes and knee osteoarthritis. International journal of Immunogenetics.2015 [2] Park HJ, Yoon SH, Zheng LT, Lee KH, Kim JW, Chung JH, Lee YA, Hong SJ: Association of the 22510A/G chemokine (C–C motif) ligand 2 polymorphism with knee osteoarthritis in a Korean population. Scand J Rheumatol 2007;36:299–306 Disclosure of Interests: None declared

Objective: A randomised controlled trial to compare negative pressure wound therapy (NPWT) using our innovative negative pressure device (NPD) and the standard pressure ulcer (PU) wound dressing of in traumatic paraplegia patients. Method: This study was conducted in the Department of Orthopaedic Surgery at King George's Medical University, Lucknow, India. Traumatic paraplegia patients with sacral pressure ulcers of stage 3 and 4 were randomised into two groups, receiving either standard wound dressings or NPWT with NPD. The outcomes monitored were length, width (surface area), depth of PU, exudates, discharge, tissue type (necrotic, slough and red granulating tissue), and cost-effectiveness during 0 to 9 weeks follow-up. Results: Length and width were significantly (pConclusion: Our NPD is better than standard wound care procedures and cost-effective for management of PU.

BACKGROUND CONTEXT Acute spinal cord injury (ASCI) is still having substantial morbidity and mortality despite of advanced therapeutics. Major obstacles are paucity of monitoring tools or biomarkers for severity determination, recovery and prognostication. A prospective case control pilot study with serum 1H NMR spectroscopic metabolic profiling was carried out to evaluate metabolites perturbations and its relationship with recovery and to see role of stem cells in facilitating neurological recovery. PURPOSE A pilot study with serum 1H NMR spectroscopic metabolic profiling was carried out to evaluate metabolites perturbations and its relationship with recovery and to see role of stem cells in facilitating neurological recovery. STUDY DESIGN/SETTING A prospective case control pilot study was conducted in the spinal cord injury (SCI) unit of the Department of Orthopaedic Surgery in collaboration with the Department of Neurology, Department of Biochemistry, King George's Medical University (KGMU), Lucknow and Department of CBMR, Sanjay Gandhi Post Graduate Institute of Medical Science (SGPGIMS), Lucknow from December 2012 to July 2018. PATIENT SAMPLE A total of 135 subjects were enrolled in the study. OUTCOME MEASURES NMR data of serum and urine samples were quantified and subjected to multivariate analysis using supervised OSC-PCA followed by OPLS-DA was performed in the full study. This finding was further validated in the VIP scores. METHODS A prospective case control pilot study total of 135 subjects were enrolled in the study; 65ASCI subjects, divided into two groups. Fixation alone (FA, n= 34). Fixation with stem cells therapy (FST, n= 31). Seventy healthy subjects (HCs) were enrolled. Serum and urine samples were collected at admission (baseline), sixth week, third month and after sixth month (follow-up). RESULTS Gender analysis revealed that 103 out of 135 participants were male. The age group of 18 to 30 years was found most prone to SCI. Fall from height and road traffic accidents were the two most common modes of injuries. Most common injured segments of thoraco-lumbar spine were T10-L2 levels. On AIS grading, highly significant improvement was observed in FST group in comparison to FA group. In FST group, 61.29% subjects remained in AIS A and the percentage improvements to AIS B, C and D were 12.90%, 16.13% and 9.68%, respectively, whereas in FA group these values were 67.65%, 17.64%, 11.76% and 2.94%, respectively. At the sixth month follow-up, improvements in sensory and motor scores were observed in both cases groups (FST and FA), but FST group showed better results. In the spectra of urine biofluid, 43 metabolites were identified and assigned and t28 metabolites were identified and assigned in serum biofluid. Predominantly amino acids and ketone bodies played vital role in the differentiation of groups. An OSC-PCA and OPLS-DA model was created for investigating the role of metabolites in differentiation amid all ASCI subjects against healthy control at baseline as well as at final follow-up. Statistical comparison was validated by OSC-PCA as well as OPLS-DA methods and multivariate data analysis resulted in to R2 value of 0.91 and 0.81 and Q2 value of 0.81 and 0.67, respectively. The generated model was robust enough for evaluating the differentiation among the present data set. The 3D OSC-PCA model generated resulted to the total explained variance of 50.21% and 50.67%, respectively. The 3D scattered score plots represented the shifting of more ASCI subjects towards healthy control in the final follow-up, which is suggestive of improved health status and an indicator of better prognosis in ASCI subjects. CONCLUSIONS Serum and urine NMR spectroscopy reveals certain metabolites perturbations having clear correlation with pattern of recovery in treated ASCI subject. Stem cells treatment group had comparatively effective recovery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

