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Cureus May 2024Mixed connective tissue disorder (MCTD) is the first overlap syndrome described with features of overlapping manifestations of at least two other autoimmune rheumatic...
Mixed connective tissue disorder (MCTD) is the first overlap syndrome described with features of overlapping manifestations of at least two other autoimmune rheumatic conditions. It is an autoimmune disease of rarity and is strongly associated with specific antibodies to U1 small nuclear ribonucleoprotein (anti-U1-RNP). This disorder affects almost all organs of the body, and it has varied clinical presentations as it has an autoimmune and inflammatory background, causing heightened immune cell activation. They present more commonly with less fatal symptoms like joint pain, stiffness, and mucocutaneous changes. The majority present initially with Raynaud's phenomenon followed by muscular skeletal involvement and around half of them present with swallowing problems due to esophageal dysmotility. Rarely do they also present with more morbid symptoms of pulmonary hypertension and central nervous system involvement. MCTD on follow-up had a 10 percent association with neurological manifestations as reported by the National Organization for Rare Diseases (NORD), and the most reported diseases were trigeminal neuralgia and aseptic meningitis. Patients presenting with such symptoms and, when treated only with guideline-based antibiotics therapy, would delay the treatment, leading to a poorer prognosis. The following is an interesting case of a young female presenting with a headache, which was masquerading as an underlying undiagnosed connective tissue disorder. Headache is a predominant presentation that has several etiologies in autoimmune disease and meticulous differential diagnosis workup is a must. This case highlights the fact that any persistent atypical, unusual symptom needs to be always considered for further evaluation to arrive at a diagnosis and for a favorable outcome.
PubMed: 38903288
DOI: 10.7759/cureus.60762 -
Journal of Otolaryngology - Head & Neck... 2024Minimally invasive cochlear implant surgery by using a microstereotactic frame demands solid connection to the bone. We aimed to determine the stability of commercially...
BACKGROUND
Minimally invasive cochlear implant surgery by using a microstereotactic frame demands solid connection to the bone. We aimed to determine the stability of commercially available orthodontic miniscrews to evaluate their feasibility for frame's fixation. In addition, which substitute material most closely resembles the mechanical properties of the human temporal bone was evaluated.
METHODS
Pull-out tests were carried out with five different types of orthodontic miniscrews in human temporal bone specimens. Furthermore, short fiber filled epoxy (SFFE), solid rigid polyurethane (SRPU50), bovine femur, and porcine iliac bone were evaluated as substitute materials. In total, 57 tests in human specimens and 180 tests in the substitute materials were performed.
RESULTS
In human temporal bone, average pull-out forces ranged from 220 N to 285 N between screws. Joint stiffness in human temporal bone ranged between 14 N/mm and 358 N/mm. Statistically significant differences between the tested screws were measured in terms of stiffness and elastic energy. One screw type failed insertion due to tip breakage. No significant differences occurred between screws in maximum pull-out force. The average pull-out values of SFFE were 14.1 N higher compared to human specimen.
CONCLUSION
Orthodontic miniscrews provided rigid fixation when partially inserted in human temporal bone, as evidenced by pull-out forces and joint stiffness. Average values exceeded requirements despite variations between screws. Differences in stiffness and elastic energy indicate screw-specific interface mechanics. With proper insertion, orthodontic miniscrews appear suitable for microstereotactic frame anchoring during minimally invasive cochlear implant surgery. However, testing under more complex loading is needed to better predict clinical performance. For further pull-out tests, the most suitable substitute material is SFFE.
Topics: Temporal Bone; Humans; Bone Screws; Animals; Swine; Cochlear Implantation; Materials Testing; Cadaver; Cattle; Minimally Invasive Surgical Procedures
PubMed: 38903014
DOI: 10.1177/19160216241248669 -
The Oncologist Jun 2024The prognostic significance of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains controversial. Notably, there is evidence suggesting an...
BACKGROUND
The prognostic significance of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains controversial. Notably, there is evidence suggesting an association between tissue stiffness and the aggressiveness of the disease. We therefore aimed to explore the effect of tissue stiffness on LNM-related invasiveness in PTC patients.
