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[Imaging methods in rheumatology: imaging in psoriasis arthritis (PsA)].

Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.

Arthritis, Psoriatic↗

Expression and localization of connective tissue growth factor (CTGF/Hcs24/CCN2) in osteoarthritic cartilage.

OBJECTIVE: The investigation of the expression and localization of connective tissue growth factor/hypertrophic chondrocyte-specific gene product 24/CCN family member 2 (CTGF/Hcs24/CCN2) in normal and osteoarthritic (OA) cartilage, and quantification of CTGF/Hcs24-positive cells. METHODS: Cartilage samples of patients (n=20) with late stage OA were obtained at total joint replacement surgery. Morphologically normal cartilage was harvested for comparison purposes from the femoral heads of 6 other patients with femoral neck fracture. Paraffin-embedded sections were stained by Safranin O. The severity of the OA lesions was divided into four stages (normal, early, moderate, and severe). The localization of protein and mRNA for CTGF/Hcs24 was investigated by immunohistochemistry and in situ hybridization, respectively. The population of CTGF/Hcs24-positive chondrocytes in OA cartilage and chondro-osteophyte was quantified by counting the number of the cells under light microscopy. RESULTS: Signals for CTGF/Hcs24 were detected in a small percentage of chondrocytes throughout the layers of normal cartilage. In early stage OA cartilage, the CTGF/Hcs24-positive chondrocytes were localized mainly in the superficial layer. In moderate to severe OA cartilage, intense staining for CTGF/Hcs24 was observed in proliferating chondrocytes forming cell clusters next to the cartilage surface. In chondro-osteophyte, strong signals were found in the chondrocytes of the proliferative and hypertrophic zones. CONCLUSION: CTGF/Hcs24 expression was detected in both normal and OA chondrocytes of human samples. The results of the current study suggested that expression of CTGF/Hcs24 was concomitant with development of OA lesions and chondrocyte differentiation in chondro-osteophyte.

Adult↗

Factors affecting the efficacy of bovine chondrocyte transplantation in vitro.

Current therapies for osteoarthritis have been primarily directed at symptom relief rather than disease modification or cure. Improved understanding of cartilage biology and metabolism has permitted exploration of disease-modifying treatments for OA. Chondrocyte transplantation is one approach to disease modification that has received increasing attention. To date, most chondrocyte transplantation has focused on surgical implantation into isolated chondral defects.Our hypothesis is that cultured chondrocytes will preferentially transplant to hyaline cartilage after intraarticular injection. The purpose of this study was to quantify chondrocyte adherence to cartilage in an in-vitro bovine explant model under differing culture conditions. The effect on chondrocyte transplantation of time, of alginate vs. monolayer culture techniques, and of differing origin of tissue explants within the knee joint were assessed. The effect on transplantation of physically modifying the explant surface was also assessed. In addition to quantification of transplantation adherence, the morphology of transplanted chondrocytes was assessed with confocal and electron microscopy. Maximal adherence occurred by 24 h post-transplantation. Baseline transplant densities exceeding 1 x 10(6) cells/cm(2)were observed on unmodified cartilage surfaces. No significant differences in binding density were noted between cartilage explants obtained from the patella, femoral condyles, tibial plateaus or the trochlear groove. In addition, no differences in chondrocyte adherence were noted in cells cultured in monolayer or alginate beads. Transplanted chondrocytes were noted to be spherical irrespective of the culture methods employed. Notably, chondrocytes demonstrated significantly improved adherence to cartilage surfaces after the superficial layer was removed as compared to normal intact cartilage surfaces (increase of 26%, P< 0. 01). This suggests that chondrocytes may preferentially adhere to cartilage surfaces where the superficial layer has been damaged, as is the case in isolated chondral lesions, or with diffuse cartilage degeneration.

Animals↗

[Functional CT imaging: Load-dependent visualization of the subchondral mineralization by means of CT osteoabsorptiometry (CT-OAM)].

