-
Medicine May 2024Gout is a chronic disease characterized by deposition of monosodium urate crystals. Tophi develop in some individuals with untreated or uncontrolled gout, which leads to...
INTRODUCTION
Gout is a chronic disease characterized by deposition of monosodium urate crystals. Tophi develop in some individuals with untreated or uncontrolled gout, which leads to ulcerations, cosmetic problems, mechanical obstruction of joint movement, joint damage and musculoskeletal disability. Currently, the treatment of gouty tophi is controversial and challenging. Both surgical and internal medical treatments have limitations and require further exploration in clinical practice.
PATIENT CONCERNS
In Case 1, we treated a patient with severe infection of diabetic foot ulcers with concomitant multiple gouty tophi in the same limb. A systematic management strategy was formulated to close the wound and save the limb. The ulcers healed successfully after half a year. In Case 2, a giant gouty tophi located in the first metatarsophalangeal joint of the left foot was removed by surgical treatment and vancomycin-loaded bone cement implantation. In Case 3, we present a case of gouty tophi that was resolved by standardized systemic medical management.
DIAGNOSIS
Three patients were all diagnosed with gout accompanied by gouty deposition, although there were other different comorbidities.
INTERVENTIONS
In case 1, we used debridement to gradually remove gouty tophi. In case 2, the giant gouty tophi was removed by surgical operation. In case 3, the gouty tophi disappeared after standardized treatment with medicine, diet and lifestyle management.
OUTCOMES
Three patients underwent different treatment therapies to remove gouty tophi based on their specific conditions.
LESSONS
We explored effective interventions for tophi in gout by surgical or other interventions in combination with pharmacotherapy.
Topics: Humans; Male; Gout; Aged; Limb Salvage; Middle Aged; Debridement; Metatarsophalangeal Joint; Anti-Bacterial Agents; Female; Vancomycin; Diabetic Foot
PubMed: 38758848
DOI: 10.1097/MD.0000000000038137 -
Archives of Medical Science : AMS 2024Hyperbaric oxygen (HBO) therapy involves the inhalation of pure oxygen in a pressure chamber under increased ambient pressure. Recent research indicates that circulating...
INTRODUCTION
Hyperbaric oxygen (HBO) therapy involves the inhalation of pure oxygen in a pressure chamber under increased ambient pressure. Recent research indicates that circulating small extracellular vesicles (sEVs) play important roles in human physiology and pathology. Therefore, the objective of this pilot study was to monitor the impact of HBO therapy on the levels of circulating sEVs in the serum of patients with necrotizing soft-tissue infections (NSTI), aseptic bone necrosis (ABN) or idiopathic sudden sensory neural hearing loss (ISSNHL).
MATERIAL AND METHODS
Serum-derived sEVs were isolated and quantified in 80 patients before and after HBO therapy applied for NSTI, ISSNHL and ABN patients as well as in normal controls who received neither HBO therapy nor steroids.
RESULTS
We observed a significant increase of circulating sEVs in patients with ISSNHL after HBO therapy ( < 0.05), as well as significantly elevated levels of sEVs after HBO therapy compared to patients with NSTI ( < 0.05) and ABN ( < 0.01).
CONCLUSIONS
The increase in the levels of sEVs in ISSNHL may be evidence for both the intended reduction of inflammation as a result of steroid therapy and the inhibitory effect of oxidative stress induced by HBO therapy. Thus, sEVs released during HBO therapy might play an important biological role in mediating the response to therapy and might be a promising approach to gain further insights into the therapeutic efficacy of HBO therapy.
PubMed: 38757025
DOI: 10.5114/aoms/169382 -
BMC Musculoskeletal Disorders May 2024Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved...
BACKGROUND
Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress.
METHODS
We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes.
RESULTS
Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening.
CONCLUSION
The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.
Topics: Humans; Female; Printing, Three-Dimensional; Male; Retrospective Studies; Adult; Middle Aged; Acetabulum; Bone Neoplasms; Prosthesis Design; Young Adult; Osteotomy; Plastic Surgery Procedures; Adolescent; Aged; Treatment Outcome; Postoperative Complications; Follow-Up Studies; Pelvic Bones
PubMed: 38755628
DOI: 10.1186/s12891-024-07509-8 -
Nature Communications May 2024Bone marrow plasma cells (BMPC) are the correlate of humoral immunity, consistently releasing antibodies into the bloodstream. It remains unclear if BMPC reflect...
