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Okay E, Connolly JJ, Gonzalez MR, Lozano-Calderon SA. Wound-Healing Effects of Common Antineoplastic Agents and Perioperative Considerations for the Orthopaedic Surgeon. J Am Acad Orthop Surg 2024; 32:e671-e682. [PMID: 38713761 DOI: 10.5435/jaaos-d-24-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/19/2024] [Indexed: 05/09/2024] Open
Abstract
In oncologic patients, optimal postoperative wound healing is crucial for the maintenance of systemic therapies and improved survival. Although several risk factors for postoperative wound complications have been identified, the clinical effect of new antineoplastic agents on wound healing remains uncertain. The available literature on the effect of antineoplastic agents in wound healing is complex to analyze because of other confounding risk factors such as radiation therapy and certain patient-specific variables. Available perioperative drug recommendations are based on database opinion and case reports from adverse event alerts. This review highlights the characteristics of old and new antineoplastic agents commonly used in the treatment of sarcoma, carcinoma, and other cancers and their potential effects on the wound-healing process. It also aims to provide perioperative treatment cessation recommendations to guide orthopaedic surgeons and prevent drug-related wound complications to the fullest extent possible.
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Affiliation(s)
- Erhan Okay
- From the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Appoo A, Christensen BL, Somayaji R. Examining the Association between Immunosuppressants and Wound Healing: A Narrative Review. Adv Skin Wound Care 2024; 37:261-267. [PMID: 38648239 DOI: 10.1097/asw.0000000000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To review how different classes of immunosuppressants affect wound healing. DATA SOURCES A literature search was conducted in PubMed, Google Scholar, and the University of Calgary Health Sciences Library. STUDY SELECTION The researchers initially screened article titles using key words such as "immunosuppressive medication," "wound healing," and "immunosuppression." Articles in which the title and/or abstract contained these key words, that addressed wound healing related to immunosuppressant medications, and were published after 2000 were included in the review. When human data were not available for an immunosuppressant (class), animal studies were included. DATA EXTRACTION The 61 included articles underwent full text review and summarization. DATA SYNTHESIS All included studies were summarized descriptively including immunosuppressive mechanism of action, study participants or subjects, and evidence of effects on wound healing. CONCLUSIONS Corticosteroids and mechanistic target of rapamycin inhibitors most consistently demonstrate detrimental effects on wound healing. For other classes of immunosuppressants, evidence is limited with varying effects on wound healing described. Larger, high-quality studies are required to better understand the effects of immunosuppressants, including those with new mechanisms of action, to identify those with the most impact on wound healing.
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Affiliation(s)
- Aria Appoo
- Aria Appoo is Medical Student, University of Oxford, United Kingdom. At the University of Calgary, Alberta, Canada, Brandon L. Christensen, MD, is Resident Physician, Division of Infectious Diseases, and Ranjani Somayaji, BScPT, MD, MPH, is Assistant Professor, Departments of Medicine, Microbiology, Immunology and Infectious Disease and Community Health Sciences. Acknowledgments: Alberta Innovates High School Youth Research Summer (HYRS) Program provided an educational stipend to the lead author for her work on this and other projects. The authors have disclosed no other financial relationships related to this article. Submitted February 1, 2023; accepted in revised form May 23, 2023
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Welte-Jzyk C, Plümer V, Schumann S, Pautz A, Erbe C. Effect of the antirheumatic medication methotrexate (MTX) on biomechanical compressed human periodontal ligament fibroblasts (hPDLFs). BMC Oral Health 2024; 24:329. [PMID: 38475789 DOI: 10.1186/s12903-024-04092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the in vitro effect of the antirheumatic drug methotrexate (MTX) on biomechanically compressed human periodontal ligament fibroblasts (hPDLFs), focusing on the expression of interleukin 6 (IL-6), as its upregulation is relevant to orthodontic tooth movement. METHODS Human PDLFs were subjected to pressure and simultaneously treated with MTX. Cell proliferation, viability and morphology were studied, as was the gene and protein expression of IL-6. RESULTS Compared with that in untreated fibroblasts, IL-6 mRNA expression in mechanically compressed ligament fibroblasts was increased (two to sixfold; ****p < 0.0001). Under compression, hPDLFs exhibited a significantly more expanded shape with an increase of cell extensions. MTX with and without pressure did not affect IL-6 mRNA expression or the morphology of hPDLFs. CONCLUSION MTX has no effect on IL-6 expression in compressed ligament fibroblasts.