AIM We investigated prognostic significance of methylation status of MASPIN gene and its protein expression in normal subjects, cholelithiasis and gallbladder cancer (GBC) patients. METHODS MASPIN protein expression and its promoter methylation in gallbladder tissue of cholelithiasis (n = 36), GBC (n = 46) and controls (n = 25) were investigated. Clinicopathological parameters and prognosis of patients with GBC were correlated with protein expression of MASPIN. Survival analysis of GBC patients was performed using Kaplan-Meier method. RESULTS Significant increased (P

Background Acute Spinal Cord Injury (ASCI) is still having substantial morbidity and mortality despite of advanced therapeutics. Major obstacles are paucity of monitoring tools or biomarkers for severity determination, recovery and prognostication. A prospective case control pilot study with serum 1H NMR spectroscopic metabolic profiling was carried out to evaluate metabolites perturbations and its relationship with recovery and to see role of stem cells in facilitating neurological recovery. Methodology Twenty subjects with ASCI were classified on the basis of therapeutic modality into surgical fixation alone (Group-1, n = 10), stem cell adjuvant (Group-2, n = 10) and healthy controls (Group-0, n = 10). Serum samples were collected at admission (baseline) and after six months (follow-up). NMR data of serum sample were quantified and subjected to Wilcoxon and ANOVA tests. Further validation was performed using supervised OSC-PCA and OPLS-DA by incorporating substantial control samples. Result Twenty-eight metabolites were identified; well resolved resonances of fifteen metabolites were quantified wherein seven were statistically significant. Predominantly amino acids and ketone bodies played vital role in the differentiation of groups. Conclusions Serum NMR spectroscopy reveals certain metabolites perturbations having clear correlation with pattern of recovery in treated ASCI subject. Stem cells treatment group had comparatively effective recovery.

Introduction: The role of genetic factors influencing osteoarthritis (OA) susceptibility is well documented and several candidate genes have been identified to be associated with it. Among these genes are Bone Morphogenetic Protein 5 (BMP5) and Smad family member 3 (SMAD3), all involved in Transforming Growth Factor (TGF) signaling pathway. The knee is the commonly affected joint, and knee OA has an especially high prevalence in Asian population. Aim: To investigate associations between Single Nucleotide Polymorphisms (SNPs) rs12901499 in SMAD3 and rs921126 in the BMP5 gene with knee OA susceptibility in and around Lucknow, Uttar Pradesh, India. Materials and Methods: SNPs rs12901499 in SMAD3 and rs921126 in BMP5 were genotyped in patients with knee OA and age- sex matched OA-free controls from our population. A total of 450 patients with knee OA and 458 controls were enrolled in the study. Venous blood samples were obtained from all cases as well as controls for PCR-RFLP (Polymerase Chain Reaction- Restriction Fragment Length Polymorphism). Data was collected and entered in excel sheets. Statistical analyses of the data were performed using statistical software package SPSS version 16.0. Chi-square, Student’s t-test and logistic regression tests were used to analyse the data. Results: GA and GG genotypes of both SNPs (rs12901499 and rs921126), and variant G, were associated with a significantly increased risk of knee OA. A significantly increased risk of knee OA was associated with the genotype GG and GA of rs12901499 (p < 0.03 and p 55 years (adjusted OR= 3.4), similarly in rs12901499, GG mutant compared with AA homozygote was strong in female (adjusted OR= 1.5) and in those aged >55 years (adjusted OR= 1.5). Conclusion: The results showed that both in SMAD3 rs12901499 and BMP5 921126, G allele is significantly associated with knee OA. A to G change and variant G genotype may contribute to knee OA risk in our study population of Lucknow.

