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BioRxiv : the Preprint Server For... May 2024Mechanical loading is required for bone health and results in skeletal adaptation to optimize strength. Local nerve axons, particularly within the periosteum, may...
Mechanical loading is required for bone health and results in skeletal adaptation to optimize strength. Local nerve axons, particularly within the periosteum, may respond to load-induced biomechanical and biochemical cues. However, their role in the bone anabolic response remains controversial. We hypothesized that spatial alignment of periosteal nerves with sites of load-induced bone formation would clarify this relationship. To achieve this, we developed RadialQuant, a custom tool for spatial histomorphometry. Tibiae of control and neurectomized (sciatic/femoral nerve cut) pan-neuronal Baf53b-tdTomato reporter mice were loaded for 5-days. Bone formation and periosteal nerve axon density were then quantified simultaneously in non-decalcified sections of the mid-diaphysis using RadialQuant. In control animals, anabolic loading induced maximal periosteal bone formation at the site of peak compression, as has been reported previously. Loading did not significantly change overall periosteal nerve density. However, a trending 28% increase in periosteal axons was noted at the site of peak compression in loaded limbs. Neurectomy depleted 88% of all periosteal axons, with near-total depletion on load-responsive surfaces. Neurectomy alone also caused de novo bone formation on the lateral aspect of the mid-diaphysis. However, neurectomy did not inhibit load-induced increases in periosteal bone area, mineralizing surface, or bone formation rate. Rather, neurectomy spatially redistributed load-induced bone formation towards the lateral tibial surface with a reduction in periosteal bone formation at the posterolateral apex (-63%) and enhancement at the lateral surface (+1360%). Altogether, this contributed to comparable load-induced changes in cortical bone area fraction (+4.4% in controls; +5.4% in neurectomized). Our results show that local skeletal innervation modulates but is not required for skeletal adaptation to applied load. This supports the continued use of loading and weight-bearing exercise as an effective strategy to increase bone mass, even in patients with peripheral nerve damage or dysfunction.
PubMed: 38798585
DOI: 10.1101/2024.05.12.593761 -
JCI Insight May 2024We present a transcriptomic analysis that provides a better understanding of regulatory mechanisms within the healthy and injured periosteum. The focus of this work is...
We present a transcriptomic analysis that provides a better understanding of regulatory mechanisms within the healthy and injured periosteum. The focus of this work is on characterizing early events controlling bone healing during formation of periosteal callus on day 3 post fracture. Building upon our previous findings showing that induced Notch1 signaling in osteoprogenitors leads to better healing, we compared samples in which Notch 1 intracellular domain is overexpressed by periosteal stem/progenitor cells with control intact and fractured periosteum. Molecular mechanisms and changes in skeletal stem/progenitor cells (SSPCs) and other cell populations within the callus, including hematopoietic lineages were determined. Notably, Notch ligands were differentially expressed in endothelial and mesenchymal populations, with Dll4 restricted to endothelial cells, whereas Jag1 was expressed by mesenchymal populations. Targeted deletion of Dll4 in endothelial cells using Cdh5CreER resulted in negative effects on early fracture healing, while deletion in SSPCs using α-smooth muscle actin-CreER did not impact bone healing. Translating these observations into clinically relevant model of bone healing revealed the beneficial effects of delivering Notch ligands alongside osteogenic inducer, BMP2. These findings provide insights into the regulatory mechanisms within the healthy and injured periosteum, paving the way for novel translational approaches to bone healing.
PubMed: 38781018
DOI: 10.1172/jci.insight.181073 -
Heliyon May 2024The supracondylar fracture of the child is a common fracture. Its physiology, physiopathology and treatment use periosteum. As far as we know, there is no 3D printed...
UNLABELLED
The supracondylar fracture of the child is a common fracture. Its physiology, physiopathology and treatment use periosteum. As far as we know, there is no 3D printed model of this typical fracture in children with periosteum. of the research are to present the concept of an educational 3D printed supra condylar model with periosteum of the child and its expert validation.
MATERIALS AND METHODS
The basis for the paediatric elbow model was a 3D scan of a four-year-old girl. Once the data had been extracted, the models were constructed using 3D Slicer®, Autodesk fusion 360® and Ultimaker Cura® software's. The Creality 3D Ender 6 SE Printer® used PLA filaments to print bone and TPU for periosteum. Printing took place at the University Hospital and the steps were modelled by hand. 3D printed bones and 3D printed periosteum were manually assembled.
PARTICIPANTS
Expert validation with twelve paediatric orthopaedic surgeons took place in three University hospitals of the North of France.