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Affiliation(s)
- Claudia Welte-Jzyk
- Department of Orthodontics, University Medical Center of the Johannes Gutenberg-University, 55131, Mainz, Germany.
| | - Vera Plümer
- Department of Orthodontics, University Medical Center of the Johannes Gutenberg-University, 55131, Mainz, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, 55128, Mainz, Germany
| | - Andrea Pautz
- Department of Pharmacology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - Christina Erbe
- Department of Orthodontics, University Medical Center of the Johannes Gutenberg-University, 55131, Mainz, Germany
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Cardoso DV, Veljkovic A. General Considerations About Foot and Ankle Arthrodesis. Any Way to Improve Our Results? Foot Ankle Clin 2022; 27:701-722. [PMID: 36368793 DOI: 10.1016/j.fcl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma Surgery, British Columbia University, Vancouver, Canada
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Schöbel T, Hantusch G, Hennings R, Schleifenbaum S, Kleber C, Spiegl U. Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa. BMC Musculoskelet Disord 2022; 23:1008. [PMID: 36419124 PMCID: PMC9685846 DOI: 10.1186/s12891-022-05980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Traumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary. MATERIAL AND METHODS In this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed. RESULTS 150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma. CONCLUSIONS Given the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- T. Schöbel
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - G. Hantusch
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - R. Hennings
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - S. Schleifenbaum
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany ,ZESBO – Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstrasse 14, D-04103 Leipzig, Germany ,grid.461651.10000 0004 0574 2038Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - C. Kleber
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - U. Spiegl
- grid.9647.c0000 0004 7669 9786Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
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Golshah A, Omidi K, Nikkerdar N, Moradpoor H, Ghorbani F. Effect of Methotrexate Injection on Orthodontic Tooth Movement: An Experimental Study on Rats. Int J Dent 2021; 2021:8451522. [PMID: 34790239 PMCID: PMC8592722 DOI: 10.1155/2021/8451522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Knowledge about the effects of medications, vitamins, and various supplements on orthodontic tooth movement (OTM) is imperative for orthodontists. This study aimed to assess the effect of methotrexate (MTX) injection on OTM in rats. MATERIALS AND METHODS Twenty-eight male Wistar rats were randomized into four groups (n = 7). The first molar and central incisor were connected using a nickel-titanium (NiTi) coil spring with a 50 g load in each rat. The two experimental groups received 0.75 mg/kg and 1.5 mg/kg MTX, respectively, intraperitoneally for 21 days. The negative control group did not receive any injection and did not undergo orthodontic treatment. The positive control group underwent orthodontic treatment and received 0.9% saline (NaCl) injections for 21 days. All rats were sacrificed with chloroform inhalation after 21 days; their maxilla was resected, and the mean number of Howship's lacunae, blood vessels, osteoclasts, and resorption lacunae was counted. The reduction in bone volume (bone volume to total volume ratio (BV/TV)) at the site of the maxillary molar was quantified by microcomputed tomography (micro-CT). RESULTS OTM, the number of osteoclasts, and the number of blood vessels significantly increased in rats treated with MTX (P < 0.05). However, the increase in the number of Howship's lacunae and resorption lacunae was not significant (P > 0.05). Lower BV/TV in the MTX groups was in agreement with the increased number of osteoclasts. CONCLUSION Injection of MTX can significantly increase OTM and decrease root resorption in rats.
