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Injury Nov 2023Tendon injury accounts for 30% of musculoskeletal diseases and often leads to disability, pain, healthcare cost, and lost productivity. Following injury to tendon,... (Review)
Review
Tendon injury accounts for 30% of musculoskeletal diseases and often leads to disability, pain, healthcare cost, and lost productivity. Following injury to tendon, tendon healing proceeds via three overlapping healing processes. However, due to the structural defects of the tendon itself, the tendon healing process is characterized by the formation of excessive fibrotic scar tissue, and injured tendons rarely return to native tendons, which can easily contribute to tendon reinjury. Moreover, the resulting fibrous scar is considered to be a precipitating factor for subsequent degenerative tendinopathy. Despite this, therapies are almost limited because underlying molecular mechanisms during tendon healing are still unknown. Transforming Growth Factor-β1 (TGF-β1) is known as one of most potent profibrogenic factors during tendon healing process. However, blockage TGF-β1 fails to effectively enhance tendon healing. A detailed understanding of real abilities of TGF-β1 involved in tendon healing can bring promising perspectives for therapeutic value that improve the tendon healing process. Thus, in this review, we describe recent efforts to identify and characterize the roles and mechanisms of TGF-β1 involved at each stage of the tendon healing and highlight potential roles of TGF-β1 leading to the fibrotic response to tendon injury.
Topics: Humans; Transforming Growth Factor beta1; Cicatrix; Tendons; Wound Healing; Tendon Injuries; Fibrosis
PubMed: 37738787
DOI: 10.1016/j.injury.2023.111052 -
Clinics in Podiatric Medicine and... Jul 2024Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries... (Review)
Review
Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries requires the ability to differentiate between stable and unstable fractures. The current literature supports the nonoperative management of stable Weber B ankle fractures, whereas unstable fractures have much better outcomes with surgical intervention. Specifically, we review the fixation strategies for the lateral, medial, and posterior malleolar fractures respectively. Finally, we discuss the current trends in postoperative management of some of the more common fracture patterns, and the safety in early weight-bearing protocols.
Topics: Female; Humans; Male; Ankle Fractures; Fracture Fixation; Fracture Fixation, Internal; Weight-Bearing; Practice Guidelines as Topic
PubMed: 38789168
DOI: 10.1016/j.cpm.2024.01.008 -
Journal of Controlled Release :... Dec 2023Stem cell transplantation holds great promise for restoring function after spinal cord injury (SCI), but its therapeutic efficacy heavily depends on the innate...
Stem cell transplantation holds great promise for restoring function after spinal cord injury (SCI), but its therapeutic efficacy heavily depends on the innate capabilities of the cells and the microenvironment at the lesion site. Herein, a potent cell therapeutic (NCs@SCs) is engineered by artificially reprogramming bone marrow mesenchymal stem cells (BMSCs) with oxidation-responsive transcytosable gene-delivery nanocomplexes (NCs), which endows cells with robust oxidative stress resistance and improved cytokine secretion. NCs@SCs can accumulate in the injured spinal cord after intravenous administration via chemotaxis and boost successive transcytosis to deliver NCs to neurons, augmenting ciliary neurotrophic factor (CNTF) production in both BMSCs and neurons in response to elevated ROS levels. Furthermore, NCs@SCs can actively sense and eliminate ROS and re-educate recruited M1-like macrophages into the anti-inflammatory M2 phenotype via a paracrine pathway, ultimately reshaping the inflammatory microenvironment. Synergistically, NCs@SCs exhibit durable survival and provide neuroprotection against secondary damage, enabling significant locomotor function recovery in SCI rats. Transcriptome analysis reveals that regulation of the ROS/MAPK signaling pathway is involved in SCI therapy by NCs@SCs. This study presents a nanomaterial-mediated cell-reprogramming approach for developing live cell therapeutics, showing significant potential in the treatment of SCI and other neuro-injury disorders.
Topics: Rats; Animals; Spinal Cord Regeneration; Reactive Oxygen Species; Spinal Cord Injuries; Neurons; Spinal Cord; Mesenchymal Stem Cells; Mesenchymal Stem Cell Transplantation; Recovery of Function
PubMed: 37926244
DOI: 10.1016/j.jconrel.2023.10.051 -
FP Essentials Dec 2023Common wrist conditions include fractures and other injuries, osteoarthritis, radial epiphysitis, joint instability, de Quervain tenosynovitis, carpal tunnel syndrome,...