METHOD
A total of 2492 PTC patients from 3 hospitals were divided into an LNM group and a non-LNM group based on their pathological results. The effects of interior lesion stiffness (E) and peri-cancerous tissue stiffness (Eshell) on the LNM-related recurrence rate and mortality in each patient with PTC subgroup were analyzed. The activation of cancer-associated fibroblasts (CAFs) and extracellular matrix component type 1 collagen (COL-I) in the lesion were compared and analyzed across different subgroups. The underlying biological basis of differences in each subgroup was identified using RNA sequencing (RNA-seq) data.
RESULTS
The Eshell value and Eshell/E in the LNM group were significantly higher than those in the non-LNM group of patients with PTC (Eshell: 72.72 ± 5.63 vs 66.05 ± 4.46; Eshell/E: 1.20 ± 1.72 vs 1.09 ± 1.10, P < .001). When Eshell/E > 1.412 and LNM were both present, the recurrence rate and mortality were significantly increased compared to those of group of patients with LNM (91.67% and 7.29%, respectively). The CAF activation and COL-I content in the Eshell/E+ group were significantly higher than those in the Eshell/E- group (all P < .001), and the RNA-seq results revealed significant extracellular matrix (ECM) remodeling in the LNM-Eshell/E+ group.
CONCLUSIONS
Stiff peri-cancerous tissue induced CAF activation, COL-I deposition, and ECM remodeling, resulting in a poor prognosis for PTC patients with LNM.
PubMed: 38902966
DOI: 10.1093/oncolo/oyae086 -
Journal of Orthopaedic Surgery and... Jun 2024The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare... (Comparative Study)
Comparative Study
BACKGROUND
The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points.
METHODS
The study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness.
RESULTS
Among the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively.
CONCLUSION
Early repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI.
Topics: Humans; Rotator Cuff Injuries; Arthroscopy; Male; Middle Aged; Female; Treatment Outcome; Range of Motion, Articular; Adult; Time Factors; Aged; Follow-Up Studies; Recovery of Function; Rotator Cuff; Time-to-Treatment
PubMed: 38902793
DOI: 10.1186/s13018-024-04858-x -
World Journal of Clinical Cases Jun 2024Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment...
BACKGROUND
Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment approach, preventing recurrence and standardized rehabilitation are also crucial. Here, we present a surgical strategy to prevent the recurrence of MO.
CASE SUMMARY
A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon. However, incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification, causing a loss of normal range of motion. The patient was diagnosed with MO based on physical examination, X-ray findings, and clinical presentation. We devised a surgical strategy to remove MO, followed by fixation with an Ilizarov frame, and implemented a scientifically reasonable rehabilitation plan. The surgery lasted for 3 h with an estimated blood loss of 45 mL. A drainage tube was placed after surgery, and fluid was aspirated through ultrasound-guided puncture. The patient experienced a significant reduction in joint stiffness after surgery. In the final follow-up at 9 mouths, there was evident improvement in the range of motion of the elbow joint, and no other symptoms were reported.
CONCLUSION
The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal. It offers benefits such as passive recovery, individualized treatment, and prompt recovery.
PubMed: 38898861
DOI: 10.12998/wjcc.v12.i17.3144 -
Materials (Basel, Switzerland) Jun 2024This paper attempts to analyze the random fatigue life and failure modes of joints using two calculation methods. Three kinds of tests were carried out, which were the...
This paper attempts to analyze the random fatigue life and failure modes of joints using two calculation methods. Three kinds of tests were carried out, which were the static test, constant amplitude fatigue test and the random fatigue test, and four kinds of joints were designed. After the static test, the joint was subjected to a constant amplitude fatigue test by selecting different percentages of load according to the static strength. In order to predict the random fatigue life more precisely, two calculation methods were carried out, which were the linear cumulative damage method and the equivalent loading finite element method. Based on the linear cumulative damage hypothesis, the fatigue life of the joint was established as a function of the load amplitude, and then, the random life prediction was calculated by the amplitude distribution of the random loading. Another method was the equivalent loading method, which was to obtain the equivalent constant amplitude fatigue loading of the random loading spectrum. The finite element model was established based on the stiffness and strength degradation rule. The equivalent random life and fatigue failure modes of the joint were modeled. The two life prediction methods show good agreement with the fatigue experimental result, and all prediction results were included in a scatter band of the factor of 2.