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Affiliation(s)
- Amin Golshah
- Department of Orthodontic, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khaled Omidi
- Student Research Committee Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nafiseh Nikkerdar
- Department of Maxillofacial Radiology, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hedaiat Moradpoor
- Department of Prosthodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Ghorbani
- Department of Orthodontic, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Two Co(II) coordination polymers: Crystal structures and important role in bone healing. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2021.130726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kunkle B, Reid J, Kothandaraman V, Eichinger JK, Friedman RJ. Increased perioperative complication rates in patients with solid organ transplants following rotator cuff repair. J Shoulder Elbow Surg 2021; 30:2048-2055. [PMID: 33571654 DOI: 10.1016/j.jse.2020.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/19/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair is the second most common soft tissue procedure performed in orthopedics. Additionally, an increasing percentage of the population has received a solid organ transplant (SOT). The chronic use of immunosuppressants as well as a high prevalence of medical comorbidities in this population are both important risk factors when considering surgical intervention. The purpose of this study is to determine the demographic profile, comorbidity profile, and perioperative complication rate of SOT patients undergoing inpatient rotator cuff repair surgery compared to nontransplanted patients. METHODS The Nationwide Inpatient Sample (NIS) database was queried from years 2002-2017 to identify all patients who underwent inpatient rotator cuff repair (n = 144,528 weighted). This group was further divided into SOT (n = 286 weighted) and nontransplant (n = 144,242 weighted) cohorts. Demographic and comorbidity analyses were performed between these groups. Additionally, a matched cohort of nontransplanted patients controlled for the year of procedure, age, sex, race, income, and hospital region was created in a 1:1 ratio to the SOT group (n = 286 each) for perioperative complication rate analysis. RESULTS Compared to nontransplanted patients, SOT patients were more likely to have at least 1 significant medical comorbidity (98% vs. 69%, P < .001), had a higher number of total comorbidities (3.1 vs. 1.4, P < .001), and had a higher Charlson-Deyo Comorbidity Index (2.6 vs. 0.54, P < .001). Compared to the matched cohort, SOT patients experienced longer hospital stays (2.9 vs. 1.8 days, P < .001), higher surgery costs ($12,031 vs. $8476, P < .001), and were more likely to experience a perioperative complication (24% vs. 3%, P < .001) with an odds ratio of 7.7 (95% confidence interval: 3.9-15.1). CONCLUSION Compared with nontransplanted patients, SOT patients undergoing rotator cuff repair had a significantly higher comorbidity index, longer hospital stays, costlier surgeries, and were >7 times more likely to experience a perioperative complication. With nearly a quarter of all SOT patients experiencing a perioperative complication following rotator cuff repair, careful consideration for surgery as well as increased postoperative surveillance should be considered in this unique population.
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Affiliation(s)
- Bryce Kunkle
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Jared Reid
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Josef K Eichinger
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J Friedman
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
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Rozis M, Vlamis J, Vasiliadis E, Mavragani C, Pneumaticos S, Evangelopoulos DS. Musculoskeletal Manifestations in Sjogren's Syndrome: An Orthopedic Point of View. J Clin Med 2021; 10:1574. [PMID: 33917955 PMCID: PMC8068384 DOI: 10.3390/jcm10081574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/12/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022] Open
Abstract
Sjogren's syndrome (SS) is a frequent entity with a broad symptomatology spectrum, mainly affecting the salivary and lachrymal glands. The disease also affects the musculoskeletal system targeting bones, specific joints, muscles, and the peripheral nerve system. Disease related clinical manifestations canhave an accumulative impact, as the syndrome is commonly associated with other rheumatic diseases. A literature review was performed with the aim to assess the in-depth association of Sjogren's syndrome and its treatment agents with the musculoskeletal system and further investigate its potential relevance with common orthopedic postoperative complications.
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Affiliation(s)
- Meletios Rozis
- 3rd Department of Orhopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (M.R.); (J.V.); (E.V.); (S.P.)
| | - John Vlamis
- 3rd Department of Orhopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (M.R.); (J.V.); (E.V.); (S.P.)
| | - Elias Vasiliadis
- 3rd Department of Orhopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (M.R.); (J.V.); (E.V.); (S.P.)
| | - Clio Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Spiros Pneumaticos
- 3rd Department of Orhopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (M.R.); (J.V.); (E.V.); (S.P.)
| | - Dimitrios Stergios Evangelopoulos
- 3rd Department of Orhopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (M.R.); (J.V.); (E.V.); (S.P.)