RESULTS
Four Lagrange and Rigault 3D printed models of supracondylar fractures with periosteum were obtained with 200 h of design, printing and manual assembly based on a four-year-old elbow. According to the paediatric orthopaedic surgery experts, the size of the model is very good, but the model itself is of little interest compared to the information provided by the reconstruction of a 3D scanner. In total, with 9 out of 12 questions scoring higher than 8/10, the model was considered to be a good model for informing parents and teaching students.
CONCLUSIONS
This study details the design of the first 3D-printed supra condylar fracture model in children with a full-size physeal and periosteum. The model has been validated by paediatric orthopaedic surgery experts.
PubMed: 38770284
DOI: 10.1016/j.heliyon.2024.e30741 -
Cureus Apr 2024This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an...
This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an edentulous maxilla. A modified buccal incision was performed in the subcrestal buccal region to promote direct access to the periosteum without incising the muscles in the region. For the installation of anterior implants, an 8.5 mm implant was locked in the cortical bone of the alveolar ridge and in the cortical bone of the floor of the pyriform cavity. The drilling point of the posterior implants was defined using the anterior implants as a visual reference, and the entry point could be visually estimated from the topography of the palatal surface of the maxilla. After bone leveling, the drilling enlargement sequence was carried out using drills that allowed the installation of long implants (18 mm). Straight mini-abutments were installed in the anterior implants and angled at 30º in the posterior implants. The flap was then perforated in the exact region where the mini-abutments were located. The buccal incision line was sutured with continuous 5-0 nylon suture. On the following day, aesthetic tests were carried out with teeth mounting. The patient presented minimal edema, and the lip motricity and smile width were completely preserved. The prosthesis was delivered five days after surgery. The suture was removed, and the prosthesis was installed while maintaining compression on the gingival tissue. The patient reported no pain during the prosthesis installation. The modified buccal flap enables implant placement for full-arch rehabilitation of an edentulous maxilla.
PubMed: 38765329
DOI: 10.7759/cureus.58453 -
Cureus Apr 2024One of the most frequent cartilage-capped outgrowths that develop beneath the periosteum due to cartilage ossification is osteochondroma. The second decade of life is...
One of the most frequent cartilage-capped outgrowths that develop beneath the periosteum due to cartilage ossification is osteochondroma. The second decade of life is noted as the most prevalent age of presentation. This case report looks at an uncommon osteochondroma presentation in a 20-year-old female with swelling along the right inferomedial border of the scapula. The patient presented with complaints of difficulty in daily activities and exhibited altered posture, decreased range of motion (ROM), muscle weakness, and altered shoulder function. The clinical assessment highlighted restricted shoulder and cervical ROM and muscle weakness in the trapezius, rhomboids, serratus anterior, and other surrounding muscles. Magnetic resonance imaging revealed an inferomedial bony outgrowth indicative of osteochondroma. A comprehensive physiotherapy intervention protocol for eight weeks was designed to alleviate pain, improve mobility, restore ROM, strengthen weakened muscles, correct posture, and enhance functions that were restricted. The protocol encompassed various techniques, such as muscle energy techniques (MET), proprioceptive neuromuscular facilitation (PNF), cold therapy, stretching, scapular mobilization, resistance exercises with TheraBand, postural correction exercises, ergonomic adjustments, scapular stabilization exercises, and 'J'-taping to aid in muscle activation and address rounded shoulder posture. Outcome measures for cervical and shoulder ROM and strength were measured to note the progression after rehabilitation. The case report emphasizes the importance of a tailored physiotherapy rehabilitation protocol in managing osteochondroma-related symptoms, showing the potential benefits of multifaceted interventions in alleviating pain, improving function, and boosting the quality of life for individuals with similar presentations.
PubMed: 38752046
DOI: 10.7759/cureus.58293 -
Journal of Nanobiotechnology May 2024The complexity of repairing large segment defects and eradicating residual tumor cell puts the osteosarcoma clinical management challenging. Current biomaterial design...
The complexity of repairing large segment defects and eradicating residual tumor cell puts the osteosarcoma clinical management challenging. Current biomaterial design often overlooks the crucial role of precisely regulating innervation in bone regeneration. Here, we develop a Germanium Selenium (GeSe) co-doped polylactic acid (PLA) nanofiber membrane-coated tricalcium phosphate bioceramic scaffold (TCP-PLA/GeSe) that mimics the bone-periosteum structure. This biomimetic scaffold offers a dual functionality, combining piezoelectric and photothermal conversion capabilities while remaining biodegradable. When subjected to ultrasound irradiation, the US-electric stimulation of TCP-PLA/GeSe enables spatiotemporal control of neurogenic differentiation. This feature supports early innervation during bone formation, promoting early neurogenic differentiation of Schwann cells (SCs) by increasing intracellular Ca and subsequently activating the PI3K-Akt and Ras signaling pathways. The biomimetic scaffold also demonstrates exceptional osteogenic differentiation potential under ultrasound irradiation. In rabbit model of large segment bone defects, the TCP-PLA/GeSe demonstrates promoted osteogenesis and nerve fibre ingrowth. The combined attributes of high photothermal conversion capacity and the sustained release of anti-tumor selenium from the TCP-PLA/GeSe enable the synergistic eradication of osteosarcoma both in vitro and in vivo. This strategy provides new insights on designing advanced biomaterials of repairing large segment bone defect and osteosarcoma.
