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Experimental and Therapeutic Medicine Jul 2024The Ilizarov technology was proposed by Former Soviet orthopedic physician Ilizarov. It is a medical method to reconstruct missing tissues. Ilizarov technology combined...
The Ilizarov technology was proposed by Former Soviet orthopedic physician Ilizarov. It is a medical method to reconstruct missing tissues. Ilizarov technology combined with soft tissue stretching technology is of great significance in the treatment of common orthopedic problems like bone defects, finger absence, joint contracture and joint stiffness following thermal-crush injuries of the hand. In the present study a 25-year-old male patient sought for limb salvage treatment 1 month after sustaining thermal-crush injuries of the right hand and forearm. The patient had been treated by another hospital with multiple procedures of debridement, and recommended for forearm amputation. The patient was diagnosed with: i) Postoperative infection of thermal-crush injuries of the right hand and right forearm; ii) comminuted open fractures of the proximal and distal phalanges of the right thumb; iii) osteomyelitis; iv) palm skin defects with exposed tendons; and v) skin defects of the opisthenar and the forearm. After a series of treatments including debridement, removal of necrotic tissue, tissue transplantation, skin pedicle, bone lengthening, external shaping, tissue release, joint fusion, traction and rehabilitation exercises, the patient recovered some hand function. Overall, thermal-crush injuries of the hand are severe, complicated combined injuries composed of both heat burn and compression injury and their treatment is challenging. Overall, microsurgery combined with Ilizarov technology can effectively reconstruct the function of complex thermal-crush injuries of the hand.
PubMed: 38827471
DOI: 10.3892/etm.2024.12580 -
Acta Biochimica Et Biophysica Sinica Jun 2024Medial arterial calcification (MAC) accompanying chronic kidney disease (CKD) leads to increased vessel wall stiffness, myocardial ischemia, heart failure, and increased...
Medial arterial calcification (MAC) accompanying chronic kidney disease (CKD) leads to increased vessel wall stiffness, myocardial ischemia, heart failure, and increased cardiovascular morbidity and mortality. Unfortunately, there are currently no drugs available to treat MAC. The natural polyphenol epigallocatechin-3-gallate (EGCG) has been demonstrated to protect against cardiovascular disease; however, whether EGCG supplementation inhibits MAC in CKD remains unclear. In this study, we utilize a CKD-associated MAC model to investigate the effects of EGCG on vascular calcification and elucidate the underlying mechanisms involved. Our findings demonstrate that EGCG treatment significantly reduces calcium phosphate deposition and osteogenic differentiation of VSMCs and in a dose-dependent manner. In addition, through RNA sequencing (RNA-seq) analysis, we show a significant activation of the transcription factor JunB both in CKD mouse arteries and in osteoblast-like VSMCs. Notably, EGCG effectively suppresses CKD-associated MAC by inhibiting the activity of JunB. In addition, overexpression of JunB can abolish while knockdown of can enhance the inhibitory effect of EGCG on the osteogenic differentiation of VSMCs. Furthermore, EGCG supplementation inhibits MAC in CKD via modulation of the JunB-dependent Ras/Raf/MEK/ERK signaling pathway. In conclusion, our study highlights the potential therapeutic value of EGCG for managing CKD-associated MAC, as it mitigates this pathological process through targeted inactivation of JunB.
PubMed: 38826134
DOI: 10.3724/abbs.2024060 -
Journal of the Mechanical Behavior of... Aug 2024Articular cartilage tissue exhibits a spatial dependence in material properties that govern mechanical behaviour. A mathematical model of cartilage tissue under one...
Articular cartilage tissue exhibits a spatial dependence in material properties that govern mechanical behaviour. A mathematical model of cartilage tissue under one dimensional confined compression testing is developed for normal tissue that takes account of these variations in material properties. Modifications to the model representative of a selection of mechanisms driving osteoarthritic cartilage are proposed, allowing application of the model to both physiological and pathophysiological, osteoarthritic tissue. Incorporating spatial variations into the model requires the specification of more parameters than are required in the absence of these variations. A global sensitivity analysis of these parameters is implemented to identify the dominant mechanisms of mechanical response, in normal and osteoarthritic cartilage tissue, to both static and dynamic loading. The most sensitive parameters differ between dynamic and static mechanics of the cartilage, and also differ between physiological and osteoarthritic pathophysiological cartilage. As a consequence changes in cartilage mechanics in response to alterations in cartilage structure are predicted to be contingent on the nature of loading and the health, or otherwise, of the cartilage. In particular the mechanical response of cartilage, especially deformation, is predicted to be much more sensitive to cartilage stiffness in the superficial zone given the onset of osteoarthritic changes to material properties, such as superficial zone increases in permeability and reductions in fixed charge. In turn this indicates that any degenerative changes in the stiffness associated with the superficial cartilage collagen mesh are amplified if other elements of osteoarthritic disease are present, which provides a suggested mechanism-based explanation for observations that the range of mechanical parameters representative of normal and osteoarthritic tissue can overlap substantially.