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Jiao C, Deng M, Ma Y, Hu G. Effect and Repair Mechanism of Nano Ag Sponge Dressing Combined with Gelatin-Bletilla Striata Gum/Salvia Miltiorrhiza on Refractory Orthopedic Wounds. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8872235. [PMID: 33860056 PMCID: PMC8026300 DOI: 10.1155/2021/8872235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the effect and mechanism of the sponge dressing on the healing of refractory orthopedic wound, and the gelatin-Bletilla striata gum/Salvia miltiorrhiza nano Ag (GBS-Ag) sponge dressing was prepared. METHODS GBS-Ag sponge dressing was prepared by the freeze-drying method. Twenty male SD rats were randomly divided into the control group (Ctrl group) and GBS-Ag group, with 10 rats in each group, and the rats in the two groups were established a model of back wound infection. The Ctrl group was treated with gauze, while the GBS-Ag group was treated with GBS-Ag sponge dressing. Wound healing rate, blood immune indexes, Ag content in each organ, morphological changes of wound, and expression of transforming growth factor-β1 (TGF-β1) in wound transformation were detected in the two groups of rats. RESULTS The mechanical properties of GBS-Ag sponge dressing were all in line with the standard, and it had good killing effect on the conventional strain after being incubated for 24 hours. Compared with the Ctrl group, the healing rate and lymphocyte percentage in the GBS-Ag group were significantly increased on day 4 and day 10 (P < 0.05), while the total number of white blood cells and the percentage of neutrophils were significantly decreased (P < 0.05). Compared with Ctrl group, the Ag content in liver, spleen, and kidney of rats in the GBS-Ag group was significantly increased (P < 0.05). The histological results showed that the Ctrl group lacked collagen fibers in the dermis, and the angiogenesis was not rich, accompanied by a large number of inflammatory cell infiltration. The epidermal repair of rats in the GBS-Ag group was complete and partially keratinized, the dermis was rich in collagen fibers, with elastic fibers and new blood vessels, inflammatory cells were rare, and new hair follicles and thick-walled blood vessels were also observed. The expression of TGF-β1 protein in the wounds of rats in the GBS-Ag group was higher than that of the Ctrl group. CONCLUSION GBS-Ag sponge dressing had multiple effects of sterilization and promoting wound healing, and its mechanism may be related to promoting the TGF-β1 protein expression.
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Affiliation(s)
- Chuanjie Jiao
- Department of Orthopedics, People's Hospital Yangxin County of Hubei Province, Huangshi 435200, China
| | - Ming Deng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yonggang Ma
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Geliang Hu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Hirao M, Ebina K, Etani Y, Kaneshiro S, Tsuboi H, Noguchi T, Okamura G, Kunugiza Y, Nakaya H, Nishikawa M, Tsuji S, Takahi K, Owaki H, Hashimoto J. Modified Anterolateral Approach for Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211013342. [PMID: 35097449 PMCID: PMC8725997 DOI: 10.1177/24730114211013342] [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] [Indexed: 11/16/2022] Open
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Hoshigaoka Medical Center, Osaka, Japan
| | - Hiroyuki Nakaya
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Masataka Nishikawa
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedic Surgery/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Koichiro Takahi
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka-Toneyama Medical Center, Osaka, Japan
| | - Hajime Owaki
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Hoshigaoka Medical Center, Osaka, Japan
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Medellín-Luna MF, Castañeda-Delgado JE, Fernández-Ruiz JC, Ochoa-González FL, Troncoso-Vázquez L, García-Cruz S, Zapata-Zúñiga M, Serrano CJ, Portales-Pérez D, Enciso-Moreno JA, Cervantes-Villagrana AR. Methotrexate reduces keratinocyte proliferation, migration and induces apoptosis in HaCaT keratinocytes in vitro and reduces wound closure in Skh1 mice in vivo. J Tissue Viability 2020; 30:51-58. [PMID: 33139157 DOI: 10.1016/j.jtv.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
The aim of the present work was to evaluate MTX treatment (0.1, 1 and 10 μg mL-1) in vitro in order to characterize its effects on cell proliferation alterations in cell cycle of HaCaT keratinocytes and wound healing in a Skh1 mice treated with MTX (low doses 30 mg kg-1, high doses 200 mg kg-1 and repeated doses at 1.5 mg kg-1). We analyzed the cytotoxic effect of methotrexate by a resazurin assay. The effects in the proliferation, cell cycle and apoptosis of HaCaT cells were analyzed by flow cytometry. The effects of MTX on wound healing in vivo were also analyzed. A trend toward reduction in the resazurin assay was found (p > 0.05). Reduced proliferation was also identified in a clonogenic assay and a CFSE assay (p < 0.05) due to the MTX treatment. A reduction in the G2/M and S phases was observed accompanied by apoptosis induction with increased sub G0 phase and annexin V FITC staining. Effect of MTX was evidenced in vivo on the wound closure process after day 10 (p < 0.05) with alterations in tissue architecture and remodeling. There is a marked effect of MTX on wound healing in vivo in Skh1 mice with implications for long-term therapy and surgical interventions.
