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Pang Q, Xu Y, Liao R, Li Y, Zhang L, Chi Y, Qi X, Li M, Jiang Y, Wang O, Xing X, Qin L, Xia W. Comparison of bone microstructure and strength in the distal radius and tibia between the different types of primary hypertrophic osteoarthropathy: an HR-pQCT study. Osteoporos Int 2023:10.1007/s00198-023-06784-w. [PMID: 37202541 PMCID: PMC10382400 DOI: 10.1007/s00198-023-06784-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
Primary hypertrophic osteoarthropathy (PHO) is a hereditary bone disease that is grouped into PHO autosomal recessive 1 (PHOAR1) and PHO autosomal recessive 2 (PHOAR2) due to different causative genes. Data comparing bone microstructure between the two subtypes are scarce. This is the first study to find that PHOAR1 patients had inferior bone microstructure compared with PHOAR2 patients. PURPOSE The primary goal of this study was to assess bone microarchitecture and strength in PHOAR1 and PHOAR2 patients and to compare them with age- and sex-matched healthy controls (HCs). The secondary goal was to assess the differences between PHOAR1 and PHOAR2 patients. METHODS Twenty-seven male Chinese PHO patients (PHOAR1 = 7; PHOAR2 = 20) were recruited from Peking Union Medical College Hospital. The areal bone mineral density (aBMD) was assessed by dual-energy X-ray absorptiometry (DXA). Peripheral bone microarchitecture at the distal radius and tibia were evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Biochemical markers of PGE2, bone turnover, and Dickkopf-1 (DKK1) were investigated. RESULTS Compared with HCs, PHOAR1 and PHOAR2 patients had distinctively larger bone geometry, substantially lower vBMD at the radius and tibia, and compromised cortical microstructure at the radius. For trabecular bone, PHOAR1 and PHOAR2 patients showed different changes at the tibia. PHOAR1 patients had significant deficits in the trabecular compartment, resulting in lower estimated bone strength. Conversely, PHOAR2 patients showed a higher trabecular number, narrower trabecular separation, and lower trabecular network inhomogeneity than HCs, translating into preserved or slightly high estimated bone strength. CONCLUSION PHOAR1 patients had inferior bone microstructure and strength compared with PHOAR2 patients and HCs. Additionally, this study was the first to find differences in the bone microstructure between PHOAR1 and PHOAR2 patients.
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Affiliation(s)
- Qianqian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuping Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ruoxi Liao
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ye Li
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, 5/F Lui Che Woo Clinical Sciences Building Shatin, N.T., Hong Kong SAR, Hong Kong
| | - Li Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yue Chi
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuan Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ling Qin
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, 5/F Lui Che Woo Clinical Sciences Building Shatin, N.T., Hong Kong SAR, Hong Kong.
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, NHC, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Awadallah Z, Dubrey S. Idiopathic digital clubbing. Br J Hosp Med (Lond) 2020; 81:1-2. [PMID: 32990079 DOI: 10.12968/hmed.2019.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zoe Awadallah
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - Simon Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK
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Wang Z, Chen Y, Huang J, Peng C, Pang W, Wu D, Cao Z. Minimally invasive thorascopic surgery in treating congenital bronchobiliary fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Uribe-Valencia MA, Ocampo Chaparro JM, Parra-Camarillo M. Hipocratismo digital: conociendo sus causas. Reporte de caso. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El hipocratismo digital es un signo clínico que afecta principalmente los dedos de las manos y se caracteriza por deformidad en uñas con abombamiento en vidrio de reloj. Puede presentarse en pacientes con cáncer diseminado, enfermedad pulmonar preexistente y dolor óseo, por lo cual es importante considerar esta entidad para un diagnóstico y un tratamiento oportunos.Presentación del caso. Paciente masculino de 86 años con hipocratismo digital, tabaquista en abstinencia, quien ingresa a urgencias por cuadro clínico de 2 meses de evolución consistente en fiebre y pérdida de 19kg de peso. Al examen físico presentaba disminución de ruidos respiratorios en base pulmonar derecha, dedos en palillo de tambor y deformidad ungüeal en manos. La radiografía de tórax mostró opacidad a nivel parahiliar derecho bien definida de 5cm. La tomografía computarizada de tórax mostró masas de bordes irregulares a nivel parahiliar derecho y en segmento apical del lóbulo inferior del pulmón derecho, y derrame pleural ipsilateral. La biopsia guiada por tomografía documentó adenocarcinoma pulmonar bien diferenciado.Conclusiones. El hipocratismo digital plantea un desafío en medicina debido a que puede ser difícil llegar a un diagnóstico etiológico y se pueden requerir muchos estudios para su confirmación.
