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Osteoarthritis: An Incurable Disease That Affects 500 Million People

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A kind of gelatinous sponge bears the burden of articulating the human body’s bones. For example, to move the knee, the femur dances on a bed of menisci that cushion the friction against the bone below, the tibia. This cartilage is elastic to bear the weight of rotation and movement; it adapts to a movement’s needs and then returns to its natural position when the leg is at rest. But these joint pads also tire and age, while overload and lifestyle habits can erode them to the point that they disappear. That’s called osteoarthritis, a disease that has no cure. The condition is extremely debilitating and affects more than 500 million people worldwide: it starts as a silent disease that doesn’t cause pain or symptoms for around 20 years; by the time it is diagnosed, the cartilage is so worn out that not much can be done. Scientists are researching biomarkers to detect the disease in its early stages and drugs to slow its progression.

Osteoarthritis diagnoses have skyrocketed by 113% over 30 years. In 1990, an estimated 248 million people had osteoarthritis; in 2020, that figure rose to 528 million, according to a study published in Arthritis and Rheumatology, the American Society for Rheumatology’s journal. An aging population partly explains this increase, but other factors also play a role.

Francisco Blanco, the coordinator of the Rheumatology Research Group at A Coruña’s Institute for Biomedical Research (Inibic) and a leading researcher of osteoarthritis, explains that there are mechanical causes, resulting from joint overload, that lead to osteoarthritis. This is not always a function of age; it also depends on the intensity of joint wear and tear, as in the case of elite athletes, for example: “The tissue has a [certain amount of] resistance, and a time comes when that’s destroyed. Mechanical overload produces a series of substances that induce the [cartilage] cell to go into apoptosis,” an active death process in which the cells decide to “commit suicide,” the researcher explains.

Aging is linked to these mechanical causes, but Blanco points out that there’s another factor at play: “As time goes by, alterations occur in the mitochondria of cells that produce certain substances, such as oxygen free radicals, that also end up causing apoptosis.” A study by the Spanish Society of Rheumatology showed that 30% of Spaniards over 40 years old suffer from osteoarthritis, and the disease is more common in women. That figure increases with the passage of time; more than half of people over the age of 80 suffer from the disease.

Researchers have also discovered that classic mediators of inflammation exist in osteoarthritis; these are the same ones that appear in other ailments, like rheumatoid arthritis. The mediators of inflammation showed up “at a lower level, but they were still present and induced cell death from inflammation,” explains Blanco, who’s a spokesperson for the Spanish Society of Rheumatology. In osteoarthritis, there’s usually a lesser degree of inflammation that’s concentrated in the joint – it hurts when moving and stops when at rest – while in arthritis there’s systemic inflammation (it can even affect other organs, such as the lungs or the heart) and usually causes pain at rest.

Experts are also exploring a metabolic cause of osteoarthritis, says Blanco: “We’ve always known that obese people have more osteoarthritis of the knee, but it had been attributed to a mechanical effect, because the joint had to carry more weight. Now, we know that there’s also a metabolic effect on cartilage: atherosclerosis occurs and there’s plaque in the cartilage.” That creates thicker tissue; biomechanically, in addition to being impractical, it can be cytotoxic.

In practice, the outcome is essentially the same: “Cartilage begins to wear down and the bone is exposed. Bone is a rigid structure that doesn’t cushion impact well; when bones rub against each other, the body’s defense mechanism for dealing with that is to produce more bone, which causes sclerosis: the bone becomes harder, while the joint deteriorates, hurts more and doesn’t move well,” says Blanco. Experts explain that osteoarthritis of the hips and knees is the leading cause of the functional inability to walk among people over 70 years old, and over half of all affected patients lack a way to control pain.

Osteoarthritis doesn’t have a cure, and there aren’t any drugs to slow its progression. Scientists are testing drugs to control the disease, but they haven’t found the root of the problem; they’re also trying to build new cartilage through tissue engineering, but none of it resembles that of a healthy human. Doctors tackle symptoms with anti-inflammatory drugs and prescribe analgesics to relieve pain.

Primary care physicians – who, along with rheumatologists, monitor these patients – also recommend that people suffering from osteoarthritis engage in physical activity, says David de la Rosa, a member of the Spanish Society of Family and Community Medicine’s Rheumatologic Diseases group: “Pain prompts these patients to go to the doctor. We have to empower them, explain the disease’s causes and evolution, tell them that there’s no cure, but that we’re going to try to prevent its progression. We have to explain to them that treatment is important, but that’s only one part of it: they also need physical exercise.” The physician points out that, while it is important to find “a drug that allows us to control the disease or prevent its progression,” it’s even more important to focus on “non-pharmacological approaches and to improve information and knowledge about the disease and care pathways.”

