-
Cureus Jan 2023Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of... (Review)
Review
Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.
PubMed: 36819450
DOI: 10.7759/cureus.33905 -
Facial Plastic Surgery : FPS Jun 2022There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal...
There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were "tear trough" OR "infraorbital" AND "dermal filler" OR "hyaluronic acid" OR "poly-L-lactic acid" OR "calcium hydroxyapatite" OR "Restylane" OR "Radiesse" OR "Perlane" OR "Juvéderm" OR "Belotero." Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue-gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.
Topics: Cosmetic Techniques; Dermal Fillers; Eyelids; Humans; Rejuvenation; Skin Aging
PubMed: 34192769
DOI: 10.1055/s-0041-1731348 -
International Journal of Biological... 2022The biomechanical environment plays a dominant role in fracture healing, and Piezo1 is regarded as a major mechanosensor in bone homeostasis. However, the role of Piezo1...
The biomechanical environment plays a dominant role in fracture healing, and Piezo1 is regarded as a major mechanosensor in bone homeostasis. However, the role of Piezo1 in fracture healing is not yet well characterized. In this study, we first delineated that Piezo1 is highly expressed in periosteal stem cells (PSCs) and their derived osteoblastic lineage cells and chondrocytes. Furthermore, downregulation of Piezo1 in callus leads to impaired fracture healing, while activation by its specific agonist promotes fracture healing through stimulation of PSC-modulated chondrogenesis and osteogenesis, along with accelerated cartilage-to-bone transformation. Interestingly, vascular endothelial growth factor A is upregulated after Yoda1 treatment of PSCs, indicating an indirect role of Piezo1 in angiogenesis. Mechanistically, activation of Piezo1 promotes expression of Yes-associated protein (YAP) and its nuclear localization in PSCs, which in turn increases the expression and nuclear localization of β-catenin. In detail, YAP directly interacts with β-catenin in the nucleus and forms a transcriptional YAP/β-catenin complex, which upregulates osteogenic, chondrogenic and angiogenic factors. Lastly, Yoda1 treatment significantly improves fracture healing in a delayed union mouse model generated by tail suspension. These findings indicate that Piezo1 is a potential therapeutic target for fracture delayed union or nonunion.
Topics: Animals; Bony Callus; Fracture Healing; Ion Channels; Mice; Osteogenesis; Stem Cells; Vascular Endothelial Growth Factor A; beta Catenin
PubMed: 35844802
DOI: 10.7150/ijbs.71390 -
The Journal of Clinical Investigation Dec 2019Bone is richly innervated by nerve growth factor-responsive (NGF-responsive) tropomyosin receptor kinase A-expressing (TrKa-expressing) sensory nerve fibers, which are...
Bone is richly innervated by nerve growth factor-responsive (NGF-responsive) tropomyosin receptor kinase A-expressing (TrKa-expressing) sensory nerve fibers, which are required for osteochondral progenitor expansion during mammalian skeletal development. Aside from pain sensation, little is known regarding the role of sensory innervation in bone repair. Here, we characterized the reinnervation of tissue following experimental ulnar stress fracture and assessed the impact of loss of TrkA signaling in this process. Sequential histological data obtained in reporter mice subjected to fracture demonstrated a marked upregulation of NGF expression in periosteal stromal progenitors and fracture-associated macrophages. Sprouting and arborization of CGRP+TrkA+ sensory nerve fibers within the reactive periosteum in NGF-enriched cellular domains were evident at time points preceding periosteal vascularization, ossification, and mineralization. Temporal inhibition of TrkA catalytic activity by administration of 1NMPP1 to TrkAF592A mice significantly reduced the numbers of sensory fibers, blunted revascularization, and delayed ossification of the fracture callus. We observed similar deficiencies in nerve regrowth and fracture healing in a mouse model of peripheral neuropathy induced by paclitaxel treatment. Together, our studies demonstrate an essential role of TrkA signaling for stress fracture repair and implicate skeletal sensory nerves as an important upstream mediator of this repair process.