PubMed: 38894004
DOI: 10.3390/ma17112740 -
Materials (Basel, Switzerland) May 2024Silicon carbide (SiC) exhibits intriguing thermo-physical properties such as higher heat capacity and conductivity, as well as a lower density than Ti6Al4V(ELI). These...
A Comparative Analysis of Low and High SiC Volume Fraction Additively Manufactured SiC/Ti6Al4V(ELI) Composites Based on the Best Process Parameters of Laser Power, Scanning Speed and Hatch Distance.
Silicon carbide (SiC) exhibits intriguing thermo-physical properties such as higher heat capacity and conductivity, as well as a lower density than Ti6Al4V(ELI). These properties make SiC a good candidate for the reinforcement of Ti6Al4V(ELI) with respect to its use as a heat shield in aero turbines to increase their efficiency. The traditional materials used in aircraft structures were required to have a combination of good mechanical properties such as strength, stiffness, and hardness and low weight, as well as low thermo-physical properties such as coefficient of thermal expansion (CTE) and thermal conductivity. The alloy Ti6Al4V(ELI) has a density of 4.45 g/cm, which is lower than that of structural steel (7.4 g/cm) and higher than that of aluminium (2.5 g/cm). Lower density benefits light weighting. Aluminium is the lightest of the traditional materials used but has relatively low strength. The CTE of SiC of 4.6 × 10/K is lower than that of Ti6Al4V(ELI) of 8.6 × 10/K, while the density of SiC of 3.21 g/cm is lower than that of Ti6Al4V(ELI) of 4.45 g/cm. Therefore, from the theory of composites, SiC/Ti6Al4V(ELI) composites are expected to have lower densities and CTEs than those of Ti6Al4V(ELI), thus providing for lightweighting and less thermal related buckling or separation at their joints with carbon/epoxy resin panels. The specific strength, stiffness, and Knoop hardness of SiC of 75-490 kNm/kg, 132 MNm/kg, and 600-3800 GPa, respectively, are generally larger than those of Ti6Al4V(ELI) of 211 KNm/kg, 24 MNm/kg, and 880 GPa, respectively. Therefore, investigating reinforcement of Ti6Al4V(ELI) with SiC particles is worthwhile as it will lead to the formation of composites that are stronger, stiffer, harder, and lighter, with lower values of CTE. For additive manufacturing, this requires initial studies to optimise the process parameters of laser power and scanning speed for single tracks. To print single tracks in the present work, different laser powers ranging from 100 W to 350 W and scanning speeds ranging from 0.3 m/s to 2.7 m/s were used for different SiC volume fraction values of values. To print single layers, different values of hatch distance were used together with the best values of laser power and scanning speed determined elsewhere by the authors for different volume fractions of SiC. Through optical microscopy, the built tracks and their cross sections were examined. By using laser power and scanning speeds of 200 W and 1.2 m/s, and 150 W and 0.8 m/s, respectively, the best tracks at 5% and 10% volume fractions were obtained, whereas the best tracks at 25% volume fraction were achieved using a laser power of 200 W and a scanning speed of 0.5 m/s. Furthermore, the results showed that the maximum SiC volume percentage of 30% resulted in limited or no penetration. Therefore, it is concluded from the study that parts with improved mechanical properties can be produced at SiC volume fractions ranging from 5% to 25%, while parts produced at the high volume fraction of 30% would have unacceptable mechanical qualities for the final part.