PURPOSE: Functional computed tomography for visualization and quantification of subchondral bone mineralization using CT osteoabsorptiometry (CT-OAM). MATERIALS AND METHODS: Tarsometatarsal (TMT) and metatarsophalangeal (MTP) joints of 46 human hallux valgus (HV) specimens were examined (sagittal 1/1/1 mm) on a single slice CT scanner SCT (Somatom Plus 4, Siemens AG). Subchondral bone pixels were segmented and assigned to 10 density value groups (Delta 100 HU, range 200 - 1200 HU) the pixels using volume rendering technique (VRT). The data analysis considered the severity of HV as determined by the radiographically measured HV-angle (a. p. projection). RESULTS: CT-OAM could generate reproducible densitograms of the distribution pattern of the subchondral bone density for all four joint surfaces (TMT and MTP joints). The bone density localization enables the assignment to different groups, showing a characteristic HV-angle-dependent distribution of the maximum bone mineralization of the load-dependent densitogram (p < 0.001). CONCLUSION: CT-OAM is a functional CT technique for visualizing and quantifying the distribution of the subchondral bone density, enabling a noninvasive load-dependent assessment of the joint surfaces. Load-dependent densitograms of hallux valgus specimens show a characteristic correlation with an increase of the HV-angle.

Absorptiometry, Photon↗

Trends in improving the embryonic stem cell test (EST): an overview.

The embryonic stem cell test (EST) is an in vitro assay that has been developed to assess the teratogenic and embryotoxic potential of drugs and chemicals. It is based on the capacity of murine ES cells (cell line D3) to differentiate into contracting myocardial cells under specific cell culture conditions. The appearance of beating cardiomyocytes in embryoid body (EB) outgrowths is used as a toxicological endpoint to assess the embryotoxic potential of a test substance. Applying linear analysis of discriminance, a biostatistical prediction model (PM) was developed to assign test chemicals to three classes of embryotoxicity. In an international validation study the EST predicted the embryotoxic potential of chemicals and drugs with the same reliability as two other in vitro embryotoxicity tests, which employed embryonic cells and tissues from pregnant animals. In a joint research project with German pharmaceutical companies we have successfully improved the EST by establishing molecular endpoints of differentiation in cultured ES cells. The quantification of cardiac-specific protein expression by intracellular flow cytometry has been studied in the presence of chemicals of different embryotoxic potential. The results obtained using molecular endpoints specific for differentiated cardiomyocytes employing FACS (fluorescence-activated cell sorting) analysis will be presented in comparison to the validated endpoint - the microscopic analysis of beating areas. FACS analysis provides a more objective endpoint for predicting the embryotoxic potential of chemicals than the validated method. Furthermore, flow cytometry promises to be suitable for high-throughput screening systems (HTS). In addition, our partners from the joint project have improved the EST by developing protocols that stimulate differentiation of ES cells into neural and endothelial cells, chondrocytes and osteoblasts, because some substances might have embryotoxic effects on specific cell-types other than cardiomyocytes. These protocols have been successfully established at ZEBET and in the participating laboratories. Additionally, molecular endpoints have been established for the detection of specific differentiation pathways. Furthermore, new prediction models (PMs) have been developed using single endpoints of the EST.

Animal Testing Alternatives↗

Synovial lesions of the hand and wrist.

Synovial tissue in the hand and wrist is frequently involved by inflammatory, degenerative, infectious, traumatic, metabolic, or neoplastic lesions. Although normal synovium is not shown on MR images, the morphology and signal characteristics of abnormal synovium is generally well demonstrated. Special MR techniques for accurate quantification of pannus are under investigation.

Adult↗

A method for measurement of joint kinematics in vivo by registration of 3-D geometric models with cine phase contrast magnetic resonance imaging data.