Luz Cánovas, a member of the Spanish Pain Society’s Working Group on Musculoskeletal Pain, notes that osteoarthritis “involves limited movement in 80% of the cases, and patients are in pain for most of the year.” That pain is only attenuated with rest; in a kind of vicious cycle, that can lead to a more sedentary lifestyle, which doesn’t support the approach to treating this disease or preventing other ones such as obesity. “Patients are most concerned about experiencing pain and functional limitations,” the specialist explains. However, she points out that there are preventive measures, such as weight loss if a patient is obese or overweight, and personalized exercises for improving mobility (cycling, yoga, swimming, etc.), as well as anti-inflammatory drugs, analgesics and even thermal radiofrequency techniques to reduce pain.

Late detection

Blanco says that late diagnosis is the biggest obstacle to treating osteoarthritis. By the time the disease emerges, the cartilage has already been suffering for about 20 years; because the tissue isn’t vascularized and doesn’t have nerves, it doesn’t bleed or hurt until it’s too late. “Now, with new treatments, such as platelet-rich plasma and growth factors, you can delay the problem for three or five years, but you can’t resolve it. We believe that the solution needs to focus on the 20 years when the disease is latent; surely, treatments or tissue engineering can control the disease in its early stages.”

Scientists are currently researching biomarkers that can predict the disease or detect it early. At present, 20 genes and proteins are associated with and signal the ailment; carriers have a greater risk of developing the disease. But we still need to learn the origins and initial causes of osteoarthritis, as well as figure out which gene plays the most important role in it.

May de Andrés, a biologist and the Miguel Servet researcher at Inibic, focuses on preventing the disease from emerging altogether. For that reason, she works on the epigenome, the chemical substances that stick to genes and are conditioned by one’s environment and life habits; the epigenome can modulate a gene’s activity, turning it on or off like a switch: “Osteoarthritis has always been seen as an age-related degenerative disease for which nothing can be done. That’s not true. The fact that other non-genetic factors influence the disease can lead to drugs for reversing it.” To that end, the researcher has launched a study at multiple Spanish research centers to examine the Mediterranean diet’s effects on osteoarthritis: the study will give a group of participants olive oil and nuts for a year to explore how they affect the joints as compared to the control group. “We want to see which epigenetic marks change when you eat a healthier diet, which could serve as markers in the future. We have to try to stop the erosion of cartilage earlier. Prevent, don’t repair.”

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Rare Diamond Destined For A Jewelry Store Has Precious Geological Value

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Gemologist Tingting Gu was working at the Gemological Institute of America (GIA) in New York when a diamond came to her for analysis and appraisal. It was to be set in a ring and sold in a jewelry store before she realized the geological significance of the gem under her microscope. It was the second ringwoodite diamond ever discovered.

To validate her find, Gu contacted Fabrizio Nestola, a professor with the Department of Geosciences at the University of Padua (Italy). The IaB-type diamond is very rare because it shows a mineral accumulation of ringwoodite with ferropericlase and enstatite. “This is the first time that this combination has occurred, which validates our laboratory experiments and provides us with exceptional new knowledge about the composition and structure of one of Earth’s most inaccessible and remote places,” said Nestola, co-author of the study published in Nature.

The 1.5 cm diamond comes from the Karowe mine in Botswana (southern Africa). A chemical analysis of the gem indicates that it originated 410 miles (660 kilometers) below the Earth’s mantle where it came in contact with water. This finding changes scientists’ current understanding of the Earth’s subsoil in that water is now believed to be much more prevalent at that depth than previously thought.

This discovery provides us with exceptional new knowledge about the composition and structure of one of Earth’s most inaccessible and remote places

Fabrizio Nestola (Department of Geosciences, University of Padua, Italy.

Detailed plane of the diamond, where the analysis highlights a composition of ferropericlase (bluish center), ringwoodite (upper edge) and enstatite (lower edge).
Detailed plane of the diamond, where the analysis highlights a composition of ferropericlase (bluish center), ringwoodite (upper edge) and enstatite (lower edge).Nathan D. Renfro y Tingting Gu (GIA)

Diamonds are (geological) time machines. High pressure and temperatures formed diamonds in Earth’s depths millions of years ago. Volcanic eruptions, earthquakes and tectonic plate movements then brought them up to the Earth’s crust. Diamonds are one of the best sources of information about what is happening deep inside the Earth, an environment to which scientists have no direct access.