PubMed: 38893871
DOI: 10.3390/ma17112606 -
Diagnostics (Basel, Switzerland) May 2024Artificial intelligence (AI) refers to the science and engineering of creating intelligent machines for imitating and expanding human intelligence. Given the ongoing... (Review)
Review
Artificial intelligence (AI) refers to the science and engineering of creating intelligent machines for imitating and expanding human intelligence. Given the ongoing evolution of the multidisciplinary integration trend in modern medicine, numerous studies have investigated the power of AI to address orthopedic-specific problems. One particular area of investigation focuses on shoulder pathology, which is a range of disorders or abnormalities of the shoulder joint, causing pain, inflammation, stiffness, weakness, and reduced range of motion. There has not yet been a comprehensive review of the recent advancements in this field. Therefore, the purpose of this review is to evaluate current AI applications in shoulder pathology. This review mainly summarizes several crucial stages of the clinical practice, including predictive models and prognosis, diagnosis, treatment, and physical therapy. In addition, the challenges and future development of AI technology are also discussed.
PubMed: 38893618
DOI: 10.3390/diagnostics14111091 -
Cureus May 2024Tenosynovial giant cell tumor (TGCT) is a monoarticular fibrohistiocytic benign or locally aggressive soft tissue tumor that originates from the synovium of joints,...
BACKGROUND
Tenosynovial giant cell tumor (TGCT) is a monoarticular fibrohistiocytic benign or locally aggressive soft tissue tumor that originates from the synovium of joints, bursae, and tendon sheaths. It has an inflammatory neoplastic nature, with a clinical presentation ranging from pain, swelling, stiffness, and limited range of movement to joint instability and blockage. Its uncommon incidence leads to a poorly understood pathogenesis. Localized forms of TGCT (LTGCT) can cause significant morbidity, interfere with daily patient activities, and decrease the patient's quality of life in challenging cases. This study aimed to investigate the immunohistochemical expression of PPARγ (peroxisome proliferator-activated receptor gamma) and P53 in LTGCT to understand the disease better and offer potential therapeutic targets.
METHODS
The study is cross-sectional, in which 27 LTGCT cases were collected from the Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Solitary and multiple LTGCT cases retrieved between January 2018 and December 2022 were included, and immunohistochemically stained with anti-PPARγ and P53 antibodies. The TGCT samples were excluded if they were insufficient for sectioning, processing, and interpretation, over-fixed, had process artifacts, or were of the diffuse TGCT type. Scoring of stain expression was performed by ImageJ (National Institutes of Health, Bethesda, MD) analysis using the threshold method and was expressed in percent area/high power field. Clinicopathological correlations were analyzed.
RESULTS
All the 27 collected LTGCT cases were located in the small joints of patients' hands. Cases with solitary LGTCTs constituted 55.6% (n = 15), while 44.4% (n = 12) had multiple LTGCTs related to one affected site/case (e.g., multiple tumors in one finger). PPARγ was expressed in the cytoplasm of mononuclear and multinucleated tumor cells and foamy histiocytes, while P53 expression was mainly in mononuclear cells' nuclei. PPARγ significantly correlated with P53 expression (r = 0.9 and P = 0.000). PPARγ (r = 0.4 and P = 0.02) and P53 (r = 0.5 and P = 0.01) were positively correlated with tumor size. Only P53 expression was positively correlated with tumor multiplicity (r = 0.4 and P = 0.03). Using the receiver operating characteristic curve test, the P53 cutoff score detecting the multiplicity of TGCTs was ≥20.5%, with a 75% sensitivity and 80% specificity.
CONCLUSION
PPARγ and P53 have a significant role in LTGCT growth, while P53 plays a role in tumor multiplicity. They can be possible targets in LTGCTs unfit for excision.
PubMed: 38882990
DOI: 10.7759/cureus.60377 -
Stem Cells International 2024Joint articular injection of mesenchymal stem cells (MSCs) has emerged as a novel treatment approach for osteoarthritis (OA). However, the effectiveness of MSCs derived... (Review)
Review
BACKGROUND
Joint articular injection of mesenchymal stem cells (MSCs) has emerged as a novel treatment approach for osteoarthritis (OA). However, the effectiveness of MSCs derived from different sources in treating OA patients remains unclear. Therefore, this study aimed to explore the differences between the effectiveness and safety of different sources of MSCs.