A new method is presented for measuring joint kinematics by optimally matching modeled trajectories of geometric surface models of bones with cine phase contrast (cine-PC) magnetic resonance imaging data. The incorporation of the geometric bone models (GBMs) allows computation of kinematics based on coordinate systems placed relative to full 3-D anatomy, as well as quantification of changes in articular contact locations and relative velocities during dynamic motion. These capabilities are additional to those of cine-PC based techniques that have been used previously to measure joint kinematics during activity. Cine-PC magnitude and velocity data are collected on a fixed image plane prescribed through a repetitively moved skeletal joint. The intersection of each GBM with a simulated image plane is calculated as the model moves along a computed trajectory, and cine-PC velocity data are sampled from the regions of the velocity images within the area of this intersection. From the sampled velocity data, the instantaneous linear and angular velocities of a coordinate system fixed to the GBM are estimated, and integration of the linear and angular velocities is used to predict updated trajectories. A moving validation phantom that produces motions and velocity data similar to those observed in an experiment on human knee kinematics was designed. This phantom was used to assess cine-PC rigid body tracking performance by comparing the kinematics of the phantom measured by this method to similar measurements made using a magnetic tracking system. Average differences between the two methods were measured as 2.82 mm rms for anterior/posterior tibial position, and 2.63 deg rms for axial rotation. An intertrial repeatability study of human knee kinematics using the new method produced rms differences in anterior/posterior tibial position and axial rotation of 1.44 mm and 2.35 deg. The performance of the method is concluded to be sufficient for the effective study of kinematic changes caused to knees by soft tissue injuries.

Biomechanical Phenomena↗

Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis.

The aim of this study was to investigate the relation between the inflammatory mediators tumor necrosis factor alpha (TNFalpha) and serotonin (5-HT), the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as rheumatoid factor (RF) and thrombocyte particle concentration (TPC) in blood versus temporomandibular joint (TMJ) radiographic changes in patients with clinical TMJ involvement by rheumatoid arthritis (RA). Twenty patients were included. Venous blood was collected for quantification of the mediators, markers, and TPC. The radiographic signs of erosion, flattening, sclerosis, subchondral pseudocyst, and osteophyte as well as radiographic grade were investigated with computed tomography. The median (IQR) plasma levels of TNFalpha and 5-HT were 0 (13) pg/ mL and 13 (22) nmol/L, respectively, while serum level of 5-HT was 1360 874) nmol/L ESR, CRP, and TPC were abnormally high in 53%, 250%, and 15% of the patients, respectively. The most frequent radiographic signs were sclerosis (75%), erosion (50%), and flattening (30%). Erosion was found to be associated with high TPC and flattening with high plasma level of TNFalpha. In conclusion, patients with clinical TMJ involvement by RA show an association between high level of TPC and TNFalpha in plasma versus radiographic signs of joint bone destruction.

Acute-Phase Proteins↗

Micro-CT arthrography: a pilot study for the ex vivo visualization of the rat knee joint.

OBJECTIVE: In our study, we evaluated the potential of micro-CT for the assessment of the rat knee joint using ex vivo micro-CT arthrography. The aims of the study were to introduce the technique of micro-CT arthrography and to visualize the normal anatomy of the rat knee. The secondary aims were the quantification of retropatellar cartilage thickness and the analysis of microstructural cancellous bone parameters within the tibial epiphysis. CONCLUSION: Micro-CT arthrography is a novel technique for the indirect visualization of the distinct features and structural analysis of the rat knee joint. This technique represents an additional imaging and analysis tool in small-animal research.

Animals↗

[New approaches in laboratory diagnosis of osteoarthritis].

The article elucidates the new laboratory tests for chronic joint diseases, with special attention to quantitative and qualitative serum markers for metabolic and immunologic processes. The assays include the quantification of keratan sulphate, hyaluronan and beta-D-xylosyltransferase in serum and pyridinolin in serum and urine as markers for cartilage catabolism, as well as the detection of autoantibodies to cartilage matrix and cell components and cartilage-directed T-cell reactions in the patients. Taken together, these assays represent models for future laboratory diagnostic tools for the characterization of arthritic diseases. So far, however, it remains unclear whether they will prove to be adequate assays for the practicing physician.