Topics: Animals; Disease Models, Animal; Fracture Healing; Fractures, Bone; Fractures, Stress; Ganglia, Spinal; Genes, Reporter; Imaging, Three-Dimensional; Male; Mice; Mice, Inbred C57BL; Nerve Growth Factor; Osteogenesis; Periosteum; Receptor, trkA; Sensory Receptor Cells; Signal Transduction; Stem Cells; Transgenes; X-Ray Microtomography
PubMed: 31638597
DOI: 10.1172/JCI128428 -
AACE Clinical Case Reports 2022Voriconazole treatment has been associated with diffuse periostitis, especially in immunocompromised patients who have had transplants or are on immunosuppressants....
BACKGROUND/OBJECTIVE
Voriconazole treatment has been associated with diffuse periostitis, especially in immunocompromised patients who have had transplants or are on immunosuppressants. Here, we present a case of diffuse periostitis induced by prophylactic low-dose voriconazole for pulmonary aspergillosis.
CASE REPORT
A 66-year-old woman presented with 1 year of progressive, diffuse bone pain most prominent over the left shoulder and bilateral hips. She had a history of sarcoidosis requiring a single orthotopic lung transplant. Left phalangeal soft tissue swelling and painful nodules without clubbing were noted on examination. Prophylactic voriconazole 200 mg twice a day for pulmonary aspergillosis was prescribed for over 7 years. Elevated levels of alkaline phosphatase (469 units/L [reference range, 38-126]), bone-specific alkaline phosphatase (125 μg/L [0-20]), and parathyroid hormone (137 pg/mL [8-54]) and normal c-telopeptide level (842 pg/mL [34-1037]) were noted. Radiographs showed "multifocal periostitis" in both hip joints and bilateral proximal femurs, findings suggestive of voriconazole-induced periostitis deformans. Voriconazole was discontinued, and the patient improved symptomatically, despite persistent bone deformities on imaging.
DISCUSSION
Diffuse bone pain can be due to various pathologies, including metabolic or inflammatory diseases and bone tumors. Voriconazole-induced periostitis is caused by skeletal fluorosis, which can result in diffuse bone pain. It is a clinical diagnosis that is supported with radiologic findings, including focal, nodular, dense, and irregular periosteal reactions. Biochemical evaluation may reveal elevated alkaline phosphatase levels, but it is usually related to normal voriconazole trough levels. Periostitis is a benign condition, and discontinuation of the drug usually leads to clinical improvement.
CONCLUSION
Voriconazole-induced periostitis should be considered as a diagnosis in elderly, immunosuppressed patients with diffuse bone pain on antifungal treatment. Early recognition of voriconazole-induced periostitis may result in both improved patient clinical outcomes and avoidance of unnecessary diagnostic testing.
PubMed: 36189133
DOI: 10.1016/j.aace.2022.05.001 -
The EMBO Journal Feb 2022Leptin receptor (LepR)-positive cells are key components of the bone marrow hematopoietic microenvironment, and highly enrich skeletal stem and progenitor cells that...
Leptin receptor (LepR)-positive cells are key components of the bone marrow hematopoietic microenvironment, and highly enrich skeletal stem and progenitor cells that maintain homeostasis of the adult skeleton. However, the heterogeneity and lineage hierarchy within this population has been elusive. Using genetic lineage tracing and single-cell RNA sequencing, we found that Lepr-Cre labels most bone marrow stromal cells and osteogenic lineage cells in adult long bones. Integrated analysis of Lepr-Cre-traced cells under homeostatic and stress conditions revealed dynamic changes of the adipogenic, osteogenic, and periosteal lineages. Importantly, we discovered a Notch3 bone marrow sub-population that is slow-cycling and closely associated with the vasculatures, as well as key transcriptional networks promoting osteo-chondrogenic differentiation. We also identified a Sca-1 periosteal sub-population with high clonogenic activity but limited osteo-chondrogenic potential. Together, we mapped the transcriptomic landscape of adult LepR stem and progenitor cells and uncovered cellular and molecular mechanisms underlying their maintenance and lineage specification.
Topics: Aging; Animals; Antigens, Ly; Bone and Bones; Cell Differentiation; Cell Lineage; Colony-Forming Units Assay; Female; Fractures, Bone; Gene Expression Profiling; Homeodomain Proteins; Male; Membrane Proteins; Mice, Inbred C57BL; Mice, Transgenic; Receptors, Leptin; Rosiglitazone; Single-Cell Analysis; Stem Cells; Stress, Physiological; Mice
PubMed: 34957577
DOI: 10.15252/embj.2021108415