PURPOSE The purpose of this study was to assess the level of matrix metalloproteinase-8 (MMP-8) and wound-healing outcome measures (length, width, and depth, exudate amount, and tissue type) in pressure injuries (PIs) of spinal cord-injured patients treated with negative pressure wound therapy (NPWT) using a novel negative pressure device versus PI treated with wet to moist gauze (conventional wound care). DESIGN Randomized controlled trial. SUBJECTS AND SETTING Forty-four spinal cord-injured patients with stage 3 and 4 sacral PI participated in the study. The study setting was the Department of Orthopedic Surgery at King George's Medical University, in Lucknow, India. METHODS Twenty two subjects were randomly allocated to undergo NPWT via a novel negative pressure device, and 22 participants received conventional wound dressing (wet to moist gauze dressings). Pressure injuries were treated for 9 weeks or until wound closure. Levels of MMP-8 were analyzed in the tissues of PIs at weeks 0, 3, 6, and 9 by enzyme-linked immunosorbent assay. RESULTS Significantly lower levels of MMP-8 were observed in the NPWT group at week 6 and week 9. There were no significant changes in the length and width of PIs between the groups till week 3. Significant reduced length and width were observed in PIs of patients in the NPWT group at week 6 (P = .04) and week 9 (P = .001). Similarly, significant reduction in the depth of PIs was observed in the NPWT group at week 9 (P < .05). At the end of 9 week, levels of MMP-8 showed a positive correlation with reduction in the length, width, and depth of PIs in the NPWT group while in the conventional dressing group, negative correlation was observed in association with MMP-8 and the length, width, and depth of PIs. Exudate levels were significantly lower in the NPWT group compared with the conventional dressing group from week 3 (2.96 ± 0.21 vs 2.62 ± 0.49); this difference persisted through week 9 (1.35 ± 0.75 vs 0.14 ± 0.35). Conversion of slough into red granulation tissue was significantly higher in the NPWT group after week 6 (P = .001). CONCLUSION Reduced levels of MMP-8 and an increased rate of healing were found in patients allocated to treatment with a novel negative pressure device as compared to wet to moist gauze conventional dressing. The novel NPWT device used in this study reduced exudate production and enhanced the rate of formation of red granulation tissue.

Nutritional imbalance, combined with endocrine abnormalities, may be involved in the pathogenesis of osteoarthritis (OA). This study was conducted to determine the association of OA with dietary factors, such as quantity and quality of nutrient intake.This case-control study enrolled 180 knee osteoarthritis (KOA) subjects who met the American College of Rheumatology definition of KOA, with an equal number of matched controls. Outcome measures, such as dietary nutrient intake and its frequency, were recorded using a food frequency questionnaire.Compared to controls, cases were older individuals with a higher body mass index (BMI). Physical activity scores were lower in female cases compared to male cases and controls. A significantly higher intake of phosphorus and fat was observed in overall cases (fat in females only). A significantly lower intake of vitamin C and vitamin D was observed in overall cases and the significance of vitamin D persisted on gender-wise bifurcation. On multiple logistic regression analysis, the intake of vitamin D (odds ratio [OR] = 0.79) and vitamin C (OR = 0.97) was inversely associated with the presence of KOA in the observation group, especially in females. Generally, the intake of food servings/day, green leafy vegetables (GLVs), and fats/oils was higher, whereas the intake of fruits, milk/milk products, and meat/poultry was lower in cases compared to controls.Low intake of vitamin D and vitamin C is a possible risk factor for KOA. Certain food groups, such as fruits, milk/milk products, and meat/poultry are beneficial for KOA. Further studies are needed to elucidate the associations between diet and KOA.

The conventional methods of treatment of pressure ulcers (PUs) by serial debridement and daily dressings require prolonged hospitalisation, associated with considerable morbidity. There is, however, recent evidence to suggest that negative pressure wound therapy (NPWT) accelerates healing. The commercial devices for NPWT are costly, cumbersome, and electricity dependent. We compared PU wound healing in traumatic paraplegia patients by conventional dressing and by an innovative negative pressure device (NPD). In this prospective, non-randomised trial, 48 traumatic paraplegia patients with PUs of stages 3 and 4 were recruited. Patients were divided into two groups: group A (n = 24) received NPWT with our NPD, and group B (n = 24) received conventional methods of dressing. All patients were followed up for 9 weeks. At week 9, all patients on NPD showed a statistically significant improvement in PU healing in terms of slough clearance, granulation tissue formation, wound discharge and culture. A significant reduction in wound size and ulcer depth was observed in NPD as compared with conventional methods at all follow-up time points (P = 0·0001). NPWT by the innovative device heals PUs at a significantly higher rate than conventional treatment. The device is safe, easy to apply and cost-effective.