Autoantibodies↗

[Sports fitness of active handball and soccer players with anterior instability of the knee joint].

Based on an epidemiological study of 582 active handball and soccer players the abilities and limitations were analysed for sports activities of 24 athletes with an ACL-deficient knee. 22 of the 24 athletes suffered from a straight anterior instability. 50% attempted to avoid cutting mechanisms. The level of motivation was better than in the whole population. Handball players could continue their sports better and longer than soccer players. However, 19 athletes had to be classified as "knee-abusers" because they continued their sports inspite of having complaints. If athletic participation following ligament injuries of the knee should be rated, an accurate quantification and qualification is imperative.

Adolescent↗

SACRAH: a score for assessment and quantification of chronic rheumatic affections of the hands.

OBJECTIVES: To establish a questionnaire to quantify the extent of the function and activities of the hand in patients with degenerative or inflammatory disease of the hand and finger joints. METHODS: One hundred and seventy-two patients with osteoarthritis (OA, n = 69) or rheumatoid arthritis (RA, n = 103) completed a new questionnaire, the SACRAH, that included 23 visual analogue scales covering the extent of hand function, stiffness and level of pain. SACRAH scores may range from 0 to 100. RESULTS: Comparing all studied patients, there was no significant difference in SACRAH scores between OA and RA patients (34 vs 32, not significant). Scores for both patient groups differed significantly from those for 30 healthy controls. Among patients taking NSAIDs only, individuals suffering from OA (n = 50) scored significantly lower than RA patients (n = 42) (36 vs 48, P < 0.004). Sixty-one RA patients taking DMARDs scored lower than the RA patient group treated with NSAIDs only (20 vs 48, P < 0.0001). Thirty-two RA patients were evaluated longitudinally at their first visit and 3 months after the initiation of DMARDs. Following therapy, SACRAH scores were significantly reduced from 50 to 11 (P < 0.0001). CONCLUSIONS: The questionnaire enables the quantification of compromised hand function, stiffness and pain in OA and RA patients, and is sensitive to therapy-related changes in RA patients.

Adult↗

Functional analysis of articular cartilage deformation, recovery, and fluid flow following dynamic exercise in vivo.

The function of articular cartilage depends on the interaction between the tissue matrix and the interstitial fluid bound to the proteoglycan molecules. Mechanical loading has been shown to be involved in both the metabolic regulation of chondrocytes and in matrix degeneration. The purpose of the present study was therefore to analyze the deformation, recovery, and fluid flow in human articular cartilage after dynamic loading in vivo. The patellae of 7 volunteers were imaged at physical rest and after performing knee bends, with a specifically optimized fat-suppressed FLASH-3D magnetic resonance (MR) sequence. To measure cartilage deformation, the total volume of the patellar cartilage was determined, employing 3D digital image analysis. Patellar cartilage deformation ranged from 2.4 to 8.6% after 50 knee bends, and from 2.4% to 8.5% after 100 knee bends. Repeated sets of dynamic exercise at intervals of 15 min did not cause further deformation. After 100 knee bends, the cartilage required more than 90 min to recover from loading. The rate of fluid flow during relaxation ranged from 1.1 to 3.5 mm(3)/min (0.08 to 0.22 mm(3)/min per square centimeter of the articular surface) and was highly correlated with the individual degree of deformation after knee bends. The data provide the first quantification of articular cartilage recovery and of the rate of fluid flow between the cartilage matrix and surrounding tissue in intact joints in vivo. Measurement in the living opens the possibility of relating interindividual variations of mechanical cartilage properties to the susceptibility of developing joint failure, to assess the load-partitioning between the fluid phase and solid cartilage matrix during load transfer, and to determine the role of mechanically induced fluid flow in the regulation of the metabolic activity of chondrocytes.

Adult↗

Magnetic resonance imaging in early detection of rheumatoid arthritis.