Common wrist conditions include fractures and other injuries, osteoarthritis, radial epiphysitis, joint instability, de Quervain tenosynovitis, carpal tunnel syndrome, ganglion cyst, and ulnar neuropathy. The initial history and physical examination, with particular focus on the anatomic structures of the wrist, can narrow the differential diagnosis. Magnetic resonance imaging study can be used to identify soft tissue masses and occult osseous processes, particularly with scaphoid fractures. Computed tomography scan is useful in cases of bony abnormalities, high clinical suspicion of occult fracture, and surgical planning. Musculoskeletal ultrasonography can help identify soft tissue injuries, synovitis, or edema. It also can assess for nerve pathology, such as increased median nerve surface area in carpal tunnel syndrome. Management of common wrist fractures, such as distal radius, carpal, and scaphoid fractures, includes nonsurgical and surgical options, immobilization, and referral for further management or surgical consultation. Other wrist conditions, including overuse conditions such as carpometacarpal osteoarthritis or radial epiphysitis, can be managed conservatively initially. Ganglion cysts can be managed with immobility and rest initially, or aspiration or surgical excision. Ulnar neuropathy is the result of local compression of the ulnar nerve at the level of the carpal bones. It typically is managed with activity modification and splinting.
Topics: Humans; Wrist; Carpal Tunnel Syndrome; Fractures, Bone; Osteoarthritis; Ulnar Neuropathies
PubMed: 38109044
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Aug 2023Peripheral nerve injury is a common sequela of lower extremity trauma. Injuries to lower extremity nerves range from contusions and stretch injuries that will often... (Review)
Review
Peripheral nerve injury is a common sequela of lower extremity trauma. Injuries to lower extremity nerves range from contusions and stretch injuries that will often resolve without interventions to traumatic disruptions requiring surgical procedures, including neurolysis, repair or even nerve grafting. While clinical examination and tools such as electromyography will often help to localize the site of injury, imaging is a critical tool in determining the extent and degree of nerve injury in the setting of trauma. Modalities such as ultrasound and radiography are often useful, but MRI is considered the primary imaging modality for assessing the extent and degree of nerve injury. Specialized techniques such as MR neurography tailored to the needs of individual patients can provide important and detailed information in support of clinical decision making and presurgical planning. In this paper, we will review the anatomy of peripheral nerves of the lower extremity, mechanisms of injury affecting nerves and provide guidance for the use of MRI correlated with validated classification systems in assessing injuries affecting the nerves of the lower extremities.
Topics: Humans; Peripheral Nerve Injuries; Lower Extremity; Surgeons; Diffusion Magnetic Resonance Imaging
PubMed: 37437972
DOI: 10.1053/j.sult.2023.04.001 -
Diving and Hyperbaric Medicine Mar 2024Decompression illness is a collective term for two maladies (decompression sickness [DCS] and arterial gas embolism [AGE]) that may arise during or after surfacing from...
Decompression illness is a collective term for two maladies (decompression sickness [DCS] and arterial gas embolism [AGE]) that may arise during or after surfacing from compressed gas diving. Bubbles are the presumed primary vector of injury in both disorders, but the respective sources of bubbles are distinct. In DCS bubbles form primarily from inert gas that becomes dissolved in tissues over the course of a compressed gas dive. During and after ascent ('decompression'), if the pressure of this dissolved gas exceeds ambient pressure small bubbles may form in the extravascular space or in tissue blood vessels, thereafter passing into the venous circulation. In AGE, if compressed gas is trapped in the lungs during ascent, pulmonary barotrauma may introduce bubbles directly into the pulmonary veins and thence to the systemic arterial circulation. In both settings, bubbles may provoke ischaemic, inflammatory, and mechanical injury to tissues and their associated microcirculation. While AGE typically presents with stroke-like manifestations referrable to cerebral involvement, DCS can affect many organs including the brain, spinal cord, inner ear, musculoskeletal tissue, cardiopulmonary system and skin, and potential symptoms are protean in both nature and severity. This comprehensive overview addresses the pathophysiology, manifestations, prevention and treatment of both disorders.
Topics: Humans; Decompression Sickness; Diving; Barotrauma; Embolism, Air; Decompression
PubMed: 38537300
DOI: 10.28920/dhm54.1.suppl.1-53 -
Journal of Bone and Mineral Research :... Oct 2023The relationship between vitamin D metabolites and lower body (pelvis and lower limb) overuse injury is unclear. In a prospective cohort study, we investigated the...