Maspin expression is a potential prognostic factor for various malignancies but its relation with gallbladder cancer is unknown and needs to be investigated needs to be investigated. We therefore here focused on maspin mRNA expression in normal, gall stone disease and gallbladder cancer subjects, with particular attention to prognostic importance in individuals with malignancies.This study was carried out at the Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India. Gallbladder samples from normal (n=25), gall stone disease (n=25) and cancer patients (n=38) were analysed for maspin mRNA expression by semi-quantitative reverse transcriptase PCR and quantitative real time PCR. Statistical analysis was carried out using the Students t test or ANOVA. Survival analysis was conducted according to the Kaplan-Meier method and correlations were assessed using the Pearson correlation method. p0.05 was considered statistically significant.Significant increase (p=0.028) in expression of maspin mRNA was observed in gallbladder cancer as compared to gall stone disease, whereas no expression was found in normal tissues. Significant correlation (Pearson's coefficient(r)=-0.798, p0.0001) was observed between relative quantification of maspin mRNA and survival of cancer patients after surgery, with significantly shorter (p=0.002) survival in patients having relative quantification1.5 as compared to those having relative quantification1.5. Similarly, significant differences in patient survival for maspin mRNA expression was observed for stage II (p=0.025) and III (p=0.011) cancer.Higher expression of maspin mRNA in gallbladder cancer has prognostic significance for stage II and III cancer, which needs to be investigated further.

The present study investigated to identify the association of polymorphism in GDF-5 gene with osteoarthritis in North Indian population. In a case-control study, 300 cases with knee osteoarthritis and an equal number of age and gender matched healthy controls were included. Cases were diagnosed using the ACR Guidelines of Knee Osteoarthritis (KOA). Clinical symptoms were assessed with the knee specific WOMAC index and VAS for knee pain. The severity of disease was determined by radiological KL grades (Kellgren Lawren). The variant genotype of GDF-5 was found to be present at significantly higher frequency in cases than in controls, resulting in about 1.79 fold increase in risk to OA. Genotype distributions of the GDF-5 also showed significant association of variant allele with clinical score of OA patients. An association between the+104T/C GDF5 polymorphism with knee OA and clinical symptom of OA in Indian population further demonstrate a strong genetic influence of this SNP in KOA.

Handwritten character recognition has been one of the most fascinating research among the various researches in field of image processing. In Handwritten character recognition method the input is scanned from images, documents and real time devices like tablets, tabloids, digitizers etc. which are then interpreted into digital text. There are basically two approaches — Online Handwritten recognition which takes the input at run time and Offline Handwritten Recognition which works on scanned images. In this paper we have discussed the architecture, the steps involved, and the various proposed methodologies of offline and online character recognition along with their comparison and few applications.

Post-operative sepsis remains a substantial cause of morbidity and mortality. In injured patients, that a polymorphism of the gene for tumor necrosis factor-β (TNF-β) has been related to the development of sepsis. Genetic factors may also have a role in etio-pathogenesis of sepsis following surgery. We investigated the relationship of the polymorphism of the gene for TNF-β and the serum concentration of TNF-α to the development of sepsis after elective major surgery.The study population consisted of 211 patients undergoing major elective surgery. The NcoI polymorphism of TNF-β was studied in genomic DNA through the analysis of restriction fragments of Nco1-digested DNA with the polymerase chain reaction (PCR). All patients were followed for 1 mo after surgery for any evidence of sepsis. Serum concentrations of TNF-α were measured pre- and post-operatively by enzyme linked immunosorbent assay (ELISA). Genotypes of TNF-β and the production of TNF-α were related to the occurrence of sepsis.Post-operative sepsis developed in 21.8% (n=46) of the patients. The overall mortality was 4.2% (n=9). The overall allele frequency of the TNF-β genotype was 0.32 for TNFB1 and 0.68 for TNFB2. Within the TNF-β genotype, 11.84% (n=25) of the patients were homozygous recessive for TNFB1, 41.23% (n=87) were heterozygous, with TNFB1/TNFB2, and 46.91% (n=99) were homozygous dominant for TNFB2. The incidence of post-operative sepsis was significantly (p=0.01) higher in patients homozygous for the TNFB2 allele. When compared with patients carrying at least one TNFB1 allele (TNFB1 homozygous and heterozygous genotype), the TNFB2 homozygous genotype was associated with an odds ratio (OR) of 2.60 (p=0.005; 95% CI 1.32-5.15) for the development of sepsis. As compared with that for the heterozygous genotype, the OR for the homozygous TNFB2 genotype was 3.00 (p=0.003; 95% CI 1.39-6.44). In patients with post-operative sepsis, serum concentrations of TNF-α were significantly higher (p=0.02) in TNFB2 homozygous individuals than in those of individuals of the other TNF-β genotypes.The development of sepsis was associated with a greater capacity to produce TNF-α after surgery. The Nco1 polymorphism of the TNF-β gene was associated with the development of post-operative sepsis with an increased serum concentration of TNF-α. In patients without post-operative sepsis, polymorphism of the TNF-β gene was not related to different levels of TNF-α production. This indicates an association between polymorphism of the TNF-β gene and post-operative sepsis, suggesting the TNFB2/B2 genotype as a high-risk factor for the development of sepsis after elective surgery.