Topics: Osteosarcoma; Animals; Bone Regeneration; Tissue Scaffolds; Rabbits; Calcium Phosphates; Osteogenesis; Polyesters; Humans; Cell Differentiation; Bone Neoplasms; Cell Line, Tumor; Biomimetic Materials; Schwann Cells; Nanofibers; Biocompatible Materials; Selenium
PubMed: 38750519
DOI: 10.1186/s12951-024-02430-7 -
Scientific Reports May 2024Gradual elevation of the periosteum from the original bone surface, based on the principle of distraction osteogenesis, induces endogenous hard and soft tissue...
Gradual elevation of the periosteum from the original bone surface, based on the principle of distraction osteogenesis, induces endogenous hard and soft tissue formation. This study aimed to assess the impact of alternating protocols of activation with relaxation (periosteal pumping) on bone modeling and remodeling. One hundred and sixty-two adult male Wistar rats were used in this study. Four test groups with different pumping protocols were created based on the relaxation applied. Two control groups underwent an activation period without relaxation or only a single activation. One group was sham-operated. Periosteal pumping without period of activation induced gene expression in bone and bone remodeling, and following activation period enhanced bone modeling. Four test groups and control group with activation period equaled the values of bone modeling at the end-consolidation period, showing significant downregulation of Sost in the bone and periosteum compared to that in the sham group (p < 0.001 and p < 0.001, respectively). When all test groups were pooled together, plate elevation from the bony surface increased bone remodeling on day 45 of the observation period (p = 0.003). Furthermore, bone modeling was significantly affected by plate elevation on days 17 and 45 (p = 0.047 and p = 0.005, respectively) and by pumping protocol on day 31 (p = 0.042). Periosteal pumping was beneficial for increasing bone repair when the periosteum remained in contact with the underlaying bony surface during the manipulation period. Following periosteal elevation, periosteal pumping accelerated bone formation from the bony surface by the modeling process.
Topics: Animals; Periosteum; Male; Bone Remodeling; Rats, Wistar; Rats; Osteogenesis; Osteogenesis, Distraction
PubMed: 38750119
DOI: 10.1038/s41598-024-61902-w -
Cureus Apr 2024The mucous membrane fold, which facilitates the attachment of the gingiva, alveolar mucosa, and the periosteum surrounding the lips and cheek, is known as the frenum....
The mucous membrane fold, which facilitates the attachment of the gingiva, alveolar mucosa, and the periosteum surrounding the lips and cheek, is known as the frenum. The frenal attachment at the gingival or papillary level may comprise periodontal health due to difficulty with plaque adherence or muscle pull. The management of such aberrant frenal attachment becomes necessary to avoid the associated future problems, such as midline diastema and periodontal attachment loss, which might lead to aesthetic problems and tooth mobility. The treatment modalities involve frenectomy using Miller's technique, conventional technique, Z-plasty, and V-Y plasty types of frenectomy procedures. The patient's requirements, specific indications, and intended results determine the method. This case report illustrates the utilisation of the V-Y plasty technique for the frenectomy of a papillary-type labial frenal attachment in a 19-year-old female patient. V-Y plasty proved to be an efficient technique for removing the aberrant labial frenum attachment, and the results were highly satisfactory, with less scar formation. V-Y plasty is reliable for covering defects and elongating the frenum area, giving desired clinical outcomes.
PubMed: 38707118
DOI: 10.7759/cureus.57663 -
Journal of Plastic, Reconstructive &... Apr 2024Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young...
BACKGROUND
Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients.
METHODS
Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side.
RESULTS
The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region.
CONCLUSIONS
Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.
PubMed: 38703712
DOI: 10.1016/j.bjps.2024.04.005 -
Journal of Medical Case Reports May 2024Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical... (Review)
Review
BACKGROUND
Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy.
CASE PRESENTATION
A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.
CONCLUSIONS
The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.
Topics: Humans; Fibroma, Ossifying; Male; Aged; Diagnosis, Differential; Gingival Neoplasms; Maxillary Neoplasms; Tomography, X-Ray Computed; Maxilla
PubMed: 38702820
DOI: 10.1186/s13256-024-04529-9