Bone marrow plasma cells (BMPC) are the correlate of humoral immunity, consistently releasing antibodies into the bloodstream. It remains unclear if BMPC reflect different activation environments or maturation of their precursors. Here we define human BMPC heterogeneity and track the recruitment of antibody-secreting cells (ASC) from SARS-CoV-2 vaccine immune reactions to the bone marrow (BM). Trajectories based on single-cell transcriptomes and repertoires of peripheral and BM ASC reveal sequential colonisation of BMPC compartments. In activated B cells, IL-21 suppresses CD19 expression, indicating that CD19-BMPC are derived from follicular, while CD19-BMPC originate from extrafollicular immune reactions. In primary immune reactions, both CD19- and CD19-BMPC compartments are populated. In secondary immune reactions, most BMPC are recruited to CD19-BMPC compartments, reflecting their origin from extrafollicular reactivations of memory B cells. A pattern also observable in vaccinated-convalescent individuals and upon diphtheria/tetanus/pertussis recall-vaccination. Thus, BMPC diversity reflects the evolution of a given humoral immune response.
Topics: Humans; Plasma Cells; Interleukins; Bone Marrow; Antigens, CD19; Immunity, Humoral; COVID-19; SARS-CoV-2; Bone Marrow Cells; Single-Cell Analysis; Adult; B-Lymphocytes; Antibody-Producing Cells; Female; Male; Vaccination; Middle Aged; Diphtheria-Tetanus-Pertussis Vaccine
PubMed: 38755157
DOI: 10.1038/s41467-024-48570-0 -
JPMA. the Journal of the Pakistan... Apr 2024We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical...
We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical signs, which is a relatively rare occurrence. However, the radiographic and histological presentation of this lesion was typical of a nasopalatine duct cyst. Therefore, this case report aims to highlight the variable presentations of the nasopalatine cyst, which is often misdiagnosed and treated as an endodontic infection.
Topics: Humans; Female; Adult; Nonodontogenic Cysts; Diagnosis, Differential; Nose Diseases; Cysts; Palate, Hard
PubMed: 38751287
DOI: 10.47391/JPMA.9934 -
The Journal of Biological Chemistry May 2024Host anti-inflammatory responses are critical for the progression of visceral leishmaniasis and the pleomorphic cytokine IL-33 was found to be upregulated in infection....
Host anti-inflammatory responses are critical for the progression of visceral leishmaniasis and the pleomorphic cytokine IL-33 was found to be upregulated in infection. The underlying mechanism is not yet known. Here, we documented that IL-33 induction is a consequence of elevated cAMP-mediated EPAC/calcineurin-dependent signaling and is essential for the sustenance of infection. L. donovani-infected RAW and bone marrow-derived macrophages showed significant up-regulation of IL-33 and its neutralization by anti-IL-33 antibody resulted in decreased parasite survival and increased inflammatory responses. Infection-induced elevated cAMP was involved in IL-33 production and of its two downstream effectors PKA and EPAC, only the latter was responsible for elevated IL-33 levels. EPAC initiated Rap-dependent phospholipase C activation, which triggered the release of intracellular calcium followed by calcium/calmodulin complex formation. Screening of calmodulin-dependent enzymes affirmed the involvement of the phosphatase calcineurin in cAMP/EPAC/calcium/calmodulin signaling-induced IL-33 production and parasite survival. Activated calcineurin thereby ensured nuclear localization of the transcription factors NFATc1 and HIF-1α for IL-33 transcription and we further ascertained their role in IL-33 transcription using a ChIP assay. Administering specific inhibitors of NFATc1 and HIF-1α in a BALB/c mouse model of visceral leishmaniasis led to decreased liver and spleen parasite burden with concomitant decrease in IL-33 levels. Splenocyte supernatants of inhibitor-treated infected mice further documented an increase in TNF-α and IL-12 with simultaneous decrease of IL-10, thereby indicating an overall disease-escalating effect of IL-33. Thus, this study demonstrates that cAMP/EPAC/calcineurin signaling is crucial for the activation of IL-33 and in effect creates anti-inflammatory responses, essential for infection.
PubMed: 38750790
DOI: 10.1016/j.jbc.2024.107366 -
BMC Musculoskeletal Disorders May 2024The objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in... (Comparative Study)
Comparative Study
PURPOSE
The objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in treating distal tibial defects > 6 cm resulting from posttraumatic osteomyelitis, highlighting the potential advantages and challenges of each method.
METHODS
A retrospective assessment was conducted on an overall population of 46 eligible patients with distal tibial defects > 6 cm who received treatment between January 2015 and January 2019. Propensity score analysis was used to pair 10 patients who received TBT with 10 patients who received PBT. The outcomes assessed included demographic information, external fixation time (EFT), external fixation index (EFI), bone and functional outcomes assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated using the Paley classification.