Early prediction of postoperative sepsis remains an enormous clinical challenge. Association of TNF-α-308 G/A polymorphism with sepsis remains controversial. We, therefore, investigated this polymorphism with serum levels of cytokines TNF-α, IL-6, and IL-8 in relation to development of sepsis following major gastrointestinal surgery. Two hundred and thirty-nine patients undergoing major gastrointestinal surgery were enrolled. Polymorphism was studied through the analysis of restriction fragments of Nco1-digested DNA with the polymerase chain reaction. All patients were followed for 1 month following surgery for evidence of sepsis. Levels of serum cytokines TNF-α, IL-6, and IL-8 were measured preoperatively and postoperatively by enzyme-linked immunosorbent assay (ELISA). Forty-seven (19.66 %) patients developed postoperative sepsis. Patients with postoperative sepsis were significantly (p = 0.002) more likely to possess AA homozygous genotype with higher capacity to produce cytokines TNF-α (p

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S251 patients aged < 60 years. Patients aged 60 years showed improved WOMAC Total score for continuous vs intermittent treatment, but statistical significance was not attained. These data may be useful for health care providers in considering the treatment of OA patients. 477 SERUM URIC ACID AS A PREDISPOSING FACTOR OF CLINICORADIOLOGICAL SEVERITY OF OSTEOARTHRITIS KNEE R.N. Srivastava, D. Sanghi, A. Mishra, A. Sharma, S. Raj, S. Natu. KG Med. Univ., Lucknow, India Purpose: Osteoarthritis (OA) is the most common arthritis worldwide. The association with age, obesity, gender and metabolic factors has been studied widely. Evidence suggests that hyperuricemia is significantly associated with OA of multiple joints. The high level of uric acid involved in cartilage degeneration may modulate radiological features of knee OA. Some study reported that uric acid is associated with generalized OA and other reported that it is a danger signal of increasing risk for OA through inflammasome activation and concluded that synovial uric acid is a marker of knee OA severity. Both OA and hyperuricemia are common in India. This study aimed to investigate the association of serum uric acid with clinico-radiological feature of knee OA in Indian population. Methods: 180 patients of OA knee diagnosed according to American College of Rheumatology (ACR) guidelines as cases and equal number of controls were enrolled. Clinical OA outcome: pain, stiffness and functional disability were recorded by knee-specific WOMAC index and knee pain was also measured by 10 point VAS. Radiological grading was done by KL grades. In addition, four individual radiological features (IRF)joint space width, osteophyte, subchondral sclerosis and tibio femoral alignment were also recorded separately. Demographic were recorded by self report. Serum uric acid levels were measured by enzymatic method using Uricase Peroxidase and analyzed for the interlinking associations. Results: OA knee cases had significant higher BMI than controls in overall and in both the genders separately. In females, serum uric acid levels were significantly higher in cases in comparison to controls but such association was not observed in males and in overall subjects. Other biochemical variable like random blood sugar and total proteins were not significantly different between cases and controls in any category. On analyzing serum uric acid level with clinical features, pain (VAS and WOMAC) was significantly associated (p1⁄40.02 and p1⁄40.03) with elevated serum uric acid levels in females; VAS pain alone in overall study population (p1⁄40.024) but not in males. While studying the radiological features, an increase severity of disease (increasing KL grades) was observed with increase in serum uric acid levels (KL grade 4 was 5.26 1.1, KL grade 3 was 4.32 0 .95 and KL grade 2 was 3.63 0.95) in overall subjects and in both the genders separately. No significant association was observed for individual radiological features (IRF). Conclusion: Radiological severity (KL grade) and knee pain was found to be significantly associated with serum uric acid levels in overall subjects and in females in OA knee. 478 PLASMA ADIPOKINES AS MEDIATORS IN EARLY KNEE OSTEOARTHRITIS: DATA FROM COHORT HIP AND COHORT KNEE (CHECK) W.E. van Spil, P.M. Welsing, M.B. Kinds, S.C. Mastbergen, J.W. Bijlsma, F.P. Lafeber. Univ. Med. Ctr. Utrecht, Utrecht, The Netherlands Purpose: Associations of body mass