The diamond that came into Tingting Gu’s hands contains ringwoodite, which is a magnesium silicate mineral first discovered in 1969 in a meteorite that struck Australia. The first terrestrial ringwoodite sample was excavated in 2014 from the Juína mine in Brazil, sealed inside a “super-deep” diamond, according to Nestola. The discovery confirmed scientific theories about the Earth’s mantle, which can only be studied via the deposits expelled by geological cataclysms. It most likely emerged millions of years ago from the depths through a “chimney” of kimberlite volcanic rock. “This was very helpful,” says Nestola, “because the longest manmade shaft ever built only goes 7.5 miles deep.”

Ringwoodite is nothing more than an olivine, one of the most common minerals in the Earth’s upper mantle, just below the crust, “… to which great atmospheric pressure has been applied,” says geologist Javier García Guinea, of Spain’s National Museum of Natural Sciences. García Guinea, who was not involved in the rare discovery, says the study is “continuist” in nature, but acknowledges that “this is science, which is done step-by-step.”

The analysis of the IaB-type diamond indicates that it comes from a transition zone between the second and third layers of the Earth, at a depth of between 250 and 420 miles. The diamond was formed at a pressure of 23.5 GPa (gigapascals), and a temperature of about 3,000ºF (1,650ºC). To help us comprehend these facts, Nestola explained, “The pressure that crushes the atoms of the mineral into a diamond is immense – a single gigapascal is equivalent to four Mount Everests on top of your head.”

The presence of H₂O in the Earth’s lower mantle has implications for the structure and evolution of the planet

Geologist Antonio García Casco (Department of Mineralogy and Petrology, University of Granada, Spain).

The chemical composition of the IaB-type diamond suggests that there are oceans of water between the Earth’s substrata, “… which is not new information – this has been known for decades,” said geologist Antonio García Casco (Department of Mineralogy and Petrology, University of Granada, Spain). But at those extreme depths, water is not the liquid we see on the surface. “It [H₂O] is transformed into a fluid that’s half-liquid and half-gas. It adheres to minerals and can comprise between 10-20% of their weight,” said García Casco.

García Casco says the study about the IaB-type diamond is significant because it leads us to “infer the presence of free-flowing H₂O in the lower mantle,” which has implications for “the structure and evolution of the planet. For example, implications for mantle convection and plate tectonics, which permanently change the planet.” For García Casco, this study is an opportunity for mineralogists to observe transformation processes that only occur “at depths that will be forever inaccessible.”

The diamond, saved in the nick of time from ending up in an engagement ring, “freezes and captures its environment, and then ferries it up from the depths until it reaches the light of day,” says Nestola. For geologists like him, the more material a gem absorbs, the more valuable it is to science. “Just the opposite for a jeweler,” he laughs.

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Abanderado: The Unlikely History Of A T-Shirt Men Wore Because Women Told Them To

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A short-sleeved white t-shirt displays little hint of transgression, yet it is capable of defining its wearer’s personality to a large extent. In the case of Marlon Brando in A Streetcar Named Desire, the garment eroticized the protagonist, underlining his status as a paragon of the prototypical masculine ideal of the era. On the opposite end is Jeff Bridges in The Big Lebowski, dressed in a grimy, faded white tee in keeping with his carefree and lazy character. Between both those extremes lie endless possibilities. Fashion brands have riffed limitlessly on the timeless potential of the simplest of designs. In Spain, the success of the white t-shirt came about through Abanderado, a brand founded in the 1960s that managed to consecrate its shirt as a symbol synonymous with success.

From Mataró to the world

Abanderado was founded by Pere Sans in 1963 in Mataró, one of the hubs of the textile industry in Spain. In its early days, the company produced underwear for women, men and children. Before long, its white men’s t-shirt had triumphed. Maruca García Paredes, director of the fashion department at Madrid’s University School of Design, Innovation and Technology (ESNE), points out that the popularity of this basic item has fluctuated throughout history: “Its origins date back to the Middle Ages, but its spread began with the dawn of mass textile production. Curiously, its popularity plummeted in 1934 when Clark Gable appeared without an undershirt in the movie It Happened One Night. Marlon Brando restored its notoriety in A Streetcar Named Desire.”

Succeeding at selling a product as ubiquitous as the white t-shirt is not an easy task: there aren’t many obvious ways to stand out from competitors. So what made Abanderado different?