RESULTS
The demographic and baseline data of the two groups were comparable. Following radical debridement, the average tibial defect was 7.02 ± 0.68 cm. The mean EFT was significantly shorter in the PBT group (130.9 ± 16.0 days) compared to the TBT group (297.3 ± 14.3 days). Similarly, the EFI was lower in the PBT group (20.67 ± 2.75 days/cm) than in the TBT group (35.86 ± 3.69 days/cm). Both groups exhibited satisfactory postoperative bone and functional results. Pin site infection was the most common complication and the rates were significantly different between the groups, with the PBT group demonstrating a higher incidence.
CONCLUSION
Both TBT and PBT effectively treat posttraumatic tibial defects greater than 6 cm, with PBT offering more efficient bone regeneration. However, PBT is associated with a higher rate of pin site infections, highlighting the importance of careful management in these complex procedures and emphasizing the need for expert surgical execution and tailored treatment approaches in orthopedic reconstructive surgery.
Topics: Humans; Osteomyelitis; Male; Female; Retrospective Studies; Adult; Middle Aged; Treatment Outcome; Debridement; Tibia; Tibial Fractures; Bone Transplantation; External Fixators
PubMed: 38750523
DOI: 10.1186/s12891-024-07507-w -
Journal of Orthopaedic Surgery (Hong... 2024Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021,...
Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021, the clinical data of 17 patients with pulley type IA fractures treated by the V-shaped fixation technique under shoulder arthroscopy were retrospectively analyzed. Preoperative X-ray, CT, and MRI examinations were completed. The functional score of the shoulder joint, such as the visual analog scale (VAS), Constant score, and Modified Rowe score, was used to evaluate the preoperative and final follow-up clinical outcomes. The active shoulder range of motion (ROM) was also collected preoperatively and at the final postoperative follow-up. Accordingly, intraoperative and postoperative complications were also observed. The mean follow-up was 49.52 months (16-79 months). The patients' follow-up exams showed that shoulder joint flexion, abduction, external rotation, internal rotation, and pain were not significantly different from those of the contralateral side ( > .05). The mean Constant score was 83.52 (58-98), and the average Modified Rowe score was 94.29 (70-100). X-ray and CT films of all cases showed good healing without articular depression or steps. Three patients had traumatic arthritis, with VAS <3 pain. No postoperative complications, such as infections, nerve or vessel damage, or suture anchor problems occurred during the follow-up period. Using the Double-pull, V-shaped fixation technique can stabilize the reduction of glenoid fractures while reducing the possibility of bone destruction. It is a good solution and provides an opportunity to treat rotator cuff tears associated with the procedure.
Topics: Humans; Male; Arthroscopy; Female; Retrospective Studies; Middle Aged; Adult; Fracture Fixation, Internal; Range of Motion, Articular; Glenoid Cavity; Fractures, Bone
PubMed: 38749489
DOI: 10.1177/10225536241254913 -
PloS One 2024The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures.
METHODS
We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2).
RESULTS
A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships.
CONCLUSION
Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
Topics: Bone Wires; Humans; Fracture Fixation, Internal; Fractures, Bone; Hand Bones; Forearm Injuries
PubMed: 38748687
DOI: 10.1371/journal.pone.0296149 -
Anais Da Academia Brasileira de Ciencias 2024The objective of the current study was to carry out a survey of the main anatomopathological alterations in raising quails and evaluate possible interference of these in...
The objective of the current study was to carry out a survey of the main anatomopathological alterations in raising quails and evaluate possible interference of these in the bone tissue. To obtain the data, 23 quails were collected from farm in the central Serrana region of Espírito Santo. Necropsies with macroscopic descriptions, microbiological, coproparasitological, radiographic and histomorphometric tests were carried out. It was done data descriptive analysis and average comparision using Student T test. It was found that they presented lesions predominantly in the digestive system, followed by urinary and reproductive, and muscular system, were the altered color of the liver (47%) was the most frequent lesion. In the parasitological exams, it was found oocysts of Eimeira sp. (39.13%). In the microbiological exams, it was detected predominantly Escherichia coli (83%). Moderate osteopenia in quails, but the percentage of trabecular bone on bones was similar between healthy and diseased quails, without bone changes in histology. Microscopically, it was observed lung congestion as predominant lesion. It is concluded that there was predominance of alterations in the digestive system and mild parasitic infection; and although there was moderate level of osteopenia, there wasn't bone change as a result of the observed infections.
Topics: Animals; Quail; Female; Poultry Diseases
PubMed: 38747837
DOI: 10.1590/0001-3765202420230815