Topics: Biomechanical Phenomena; Cartilage, Articular; Osteoarthritis; Mechanical Phenomena; Models, Biological; Humans; Stress, Mechanical; Materials Testing; Weight-Bearing; Mechanical Tests
PubMed: 38824865
DOI: 10.1016/j.jmbbm.2024.106575 -
Annals of the Rheumatic Diseases May 2024The objective of this study is to develop classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA based on self-reported data...
OBJECTIVES
The objective of this study is to develop classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA based on self-reported data and radiographic features.
METHODS
The classification criteria sets were developed in three phases. In phase 1, we identified criteria that discriminated hand OA from controls. In phase 2, we used a consensus-based decision analysis approach to derive a clinician-based evaluation of the relative importance of the criteria. In phase 3, we refined the scoring system, determined the cut-offs for disease classification and compared the sensitivity and specificity of the European Alliance of Associations for Rheumatology (EULAR) criteria with the 1990 American College of Rheumatology (ACR) criteria.
RESULTS
In persons with hand symptoms and no other disease (including psoriasis) or acute injury that can explain the hand symptoms (mandatory criteria), hand OA can be classified based on age, duration of morning stiffness, number of joints with osteophytes and joint space narrowing, and concordance between symptoms and radiographic findings. Using a sum of scores based on each diagnostic element, overall hand OA can be classified if a person achieves 9 or more points on a 0-15 scale. The cut-off for interphalangeal OA and thumb base OA is 8 points. While the EULAR criteria demonstrated better sensitivity than the ACR criteria in the phase 1 data set, the performance of the two criteria sets was similar in two external cohorts.
CONCLUSIONS
International experts developed the EULAR criteria to classify overall hand OA, interphalangeal OA and thumb base OA in clinical studies using a rigorous methodology.
PubMed: 38821712
DOI: 10.1136/ard-2023-225073 -
Shoulder & Elbow Jul 2024An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and... (Review)
Review
BACKGROUND
An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction.
METHODS
A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case.
RESULTS
Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach.
DISCUSSION AND CONCLUSIONS
From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering +/- methicillin-resistant , (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.
PubMed: 38818095
DOI: 10.1177/17585732231165194 -
Future Science OA 2024This study endeavors to explore the anti-arthritic effects of macerated oil derived from the plant's aerial parts. The macerated oil was prepared using maceration in...
This study endeavors to explore the anti-arthritic effects of macerated oil derived from the plant's aerial parts. The macerated oil was prepared using maceration in coconut oil, and its phytochemical composition was elucidated using GC-MS. To assess its anti-arthritic activity, studies were conducted using various assays. The macerated oil showed better antioxidant and anti-arthritic potential by - investigations. Molecular docking studies elucidated potential binding interactions between specific constituents of the oil and critical molecular targets implicated in the pathogenesis of arthritis, further substantiating its therapeutic potential. The results demonstrated that macerated oil could ameliorate arthritis severity in a dose-dependent manner.
PubMed: 38817355
DOI: 10.2144/fsoa-2023-0248 -
Scientific Reports May 2024Electromyography (EMG) is considered a potential predictive tool for the severity of knee osteoarthritis (OA) symptoms and functional outcomes. Patient-reported outcome...
Electromyography (EMG) is considered a potential predictive tool for the severity of knee osteoarthritis (OA) symptoms and functional outcomes. Patient-reported outcome measures (PROMs), such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), are used to determine the severity of knee OA. We aim to investigate muscle activation and co-contraction patterns through EMG from the lower extremity muscles of patients with advanced knee OA patients and evaluate the effectiveness of an interpretable machine-learning model to estimate the severity of knee OA according to the WOMAC (pain, stiffness, and physical function) and VAS using EMG gait features. To explore neuromuscular gait patterns with knee OA severity, EMG from rectus femoris, medial hamstring, tibialis anterior, and gastrocnemius muscles were recorded from 84 patients diagnosed with advanced knee OA during ground walking. Muscle activation patterns and co-activation indices were calculated over the gait cycle for pairs of medial and lateral muscles. We utilized machine-learning regression models to estimate the severity of knee OA symptoms according to the PROMs using muscle activity and co-contraction features. Additionally, we utilized the Shapley Additive Explanations (SHAP) to interpret the contribution of the EMG features to the regression model for estimation of knee OA severity according to WOMAC and VAS. Muscle activity and co-contraction patterns varied according to the functional limitations associated with knee OA severity according to VAS and WOMAC. The coefficient of determination of the cross-validated regression model is 0.85 for estimating WOMAC, 0.82 for pain, 0.85 for stiffness, and 0.85 for physical function, as well as VAS scores, utilizing the gait features. SHAP explanation revealed that greater co-contraction of lower extremity muscles during the weight acceptance and swing phases indicated more severe knee OA. The identified muscle co-activation patterns may be utilized as objective candidate outcomes to better understand the severity of knee OA.