History of advertising in Spain

Decades before Calvin Klein revolutionized the fashion industry with provocative underwear ads starring a teenaged Kate Moss and a chiseled Mark Wahlberg, Abanderado had already made history on Spanish television: advertising was one of the brand’s strengths. At that time, the viewing audience was not as diversified as it is today and broadcasts on non-state run and regional channels had not yet begun. A TV advertisement was guaranteed to reach hundreds of thousands of potential customers. Thus, Abanderado became the first brand to advertise men’s underwear in Spain in the 1970s and sales skyrocketed.

The spots were hardly innovative. They extolled the values of the time by glorifying the “masculine” man. Although Abanderado’s clothing was designed for men, some of its advertisements were nonetheless directed at women. What is perhaps one of its most remembered spots ended with an eloquent musical slogan: “Men wear Abanderado because women buy Abanderado.” In the space of a few seconds, that song synthesized and legitimized a chauvinistic idea rooted in the era: that men wouldn’t dream of buying their underwear. This was a task reserved for women, that is, their mothers or wives.

The brand’s white t-shirts, with short sleeves or straps, became a consumer favorite. Children wore them to school and through adulthood. The lyrics of one of the jingles, sung by a woman, emphasized that idea of Abanderado as a signature present in the key moments of your life: “Since you were little you have always carried Abanderado within you. On the most important day, when serving as a soldier, when you fall in love, Abanderado.” The song alluded to the first communion and military service, two essential pillars for the most conservative sectors of Spanish society.

The message came at a time when Spain was facing great societal change following the death of the dictator Francisco Franco and the transition to democracy. On its website, the brand cites a 1980s study that listed Abanderado as the leader in men’s underwear sales, with a 37% market share. At that time, the company had more than 600 workers in its Mataró factory, making it one of the most important companies in the Catalonian municipality.

Michael Jordan signs with Abanderado

The turn of a new decade provided a huge boost for the brand. In 1991, Abanderado was sold to the American company Sara Lee. Its campaigns had borne fruit and Abanderado ads were already part of the collective imagination, although the firm ran the risk of appearing somewhat dated. The new parent company ensured it would reach a whole new generation by signing the biggest sports star in the world at the time: NBA star Michael Jordan wore Abanderado shorts in a spot that has become part of history. It was 1992 and Jordan and the Dream Team had just returned from the Barcelona Olympics with gold medals. According to the commercial, Jordan had also discovered Abanderado briefs while at the Games. The campaign signaled a powerful change in the brand’s mentality: women were no longer identified as the primary audience and an influential male figure was chosen to appeal to the interests of men, the primary wearers of Abanderado products.

At the beginning of the 2000s, Abanderado changed hands again. It was acquired by the Sun Capital fund, which moved its headquarters from Mataró to Madrid. Shortly afterward, the brand’s t-shirts ceased to be manufactured in Spain. As of 2014, Abanderado has been owned by the American multinational Hanesbrands, the parent company of other underwear labels including Dim, Wonderbra Champion and Playtex.

Where is Abanderado today? Has the company managed to keep its shirts relevant? Is the brand name familiar to younger generations outside of television and traditional advertising? The brand’s golden age may be in the past but the current panorama works in its favor. The white tank top has grown ever more popular among followers of current fashion trends. Luxury brands such as Prada and Bottega Veneta have not passed up the opportunity to include simple white shirts in their latest collections – with three-figure prices. “That has been the major change,” says stylist Inés Marinero, “the transition from an undershirt to a trendy garment. It’s something that started in 1990s and it’s now back in fashion. Sporty luxury is now a part of our lives, which is why the white shirt is now also worn with more elaborate and sophisticated fabric designs.” A few weeks ago, the style section of The New York Times dedicated an expansive article to the garment entitled: “Reinventing the Humble Tank Top.” García Paredes also links the popularity of the white t-shirt to “the informalization of the intimate garment”, adding that it has become “a staple whose versatility can go from elegance and sophistication to daring, comfort and simplicity.”

Almost six decades after announcing itself on the market, Abanderado is now just a shadow of what it was in its heyday, citing economic problems and a constant trickle of layoffs. But its white shirt remains ingrained on the minds of a large part of Spanish society. Its next task is to try and repeat its marketing success on the new generation.

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Russia Annexes Ukrainian Territories, Escalating Rhetoric Against The West

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Russian President Vladimir Putin on Friday inaugurated a new phase in the Ukraine offensive by proclaiming the annexation of four provinces that he has illegally occupied. With their incorporation, equivalent to 15% of the Ukrainian territory, Putin has blown up the bridges to an immediate peace negotiation.