MATERIALS AND METHODS
For inclusion consideration, we searched trial registries and published databases, including PubMed, Cochrane Library, Embase, and Web of Science databases. Revman (V5.3), STATA (V16.0), and R (V4.0) were utilized for conducting data analysis, while the Cochrane Risk of Bias Tool was employed for assessing the quality of the studies. We derived outcome measures at 6 and 12 months based on the duration of study follow-up, including visual analog scale (VAS) score, WOMAC score, WOMAC pain, WOMAC Functional Limitation, and WOMAC stiffness. The evaluation time for short-term effectiveness is set at 6 months, while 12 months is utilized as the longest follow-up time for most studies to assess long-term effectiveness.
RESULTS
The evaluation of literature quality showed that the included studies had excellent methodological quality. A meta-analysis revealed that different sources of MSCs improved knee function and pain more effectively among patients suffering from knee OA (KOA) than controls. The results of the network meta-analysis showed the following: short-term functional improvement (the indexes were evaluated after 6 months of follow-up) (WOMAC total score: bone marrow-derived MSC (BMMSC) vs. adipose-derived MSC (ADMSC) (mean difference (MD) = -20.12, 95% confidence interval (CI) -125.24 to 42.88), umbilical cord-derived MSC (UCMSC) (MD = -7.81, 95% CI -158.13 to 74.99); WOMAC stiffness: BMMSC vs. ADMSC (MD = -0.51, 95% CI -7.27 to 4.29), UCMSC (MD = -0.75, 95% CI -9.74 to 6.63); WOMAC functional limitation: BMMSC vs. ADMSC (MD = -12.22, 95% CI -35.05 to 18.86), UCMSC (MD = -9.31, 95% CI -44.26 to 35.27)). Long-term functional improvement (the indexes were evaluated after 12 months of follow-up) (WOMAC total: BMMSC vs. ADMSC (MD = -176.77, 95% CI -757.1 to 378.25), UCMSC (MD = -181.55, 95% CI -937.83 to 541.13); WOMAC stiffness: BMMSC vs. ADMSC (MD = -0.5, 95% CI -26.05 to 18.61), UCMSC (MD = -1.03, 95% CI -30.44 to 21.69); WOMAC functional limitation: BMMSC vs. ADMSC (MD = -5.18, 95% CI -316.72 to 177.1), UCMSC (MD = -8.33, 95% CI -358.78 to 218.76)). Short-term pain relief (the indexes were evaluated after 6 months of follow-up) (VAS score: UCMSC vs. BMMSC (MD = -10.92, 95% CI -31.79 to 12.03), ADMSC (MD = -14.02, 95% CI -36.01 to 9.81), PLMSC (MD = -17.09, 95% CI -46.31 to 13.17); WOMAC pain relief: BMMSC vs. ADMSC (MD = -11.42, 95% CI -39.52 to 11.77), UCMSC (MD = -6.73, 95% CI -47.36 to 29.15)). Long-term pain relief (the indexes were evaluated after 12 months of follow-up) (VAS score: BMMSC vs. UCMSC (MD = -4.33, 95% CI -36.81 to 27.08), ADMSC (MD = -11.43, 95% CI -37.5 to 13.42); WOMAC pain relief: UCMSC vs. ADMSC (MD = 0.23, 95% CI -37.87 to 38.11), BMMSC (MD = 5.89, 95% CI -25.39 to 51.41)). According to the GRADE scoring system, WOMAC, VAS, and AE scores were of low quality.
CONCLUSION
Meta-analysis suggests MSCs can effectively treat KOA by improving pain and knee function compared to control groups. In terms of functional improvement in KOA patients, both short-term (6-month follow-up) and long-term (12-month follow-up) results indicated that while the differences between most treatments were not statistically significant, bone marrow-derived MSCs may have some advantages over other sources of MSCs. Additionally, BM-MSCs and UC-MSCs may offer certain benefits over ADMSCs in terms of pain relief for KOA patients, although the variances between most studies were not statistically significant. Therefore, this study suggests that BM-MSCs may present clinical advantages over other sources of MSCs.
PubMed: 38882598
DOI: 10.1155/2024/2741681