index (BMI) with hand osteoarthritis (OA) have suggested that humoral obesity-related factors may be involved in the pathogenesis of OA. Systemic adipokine levels depend on BMI (amount of fat), gender (different fat distribution between genders), and to a lesser extent age. The purpose of the current study was to determine whether plasma adipokines could be identified as potential mediators of associations of BMI and other demographic variables with radiographic knee parameters in CHECK (Cohort Hip and Cohort Knee), a cohort of (very) early-stage symptomatic knee and/or hip osteoarthritis (OA). Methods: Plasma (p-) leptin, adiponectin, and resistin levels were determined by enzyme-linked immunosorbent assay. Joint space width (JSW; minimum, mean medial, and mean lateral), osteophyte (OP) area, and subchondral bone density (BD) were quantified in detail on posteroanterior knee radiographs using Knee Image Digital Analysis (KIDA). Mediation analysis was performed to determine whether indirect associations through adipokines could explain (part of the) associations of BMI and other demographic variables with radiographic knee parameters. Results: Adipokine and radiographic data were complete for approximately 430 CHECK subjects with knee pain. pLeptin was identified as potential mediator of associations of BMI and female gender with JSW. Likewise, pResistin was a potential mediator of an association of BMI with JSW. None of the adipokines could be identified as potential mediators between demographic variables and OP area. pAdiponectin appeared to be a potential mediator of associations of BMI and female gender with subchondral BD. Although statistically significant, associations of demographic variables and adipokines with radiographic knee parameters were weak and adipokines could explain only part of the associations between demographic variables and knee parameters. Conclusions: Systemic adipokines might be mediators of associations of BMI and gender with JSW and subchondral BD. As such, although their rolemight be limited, theymay play a role in the etiology of (knee) OA. 479 THE ASSOCIATION BETWEEN KNEE FUNCTION AND RADIOGRAPHIC OSTEOARTHRITIS IN A POPULATION BASED COHORT THE MUSCULOSKELETAL ULLENSAKER STUDY B. Oiestad y,z, C. Norstad Engen x, M. Risberg k,y. yNorwegian research centre for Active Rehabilitation, Oslo, Norway; zOslo Univ. Hosp., Oslo, Norway; xOslo Sports Trauma Research Ctr., Oslo, Norway; kNorwegian Sch. of Sport Sci., Oslo, Norway Purpose: The objective of this study was to investigate the association between radiographic knee osteoarthritis and knee function evaluated by both self-reported questionnaires and performance based tests. Methods: The Musculoskeletal Ullensaker study (MUST) is an ongoing population-based study of musculoskeletal disorders performed in Ullensaker municipality representing the Norwegian population. Invitation letters were sent to all the inhabitants between 40 and 79 years (n1⁄412000), and those who self-reported either hand, knee, or hip osteoarthritis, verified by their general practitioner, were invited to a clinical examination including functional, clinical, and radiographic measures of the three joints. Standing radiographs using SynaFlexer frame for standardized positioning were taken of all the invited participants and scored with the Kellgren and Lawrence atlas (grade 0-4). Osteoarthritis was defined as KL grade 2. Knee injury and Osteoarthritis Outcome Score (KOOS) was used for measuring pain, symptoms, and activities of daily living (ADL), function in sport and recreation (sport/rec), and knee-related quality of life (QOL). The 30-second Chair Stand test and 6 min-walk test were included to measure performance based function. Multivariate regression analyses with each KOOS subscale and the performance based tests as dependent variable were associated with radiographic osteoarthritis in one knee, adjusted for gender, age, and body mass index (BMI). Results: Three hundred and twenty three patients were examined between 2010 and 2012 (31% males and 69% females). The mean age was 63.5 8.8 years. Knee osteoarthritis was found in 8.7% for the right knee (n1⁄428), in 6.8 % for the left knee (n1⁄422), and 34 patients (10.5%) had osteoarthritis in both knee joints. Two hundred and twenty seven patients (70%) had no radiographic knee osteoarthritis. Significant associations were found between radiographic osteoarthritis in one knee and the following KOOS subscales: pain (Beta SE: -13.7 3.7, p