Magnetic resonance imaging (MRI) is the modality of choice in early diagnosis and management of rheumatoid arthritis (RA). The pathologic processes in RA involve synovitis, joint effusion, proliferation of fibrovascular connective tissue, and the formation of pannus. Other imaging techniques available for imaging of RA include ultrasound, scintigraphy, computed tomography, and plain radiography (PR). MRI provides high sensitivity in detecting inflammatory changes in the joints. Several studies report high intra- and interobserver reliability and low variation for MRI. MRI allows detection and, in some cases, quantification of synovial changes. Dynamic MRI is a new technique that utilizes rate of synovial enhancement in evaluation of inflammatory changes. MRI allows visualization of erosions in three orthogonal planes. MRI has been shown in many studies to have much greater sensitivity than PR in detecting erosions. Use of a contrast agent further increases the sensitivity in detecting erosions and differentiates and outlines synovial proliferation from fluid collection. Other manifestations of RA such as intraosseous cysts, tenosynovitis, bone marrow edema, and carpal tunnel syndrome can also be visualized on magnetic resonance images. Advances in MRI include contrast-enhancement, dynamic, and quantitative techniques. MRI assists in the early detection of RA, which allows earlier initiation of treatment with disease-modifying therapies.

Arthritis, Rheumatoid↗

Variability in cytokine and cell adhesion molecule staining in arthroscopic synovial biopsies: quantification using color video image analysis.

OBJECTIVE: To investigate the variability in immunostaining for cytokines and cell adhesion molecules using multiple arthroscopically directed synovial biopsies from within a rheumatoid knee joint, quantitated by color video image analysis. METHODS: Needle arthroscopic biopsies were taken from multiple sites (4-7 sites) around a knee joint in 8 patients with rheumatoid arthritis (RA). In 5 patients, immunoperoxidase staining for the cytokines tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and IL-1beta as well as the IL-1 receptor antagonist protein (IL-1ra) was performed. In 3 patients, immunoperoxidase staining for the cell adhesion molecules E-selectin (CD62E), P-selectin (CD62P), intercellular adhesion molecule 1 (ICAM-1, CD54), and platelet endothelial cell adhesion molecule (PECAM, CD31) was performed. Immunostaining was quantified using color video image analysis. RESULTS: The overall probability of paired biopsies from the same RA knee joint being significantly different from each other due to sampling variation was at most 22% for cytokine staining (usually less than 10%). There were no significant differences between intrabiopsy and interbiopsy variability for cell adhesion molecule staining of the sublining and vessels. CONCLUSION: The variability in cytokine and cell adhesion molecule staining within any single biopsy usually reflects the variability between biopsies taken from different sites in the same rheumatoid joint when the immunostaining is quantified using color video image analysis. Therefore, only a small number of synovial biopsies are required to accurately determine the cytokine and cell adhesion molecule expression in a single joint.

Aged↗

Patterns of stiffness during clinical examination of the glenohumeral joint.

OBJECTIVE: The purpose of our study was to develop a quantitative technique for performing clinical laxity tests, and to characterize the force-displacement response patterns in normal shoulders during two commonly applied clinical tests in different arm positions. DESIGN: The study was an in vivo clinical experiment.Background. We developed a method to objectively quantify the effects of clinical laxity testing at the shoulder. No previous studies have measured the applied force during clinical testing along with the displacement so that glenohumeral joint stiffness could be determined in vivo. METHODS: Manually applied forces were measured and shoulder displacement was recorded using electromagnetic tracking sensors during clinical stability testing in 21 subjects with normal shoulders. End-range stiffness was calculated and compared across all test conditions using repeated measures analysis of variance. RESULTS: The maximum force applied by the examiner to reach clinical end-point across all tests ranged from 101-113 N The stiffest position for posterior drawer test was at 180 degrees of abduction with the arm in internal rotation. This position was the most compliant position for the anterior drawer test. Only by internally rotating the arm did the force-displacement pattern change significantly (P<0.05). For anterior drawer tests, the patterns changed significantly (P<0.05) only when the arm was in external rotation. CONCLUSIONS: Results showed that end-range stiffness was predominantly dependent on humeral rotation angle and not effected by arm abduction angle for the three angles studied. Stiffness from anterior drawer tests was highest with the arm in external rotation, and stiffness from posterior drawer tests was highest with the arm in internal rotation. RELEVANCE: This study has several clinically relevant implications for quantification of a clinical shoulder examination, and as a valuable teaching tool. Our findings also question some accepted notions about clinical "closed-packed" joint positions. The study provides normal patterns of force-displacement and normative stiffness values that can be compared to patients with shoulder pathology for similar testing.