Topics: Humans; Osteoarthritis, Knee; Male; Female; Patient Reported Outcome Measures; Middle Aged; Electromyography; Aged; Knee Joint; Muscle, Skeletal; Gait; Machine Learning; Severity of Illness Index; Muscle Contraction
PubMed: 38816528
DOI: 10.1038/s41598-024-63266-7 -
The Turkish Journal of Pediatrics May 2024Hyaline fibromatosis syndrome is a rare autosomal recessive disorder caused by ANTXR2 pathogenic variants. The disorder is characterized by the deposition of amorphous...
BACKGROUND
Hyaline fibromatosis syndrome is a rare autosomal recessive disorder caused by ANTXR2 pathogenic variants. The disorder is characterized by the deposition of amorphous hyaline material in connective tissues. The hallmarks of the disease are joint contractures, generalized skin stiffness, hyperpigmented papules over extensor surfaces of joints, fleshy perianal masses, severe diarrhea, and gingival hypertrophy. The severity of the disease varies and prognosis is poor. No specific treatment is yet available. Most patients with the severe form of the condition pass away before the second year of age. In this study, we describe the clinical and molecular findings of a cohort of seven hyaline fibromatosis syndrome patients who were diagnosed and followed up at a single tertiary reference center in Turkey.
METHODS
Genomic DNA was extracted by standard salting out method from peripheric blood samples of three patients. In one patient DNA extraction was performed on pathology slides since peripheric blood DNA was not available. All coding exons of the ANTXR2 were amplified and sequenced on ABI Prism 3500 Genetic Analyser.
RESULTS
Sanger sequencing was performed in 3 patients and homozygous c.945T>G p.(Cys315Trp), c.1073dup p.(Ala359CysfsTer13), and c.1074del p.(Ala359HisfsTer50) variants were identified in ANTXR2. All patients passed away before the age of five years.
CONCLUSIONS
HFS is a rare, progressive disorder with a broad phenotypic spectrum. HFS can be recognized easily with distinctive clinical features. Nevertheless, it has poor prognosis with increased mortality due to severe clinical decompensation.
Topics: Humans; Hyaline Fibromatosis Syndrome; Male; Female; Infant; Child, Preschool; Receptors, Peptide; Turkey; Child
PubMed: 38814306
DOI: 10.24953/turkjpediatr.2024.4511 -
BMC Musculoskeletal Disorders May 2024This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19...
BACKGROUND
This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19 infection.
METHODS
A literature search for eligible articles was conducted using MEDLINE/Pubmed, Global Health, and Scopus databases (January 12th, 2023), including all case reports and case series from any country and language. The criteria for inclusion in this review were cases of COVID-19 infection subsequently developing heterotopic ossification.
RESULTS
This systematic review analysed 15 reports (n = 20 patients) documenting cases of heterotopic ossification following COVID-19 infection. 80% of the patients were male, with a median age of 59 years. All patients required intensive care unit stay with an average duration of 48.5 days. Mechanical ventilation was necessary for all patients and 30% of them underwent tracheostomy. Common symptoms included stiffness and pain, most frequently affecting multiple locations (70%), with the hips and shoulders being predominantly involved. X-rays were the most commonly used imaging modality, followed by computed tomography. Although treatment was given, some of the patients continued to experience symptoms, particularly stiffness.
CONCLUSION
20 patients who developed heterotopic ossification after COVID-19 have been reported, the majority of which had at least two independent risk factors for this condition. The link between those two clinical entities is therefore uncertain, requiring further investigation. It is nonetheless important to suspect heterotopic ossification in patients with severe COVID-19 infection, prolonged immobilisation, mechanical ventilation, who develop joint pain and stiffness, as this condition can significantly impact patients' quality of life.
PROTOCOL REGISTRATION
CRD42023393516.
Topics: Humans; Ossification, Heterotopic; COVID-19; Male; Middle Aged; Female; Respiration, Artificial; Aged; SARS-CoV-2; Adult
PubMed: 38811925
DOI: 10.1186/s12891-024-07537-4 -
Scientific Reports May 2024Precast concrete structures have developed rapidly because they meet the requirements of green and low-carbon social development. In this paper, a precast post-tensioned...
Precast concrete structures have developed rapidly because they meet the requirements of green and low-carbon social development. In this paper, a precast post-tensioned high-performance concrete frame beam-column joint was proposed, and the low-cycle reversed load test was performed on the four proposed joints. The main differences between the four joints are the different prestress values applied by the joints and whether the beam-column joint is provided with L-shaped steel. The seismic performance indexes such as hysteresis curve, stiffness degradation, deformation capacity, energy dissipation capacity and residual deformation of each node were obtained through experiments. By comparing various seismic performance indicators, it could be found that the use of high-performance concrete could effectively avoid the phenomenon of local crushing of concrete due to excessive prestressing. At the same time, it was found that the setting of L-shaped steel plate at the beam-column junction could effectively avoid the early damage at the beam-column junction. On the basis of the test, the three-line restoring force model of the joint was established by the method of experimental regression analysis. The model could better reflect the stress situation of each stage of the joint. Based on the experimental and theoretical analysis, the finite element analysis model of the joint was established, and the model calculation results were in good agreement with the experimental results.
PubMed: 38811693
DOI: 10.1038/s41598-024-63083-y