“We will defend our land with all the force and means at our disposal and we will do everything possible to ensure the safety of our people. This is the great liberating mission of our people,” Putin said to the applause of senior regime officials. The annexation, though widely anticipated for days, was met by immediate condemnation from the European Union and the United States.

The Russian president also warned that his country has embarked on a historic struggle. “The destruction of Western hegemony that has begun is irreversible. Nothing will be the way it used to be. The battlefield to which destiny and history have called us is the battlefield of our people, for a great historic Russia,” he proclaimed.

After holding pseudo-referendums in the occupied territories of Zaporizhzhia, Kherson, Donetsk and Luhansk to justify the annexation, Putin demanded from Kiyv “an immediate cease-fire and a return to the negotiating table,” although he warned that “Russia will not address at the talks the return of Donetsk, Lugansk, Kherson and Zaporizhia.” The only thing the Kremlin is offering in return is the pledge not to use its most destructive weapons in battle.

Early on Friday, Russian troops once again launched an attack on civilian targets. At least 25 people have been killed and a further 50 wounded in a missile attack on a convoy of civilian vehicles in the Zaporizhzhia region of southern Ukraine, the Prosecutor General’s Office in Kyiv said in a statement. It is the largest single civilian fatality count of the war since the massacre at the Kramatorsk train station in Donetsk on April 8, which left more than 50 people dead. The attack occurred at 7.15am local time and targeted a used vehicle market where dozens of civilian cars and vans were waiting to “leave the temporarily occupied territory, pick up their relatives and bring help,” the governor of Zaporizhzhia province, Oleksandr Staruj, confirmed via Telegram.

Air raid sirens had been sounding throughout the night and numerous explosions were heard in the area. Ukrainian anti-aircraft units worked for hours to prevent the impact of Russian missiles but three managed to get through the barrage and hit the dozens of vehicles that were waiting for a pause in the attack to resume their journeys. A huge crater, several meters deep, marks the site of the main explosion where a missile that apparently caused most of the deaths struck. “The occupiers launched 16 missiles in a single morning against Zaporizhzhia and the surrounding district. Only terrorists who have no place in the civilized world could do something like this,” Ukrainian President Volodymir Zelenskyy wrote on his Telegram account.

By mid-morning the victims of the attack, covered with blankets and plastic sheeting, had not all been removed. At least a dozen corpses were still lying on the floor – on the blanket covering one of them, where a large pool of blood had formed, the number 17 was written in black. Many more bodies remained in the vehicles they had traveling in, some of them also containing pets. People of various ages could be seen in the destroyed convoy, sitting in the front and back seats and surrounded by the possessions they had been carrying.

Murdered civilians lie on an esplanade in Zaporizhia, this Friday after a Russian missile attack.
Murdered civilians lie on an esplanade in Zaporizhia, this Friday after a Russian missile attack.KATERYNA KLOCHKO (AFP)

At least 30 cars were damaged in the attack, their windows shattered and their doors ripped out. The Ukrainian civilian and military police, as well as members of the War Crimes Prosecutor’s Office, arrived on the scene in the aftermath to begin an investigation. However, their work has been hampered by the need to keep evacuating the area: air raid sirens continued to warn of another attack throughout the day, forcing everyone to take shelter, including relatives who have been searching the devastation for family members. “We were just sitting here, and then something unexplainable happened; everything went flying,” said Natalia, a survivor of the attack. We got out of the car and ran. I don’t remember anything, I’m in shock. There are a lot of dead people. The car isn’t important. What’s important is that we are alive.”

The area targeted by the Russian bombardment is well-known. The main road running from the south of Ukraine, which follows the Dnieper River and is the most habitual route for refugees seeking to escape the occupied zones, ends there. Nearby is a disused shopping center, where the car park now serves as a reception area for NGOs, humanitarian aid agencies and Ukrainian authorities to help and process refugees arriving from the regions that were the subject of the annexation treaties signed by Putin on Friday.

Russia denies the attack

The Russian administrator of the occupied Zaporizhzhia region, Vladimir Rogov, has denied Russian forces were responsible for the massacre and blamed the attack on the Ukrainian military. “They have fired on a group of cars waiting to move to liberated territory at the exit of Zaporizhzhia,” Rogov wrote on his Telegram account.

“It is classic Anglo-Saxon provocation against a disloyal civil population,” Rogov continued, suggesting that the convoy had been hit by friendly fire so that Russia could be accused of the attack afterward. According to Rogov, the convoy “had been blocking the road for two days asking for permission [from Russia] to enter the liberated territories.”

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