The relationship between vitamin D metabolites and lower body (pelvis and lower limb) overuse injury is unclear. In a prospective cohort study, we investigated the association between vitamin D metabolites and incidence of lower body overuse musculoskeletal and bone stress injury in young adults undergoing initial military training during all seasons. In 1637 men and 530 women (aged 22.6 ± 7.5 years; body mass index [BMI], 24.0 ± 2.6 kg/m ; 94.3% white ethnicity), we measured serum 25-hydroxyvitamin D (25(OH)D) and 24,25-dihydroxyvitamin D (24,25(OH) D) by high-performance liquid chromatography tandem mass spectrometry, and 1,25-dihydroxyvitamin D (1,25(OH) D) by immunoassay during week 1 of training. We examined whether the relationship between 25(OH)D and 1,25(OH) D:24,25(OH) D ratio was associated with overuse injury. During 12 weeks of training, 21.0% sustained ≥1 overuse musculoskeletal injury, and 5.6% sustained ≥1 bone stress injury. After controlling for sex, BMI, 2.4 km run time, smoking, bone injury history, and Army training course (Officer, standard, or Infantry), lower body overuse musculoskeletal injury incidence was higher for participants within the second lowest versus highest quartile of 24,25(OH) D (odds ratio [OR] = 1.62; 95% confidence interval [CI] 1.13-2.32; p = 0.009) and lowest versus highest cluster of 25(OH)D and 1,25(OH) D:24,25(OH) D (OR = 6.30; 95% CI 1.89-21.2; p = 0.003). Lower body bone stress injury incidence was higher for participants within the lowest versus highest quartile of 24,25(OH) D (OR = 4.02; 95% CI 1.82-8.87; p < 0.001) and lowest versus highest cluster of 25(OH)D and 1,25(OH) D:24,25(OH) D (OR = 22.08; 95% CI 3.26-149.4; p = 0.001), after controlling for the same covariates. Greater conversion of 25(OH)D to 24,25(OH) D, relative to 1,25(OH) D (ie, low 1,25(OH) D:24,25(OH) D), and higher serum 24,25(OH) D were associated with a lower incidence of lower body overuse musculoskeletal and bone stress injury. Serum 24,25(OH) D may have a role in preventing overuse injury in young adults undertaking arduous physical training. © 2023 Crown copyright and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.
Topics: Male; Humans; Female; Young Adult; Prospective Studies; Vitamin D; Calcifediol; Cumulative Trauma Disorders; Minerals
PubMed: 37526272
DOI: 10.1002/jbmr.4890 -
Journal of Integrative Neuroscience Nov 2023In the past, the spinal cord was considered a hard-wired network responsible for spinal reflexes and a conduit for long-range connections. This view has changed... (Review)
Review
In the past, the spinal cord was considered a hard-wired network responsible for spinal reflexes and a conduit for long-range connections. This view has changed dramatically over the past few decades. It is now recognized as a plastic structure that has the potential to adapt to changing environments. While such changes occur under physiological conditions, the most dramatic alterations take place in response to pathological events. Many of the changes that occur following such pathological events are maladaptive, but some appear to help adapt to the new conditions. Although a number of studies have been devoted to elucidating the underlying mechanisms, in humans and animal models, the etiology and pathophysiology of various diseases impacting the spinal cord are still not well understood. In this review, we summarize current understanding and outstanding challenges for a number of diseases, including spinal muscular atrophy (SMA), amyotrophic laterals sclerosis (ALS), and spinal cord injury (SCI), with occasional relations to stroke. In particular, we focus on changes resulting from SCI (and stroke), and various influencing factors such as cause, site and extent of the afflicted damage.
Topics: Animals; Humans; Spinal Cord; Amyotrophic Lateral Sclerosis; Muscular Atrophy, Spinal; Spinal Cord Injuries; Disease Models, Animal; Stroke
PubMed: 38176936
DOI: 10.31083/j.jin2206167 -
JAMA Network Open May 2024Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial.
OBJECTIVE
To compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection.
DESIGN, SETTING, AND PARTICIPANTS
This surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023.
INTERVENTIONS
Participants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule.
MAIN OUTCOMES AND MEASURES
The primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months.
RESULTS
Among the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, -2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2000040262.
Topics: Humans; Platelet-Rich Plasma; Anterior Cruciate Ligament Reconstruction; Adult; Male; Female; Injections, Intra-Articular; Young Adult; Adolescent; Middle Aged; China; Treatment Outcome; Anterior Cruciate Ligament Injuries
PubMed: 38728032
DOI: 10.1001/jamanetworkopen.2024.10134 -
The Lancet. Infectious Diseases Jun 2024Fracture-related infection is a major complication related to musculoskeletal injuries that not only has important clinical consequences, but also a substantial... (Review)
Review
Fracture-related infection is a major complication related to musculoskeletal injuries that not only has important clinical consequences, but also a substantial socioeconomic impact. Although fracture-related infection is one of the oldest disease entities known to mankind, it has only recently been defined and, therefore, its global burden is still largely unknown. In this Personal View, we describe the origin of the term fracture-related infection, present the available data on its global impact, and discuss important aspects regarding its prevention and management that could lead to improved outcomes in both high-resource and low-resource settings. We also highlight the need for health-care systems to be adequately compensated for the high cost of human resources (trained staff) and well-equipped facilities required to adequately care for these complex patients. Our aim is to increase awareness among clinicians and policy makers that fracture-related infection is a disease entity that deserves prioritisation in terms of research, with the goal to standardise treatment and improve patient outcomes on a global scale.
Topics: Humans; Fractures, Bone; Global Health; Cost of Illness
PubMed: 38042164
DOI: 10.1016/S1473-3099(23)00503-0