Materials and methods This randomized placebo-controlled trial recruited 103 KOA cases as per American College of Rheumatology (ACR) guideline having vitamin D insufficiency (25(OH) D≤50 nmol/L). Enrolled cases were randomly allocated in two groups to receive placebo (51) and vitamin D (52). Primary outcome measures: pain and functional disability which were recorded by knee specific WOMAC index and secondary outcome measure were radiological features (joint space width and osteophytes). The serum levels of vitamin D were assessed by ELISA method using IDS, UK kit. Detection of VDR polymorphisms (Taq1 & Apa I) were done by PCR-RFLP technique. 25(OH)D levels, clinical and radiological features were recorded at baseline and at one year follow up.

Background Postoperative sepsis remains a challenge for joint care surgeons as it is a significant cause of morbidity and mortality. It has been postulated that genetic factors may have a role and the accurate identification of such risk factors may develop strategies to prevent these potentially devastating catastrophes. Tumor Necrosis Factor (TNF) is believed to be a cytokine central to pathogenesis of sepsis and the TNF-β Nco1 polymorphism has been found to be associated with increased mortality rate in severe sepsis. We postulated that Nco1 polymorphism may be associated with post operative infection in some patients but not in others Objectives The objective of the study was to analyze TNF- β Nco1 polymorphism in relation to postoperative sepsis outcome in joint care surgeries Methods The study group consisted of 153 patients undergoing major elective surgery (surgical time more than 1 hour and requiring general anesthesia and or respiratory assistance). Blood samples were obtained for genomic DNA isolation. Genotyping of each patient for TNF- β polymorphism was performed by analyzing restriction fragments of an Nco1-digested DNA fragment obtained using polymerase chain reaction. All the patients were followed for 1 month following surgery for any evidence of sepsis as determined by guidelines from Bone et al. Subjects with and without post-operative infection were compared on presence or absence of polymorphism and of confounder status. Comparison of the proportions gave the odds ratio and odds ratios adjusted for confounders. All the possible confounders were controlled by stratified or regression analysis. Results The overall allele frequency for TNF-β genotype was 0.32 for TNFB1 and 0.68 for TNFB2. In TNF-β genotype, homozygous recessive TNFB1 were 17 (11.1%), heterozygous TNFB1/TNFB2 were 63 (41.2%) and homozygous dominant TNFB2 were 73 (47.7%). 125 patients showed an uncomplicated postoperative recovery, while 25 developed mild sepsis and 3 developed severe sepsis. Genotype distribution in patients with an uncomplicated clinical course was significantly different from that in patients with postoperative sepsis. Development of postoperative sepsis was significantly higher in patients homozygous for the allele TNFB2. When compared with patients carrying at least one TNFB1 allele (TNFB1 homozygous and heterozygous genotype), the TNFB2 homozygous genotype was associated with an OR of 3.39 (p=0.005; 95% CI 1.4 to 8.3) for the development of severe sepsis. Compared with the heterozygous genotype, the OR for the homozygous TNFB2 genotype was 5.5 (p=0.001; 95% CI 1.78 to 17.33). Although the small number of TNFB1 homozygous surgical patients makes their risk estimate less accurate, the data indicate that both homozygous genotypes possess a significantly increased susceptibility for the development of postoperative sepsis compared with the heterozygous genotype Conclusions The Nco1 polymorphism within the TNF-β gene influences the development of postoperative sepsis. Both homozygous genotype TNFB1 and TNFB2 has a higher risk of developing post operative infection. In general, TNFB2 homozygous genotype is significantly associated with development of postoperative sepsis. This suggests a genetic determination of the individual inflammatory response, which significantly influences susceptibility to postoperative infection in joint care surgeries Disclosure of Interest None Declared

Background: An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations. Aim: The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ) and their effect on endotoxemia. Materials and Methods: Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer's lactate) was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored. Results: Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020) and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P > 0.0001) was observed in both groups after resuscitation. Significantly decreased (P = 0.036) post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023) in Group B as compared to Group A (6 vs 0). Electrolyte abnormalities were found more in Group B, however statistically insignificant. Conclusion: In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.