Adult↗

Local blockade of integrins in the temporomandibular joint region reduces Fos-positive neurons in trigeminal subnucleus caudalis of female rats produced by jaw movement.

This study assessed the influence of integrins on trigeminal brainstem neural activity evoked during jaw movement (JM). Limited range of motion and pain during jaw opening are common complaints of patients with temporomandibular joint (TMJ) disorders. JM (0.5 Hz, 30 min) was presented to ovariectomized (OvX) female rats given estrogen replacement and males under barbiturate anesthesia. Quantification of Fos-like immunoreactivity (Fos-LI) after JM served as an index of evoked neural activity. Rats were injected locally in the TMJ with either an active (GRGDS, 300 microM, 25 microl) or an inactive integrin antagonist (SDGRG) prior to JM. The effect of prior inflammation of the TMJ region was assessed in separate groups of rats by injecting bradykinin (10 microM, 25 microl) with or without integrin drugs prior to JM. Active integrin antagonist significantly reduced JM-evoked Fos-LI in superficial laminae at the trigeminal subnucleus caudalis/upper cervical cord (Vc/C2) junction in OvX compared to male rats independent of bradykinin pretreatment. Fos-LI produced in the dorsal paratrigeminal and trigeminal subnucleus interpolaris/caudalis (Vi/Vc) transition regions was not reduced by active integrin antagonist in males or OvX females. Active integrin antagonist did not affect Fos-LI produced after injection of bradykinin alone into the TMJ. These results suggest that RGD binding integrins contribute to JM-evoked neural activity at the Vc/C2 junction under naive and inflamed conditions in a sex-dependent manner.

Animals↗

A real-time quantitative PCR detection method specific to widestrike transgenic cotton (event 281-24-236/3006-210-23).

In compliance with global regulations on transgenic crops, a real-time quantitative PCR method specific to Widestrike transgenic cotton (event 281-24-236/3006-210-23, OECD Unique Identifier DAS-24236-5/DAS-21023-5) was established on the basis of the DNA sequences in the junction between the transgene insert and cotton genome. The optimized method consists of a DNA extraction method for cotton seeds and three PCR systems corresponding to a cotton-specific endogenous reference DNA sequence SAH7 (Sinapis Arabidopsis Homolog 7) and specific detection of event 281-24-236 and event 3006-210-23. The method performance including specificity, sensitivity, accuracy, and precision was determined at a dynamic range of Widestrike DNA levels from 0.04% to 5.0%. The limits of detection (LOD) and quantification (LOQ) were < or =0.04% and < or =0.09%, respectively, at 100 ng of DNA sample per reaction. The quantification results using either the event 281-24-236 or 3006-210-23 system were consistent, and the relative deviation from the expected (true) value was in the range of +/-25%. The robustness of the method was demonstrated by a series of tests with deviations from the optimized assay parameters such as annealing temperature, extension time, PCR instrument, interlaboratory transferability, etc. All the measurements from these tests met the criteria set by EU JRC-CRL (European Commission Joint Research Centre-Community Reference Lab). This real-time quantitative PCR method is accurate and robust, and is recommended as a global benchmark method for the detection and quantification of Widestrike cotton. The method including description, protocol, and performance results is available on the JRC-CRL website (http://gmo-crl.jrc.it/statusofdoss.htm).

DNA, Plant↗