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The Journal of Oral Implantology May 2024We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone...
We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a two-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p<0.0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p=0.770). PROMs for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at seven days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the two-step procedure described here are a predictable technique to obtain coronal flap displacements > 8 mm without increased surgical complications.
PubMed: 38703005
DOI: 10.1563/aaid-joi-D-24-00032 -
Clinical Case Reports May 2024The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of...
KEY CLINICAL MESSAGE
The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS.
ABSTRACT
Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
PubMed: 38689684
DOI: 10.1002/ccr3.8858 -
Cureus Mar 2024This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition...
This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition requiring surgical drainage. Subgaleal hematomas occur when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture. In many cases, subgaleal hematomas undergo spontaneous absorption without intervention. However, in this particular case, the hematoma measured approximately 1300 ml, making it the largest documented in medical literature and necessitating surgical intervention. In cases where hematoma absorption is problematic, clinicians should consider the possibility of underlying coagulopathy or persistent trauma, such as head banging, child maltreatment, or repeated falls due to seizure attacks, as observed in this patient. While there is no universally agreed-upon treatment protocol for subgaleal hematomas, incision and drainage offer immediate relief by evacuating the collection. Employing a negative-pressure suction drain can help alleviate the loss of tamponade effect. In addition, subsequent behavioral therapy and rehabilitation efforts may enhance the overall recovery and well-being of affected individuals.
PubMed: 38686222
DOI: 10.7759/cureus.57194 -
Journal of Pediatric Urology Jun 2024The decreased penile length in patients born with bladder exstrophy (BE) results partly from pubic symphysis diastasis and the separation of the corporal bodies. Also,...
INTRODUCTION
The decreased penile length in patients born with bladder exstrophy (BE) results partly from pubic symphysis diastasis and the separation of the corporal bodies. Also, intrinsic shortening of anterior corporal compartment, residual penile dorsal curvature, and postsurgical scarred skin share in creation of short penile length.
OBJECTIVE
The goal of this study was to look at whether adult men who had bladder exstrophy (BE) surgery as babies needed and benefited from penile reconstruction, which included penile lengthening and repair of any redo penile pathology that was present at the same time.
STUDY DESIGN
We reviewed the records of 31 repaired BE patients with mean age of 21.4 ± 3.7 years. The patients complained of their dissatisfaction with short penile length, residual dorsal penile curvature, distal dorsal or hypospadiac urethral opening and scared penopubic skin. The penile lengthening was performed by sub-periosteal detachment of the corporal bodies from the pubic rami in all cases. In 8 patients full thickness dermal grafts were used to penile resurfacing after its lengthening. Twelve patients underwent coronal or glanular urethroplasty. Phalloplasty was performed in one patient using forearm free graft.
RESULTS
Subjective evaluation by the patient reported satisfactory results in 25/31 (80.6 %). The degree of penile lengthening measured at 6 months and one year postoperatively showed increased length which varied between 50 % and 150 % of the preoperative penile length.
DISCUSSION
We hypothesize that congenital causes, such as short anterior corporeal compartment, wide pubic rami diastasis, and short penile urethra, as well as iatrogenic causes, such as post-surgical peno-pubic scars, could account for the coexisting multifactorial causes of penile shortening in male adults with BE. Penile lengthening is permitted, in our opinion, provided that the crura from the pubic rami is carefully and partially mobilized.
CONCLUSIONS
The short phallus, residual dorsal chordee and distal urethroplasty can be corrected successfully in the majority of patients. Adult males with BE may have short penis that requires another reconstructive stage. The short phallus, residual chordee and distal urethroplasty can be corrected` successfully in the majority of patients.
Topics: Humans; Bladder Exstrophy; Male; Penis; Plastic Surgery Procedures; Urologic Surgical Procedures, Male; Young Adult; Adult; Retrospective Studies; Adolescent; Treatment Outcome; Follow-Up Studies
PubMed: 38670859
DOI: 10.1016/j.jpurol.2024.01.016 -
Journal of Postgraduate Medicine Apr 2024
Topics: Humans; Jugular Veins; Venous Thrombosis; Jugular Foramina; Male; Female; Tomography, X-Ray Computed; Periosteum; Middle Aged; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 38668649
DOI: 10.4103/jpgm.jpgm_763_23 -
Journal of Medical Ultrasound 2024Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed... (Review)
Review
Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed their diagnostic utility for osteomyelitis (OM) and arthritis. We included articles that studied ultrasonographic findings of periosteal changes in OM and arthropathies with aims to systematically review periosteal manifestations of each condition and summarize diagnostic values of each finding. A total of 13 articles were included in the systematic review. Of these, 10 articles are on OM, 3 articles are on psoriatic arthritis (PsA), 1 article is on rheumatoid arthritis (RA), and 1 article is on gouty arthritis (GA). In OM, subperiosteal fluid/subperiosteal collection (SF/SC) was detected in 32%-76% within 72 h after presentation. Periosteal reaction (PR) was seen after day 4 and the sensitivity on US ranges from 33% to 100%. In PsA, PR was seen near 16%-59% in active PsA joints. Periosteal changes are rarely detected in RA joints. Small hyperechoic spots were seen in 87.5% of GA. SF/SC may be seen on US as the earliest sign followed by PR for OM. PR is more specific in PsA than RA. Further investigations on periosteal abnormalities on US are warranted to confirm our findings.
PubMed: 38665346
DOI: 10.4103/jmu.jmu_16_23 -
The Journal of Biological Chemistry Jun 2024A deleterious effect of elevated levels of vitamin A on bone health has been reported in clinical studies. Mechanistic studies in rodents have shown that numbers of...