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Targeted exome sequencing identified a novel mutation hotspot and a deletion in Chinese primary hypertrophic osteoarthropathy patients. Clin Chim Acta 2018; 487:264-269. [DOI: 10.1016/j.cca.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/03/2018] [Indexed: 11/18/2022]
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Nakazawa S, Niizeki H, Nakabayashi K, Tanese K, Tokura Y. Congenital nail clubbing. J Dermatol 2018; 46:e101-e102. [PMID: 30151908 DOI: 10.1111/1346-8138.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shinsuke Nakazawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironori Niizeki
- Department of Dermatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Yuan L, Chen L, Liao RX, Lin YY, Jiang Y, Wang O, Li M, Xing XP, Pang QQ, Jiajue R, Xia WB. A Common Mutation and a Novel Mutation in the HPGD Gene in Nine Patients with Primary Hypertrophic Osteoarthropathy. Calcif Tissue Int 2015; 97:336-42. [PMID: 26135126 DOI: 10.1007/s00223-015-0024-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
Primary hypertrophic osteoarthropathy (PHO) is a hereditary bone disease characterized by digital clubbing, periostosis, and pachydermia. The HPGD gene encoding 15-prostaglandin dehydrogenase and SLCO2A1 encoding one type of prostaglandin transporter were found to be responsible for PHO. Mutations of either gene would lead to increased level of prostaglandin E2 (PGE2), which might contribute to the constellation of the symptoms. The aim of the study was to analyze the HPGD gene and the clinical characteristics in nine patients with the diagnosis of PHO. Nine patients, (eight males and one female) including two siblings and seven sporadic cases, were enrolled in the study. Clinical features were summarized, and blood and urine samples were collected. Sanger method was used to sequence the HPGD gene to detect mutations. Urinary PGE2 and prostaglandin metabolite (PGE-M) levels for each patient were measured and compared to the healthy controls. A recurrent c.310_311delCT mutation was identified in all patients, of which six were homozygous, two were heterozygous, and one was compound heterozygous with this mutation and a novel heterozygous missense mutation c.488G>A (p.R163H). The levels of PGE2 in urine were much higher than normal in all patients, along with lower PGE-M levels. In conclusion, nine PHO patients were characterized by typical clinical manifestations including digital clubbing, periostosis, and pachydermia. A common mutation and a novel mutation in HPGD gene were identified to be responsible for the disease, and c.310_311delCT mutation is likely to be a hot-spot mutation site for Asian PHO patients.
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Affiliation(s)
- Lu Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ling Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ruo-xi Liao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yuan-yuan Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
- Department of Endocrinology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xiao-Ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Qian-Qian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
- Department of Endocrinology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Wei-bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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Sharma V, Sharma A, Kumar V, Aggarwal S. Image diagnosis: a curious case of causeless clubbing. Perm J 2013; 17:e119. [PMID: 24355901 PMCID: PMC3783071 DOI: 10.7812/tpp/12-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vishal Sharma
- Senior Resident in the Department of Medicine at the University College of Medical Sciences, Delhi, India. E-mail:
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Affiliation(s)
- Sarah M McMullen
- Division of Critical Care/Department of Anaesthesia, Dalhousie University, Halifax, NS, Canada.
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Magazine R, Shetty R, Goneppanavar U, Mohapatra AK. Idiopathic clubbing confined to lower limb digits and idiopathic pulmonary fibrosis: an unusual association. Case Rep Pulmonol 2012; 2012:684285. [PMID: 23133780 PMCID: PMC3485489 DOI: 10.1155/2012/684285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old housewife presented to the chest outpatient department with a history of exertional breathlessness of four-month duration. On general physical examination, clubbing of toes was present with sparing of fingers. Chest examination revealed bilateral basal end inspiratory fine crepitations. A diagnosis of idiopathic pulmonary fibrosis was made on the basis of clinical, spirometric, and high-resolution computed tomography findings. Extensive evaluation could not reveal any cause for the differential clubbing. The unusual distribution of clubbing in a clinical condition, such as idiopathic pulmonary fibrosis, where generalized clubbing is expected can lead to a diagnostic confusion. This can lead to a further burden of investigations on the patient as clubbing being a significant finding cannot be ignored.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Ranjan Shetty
- Department of Cardiology, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Umesh Goneppanavar
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Aswini K. Mohapatra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
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Wavreille G, Baroncini M, Rtaimate M. Une cause rare de pseudohippocratisme digital : l’acrométastase. À propos d’un cas. ACTA ACUST UNITED AC 2009; 28:381-3. [DOI: 10.1016/j.main.2009.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 08/06/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
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Expressions rhumatologiques paranéoplasiques. ONCOLOGIE 2009. [DOI: 10.1007/s10269-008-0976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Singh A. Unidigital clubbing. Am J Med 2008; 121:e15. [PMID: 18374671 DOI: 10.1016/j.amjmed.2007.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
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