A deleterious effect of elevated levels of vitamin A on bone health has been reported in clinical studies. Mechanistic studies in rodents have shown that numbers of periosteal osteoclasts are increased, while endocortical osteoclasts are simultaneously decreased by vitamin A treatment. The present study investigated the in vitro and in vivo effect of all-trans retinoic acid (ATRA), the active metabolite of vitamin A, on periosteal osteoclast progenitors. Mouse calvarial bone cells were cultured in media containing ATRA, with or without the osteoclastogenic cytokine receptor activator of nuclear factor kappa B-ligand (RANKL), on plastic dishes or bone discs. Whereas ATRA did not stimulate osteoclast formation alone, the compound robustly potentiated the formation of RANKL-induced bone resorbing osteoclasts. This effect was due to stimulation by ATRA (half-maximal stimulation ∼3 nM) on the numbers of macrophages/osteoclast progenitors in the bone cell cultures, as assessed by mRNA and protein expression of several macrophage and osteoclast progenitor cell markers, such as macrophage colony-stimulating factor receptor, receptor activator of nuclear factor kappa B, F4/80, and CD11b, as well as by flow cytometry (FACS) analysis of CD11b/F480/Gr1 cells. The stimulation of macrophage numbers in the periosteal cell cultures was not mediated by increased macrophage colony-stimulating factor or interleukin-34. In contrast, ATRA did not enhance macrophages in bone marrow cell cultures. Importantly, ATRA treatment upregulated the mRNA expression of several macrophage-related genes in the periosteum of tibia in adult mice. These observations demonstrate a novel mechanism by which vitamin A enhances osteoclast formation specifically on periosteal surfaces.
Topics: Animals; Mice; Osteoclasts; Macrophages; Periosteum; RANK Ligand; Vitamin A; Stem Cells; Cells, Cultured; Tretinoin; Osteogenesis; Mice, Inbred C57BL; Male
PubMed: 38657862
DOI: 10.1016/j.jbc.2024.107308 -
Journal of Biophotonics Apr 2024We investigate the efficacy of photodynamic antimicrobial chemotherapy (PACT) and its combination with an antibiotic in the treatment of diabetic foot ulcers (DFUs) in...
We investigate the efficacy of photodynamic antimicrobial chemotherapy (PACT) and its combination with an antibiotic in the treatment of diabetic foot ulcers (DFUs) in rats using a novel cationic amino acid porphyrin-based photosensitizer. The research findings demonstrate that the combination of novel cationic photosensitizer-mediated PACT and an antibiotic exhibits significant therapeutic efficacy in treating deep ulcers in a rat model of DFUs. Moreover, the PACT + Antibiotic group displays enhanced angiogenesis, improved tissue maturation, and superior wound healing effect. Micro-computed tomography examination showed that the periosteal reaction was most obvious in the PACT + Antibiotic group. The cortical bone volume ratio (BV/TV), the bone mineral density, and trabecular thickness were significantly higher in the PACT + Antibiotic group than in the model group (p < 0.05). The combination of PACT and antibiotic plays a sensitizing therapeutic role, which provides a new idea for the clinical treatment of DFUs.
PubMed: 38651324
DOI: 10.1002/jbio.202300568 -
Theranostics 2024Mechanical forces are indispensable for bone healing, disruption of which is recognized as a contributing cause to nonunion or delayed union. However, the underlying...
Mechanical forces are indispensable for bone healing, disruption of which is recognized as a contributing cause to nonunion or delayed union. However, the underlying mechanism of mechanical regulation of fracture healing is elusive. We used the lineage-tracing mouse model, conditional knockout depletion mouse model, hindlimb unloading model and single-cell RNA sequencing to analyze the crucial roles of mechanosensitive protein polycystin-1 (PC1, ) promotes periosteal stem/progenitor cells (PSPCs) osteochondral differentiation in fracture healing. Our results showed that cathepsin ()-positive PSPCs are fracture-responsive and mechanosensitive and can differentiate into osteoblasts and chondrocytes during fracture repair. We found that polycystin-1 declines markedly in PSPCs with mechanical unloading while increasing in response to mechanical stimulus. Mice with conditional depletion of in PSPCs show impaired osteochondrogenesis, reduced cortical bone formation, delayed fracture healing, and diminished responsiveness to mechanical unloading. Mechanistically, PC1 facilitates nuclear translocation of transcriptional coactivator TAZ via PC1 C-terminal tail cleavage, enhancing osteochondral differentiation potential of PSPCs. Pharmacological intervention of the PC1-TAZ axis and promotion of TAZ nuclear translocation using Zinc01442821 enhances fracture healing and alleviates delayed union or nonunion induced by mechanical unloading. Our study reveals that PSPCs within the callus can sense mechanical forces through the PC1-TAZ axis, targeting which represents great therapeutic potential for delayed fracture union or nonunion.
Topics: Animals; Fracture Healing; Mice; Cell Differentiation; TRPP Cation Channels; Chondrocytes; Stem Cells; Osteogenesis; Mice, Knockout; Chondrogenesis; Periosteum; Osteoblasts; Disease Models, Animal; Male; Adaptor Proteins, Signal Transducing
PubMed: 38646641
DOI: 10.7150/thno.93269 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Mar 2024Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including... (Review)
Review
Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes.
Topics: Talus; Humans; Bone Transplantation; Platelet-Rich Plasma; Osteochondritis Dissecans; Cartilage; Arthroplasty, Subchondral; Cartilage, Articular
PubMed: 38645844
DOI: 10.12182/20240360206