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Affiliation(s)
- Mitzzy F Medellín-Luna
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico; Maestría en Ciencias Farmacobiológicas, Facultad de Ciencias Químicas, Universidad Autónoma de San Luís Potosí, San Luis Potosí, Mexico
| | - Julio E Castañeda-Delgado
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico; Cátedras-CONACYT, Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Julio C Fernández-Ruiz
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico; Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luís Potosí, San Luis Potosí, Mexico
| | - Fátima L Ochoa-González
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico; Doctorado en Ciencias Básicas, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Lorena Troncoso-Vázquez
- Maestría en Ciencias Biomédicas, Area de Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Salvador García-Cruz
- Departamento de Cirugía Experimental e Investigación Quirúrgica y Bioterio. "Claude Bernard", Área de Ciencias de la Salud, Universidad Autónoma de México, Zacatecas, Mexico; Facultad de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Martín Zapata-Zúñiga
- Facultad de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico; Hospital Rural No.51 IMSS Bienestar. Villanueva, Zacatecas, Mexico
| | - Carmen J Serrano
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Diana Portales-Pérez
- Maestría en Ciencias Farmacobiológicas, Facultad de Ciencias Químicas, Universidad Autónoma de San Luís Potosí, San Luis Potosí, Mexico
| | - José A Enciso-Moreno
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Alberto R Cervantes-Villagrana
- Maestría en Ciencias Biomédicas, Area de Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico; Maestría en Ciencia y Tecnología Química, Unidad Académica de Ciencias Químicas, Área de Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico.
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Effects of Chronic Corticosteroid and Immunosuppressant Use in Patients Undergoing Bariatric Surgery. Obes Surg 2020; 29:3309-3315. [PMID: 31165404 DOI: 10.1007/s11695-019-03995-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic immunosuppression can put surgical patients at additional risk for complications, particularly infection. This is not a contraindication for patients undergoing bariatric surgery. However, with the increasing prevalence of bariatric surgery, it is important to characterize the additional risks for immunosuppressed patients. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry was used to identify immunosuppressed patients who had undergone bariatric surgery. Patients undergoing primary bariatric surgery (laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy) at an accredited institution between 2015 and 2017 were included. A multivariable regression analysis was performed, controlling for age, sex, procedure, and several other comorbidities. Overall 30-day incidence of major complications was the primary outcome. A secondary analysis compared outcomes amongst immunosuppressed patients by procedure type using a propensity-matched analysis. Propensity matching was performed based on preoperative comorbidities and bariatric procedure. RESULTS A total of 430,936 patients were included in the study. Of these, 7214 (1.7%) were chronically immunosuppressed. Our multivariable regression analysis found statistically higher odds of 30-day major complications (OR 1.39, 95% CI 1.25-1.55; p < 0.001), bleed (OR 1.49, 95% CI 1.24-1.80; p < 0.001) and anastomotic leak (OR 1.38, 95% CI 1.02-1.87; p = 0.037) amongst immunosuppressed patients. However, there was no difference between 30-day mortality (OR 1.15, 95% CI 0.64-2.07; p = 0.644). Our secondary analysis found higher rates of 30-day major complications for immunosuppressed patients undergoing gastric bypass (9.6% vs. 5.0%; p < 0.001). CONCLUSION Immunosuppressed patients are at higher risk of major complications when undergoing bariatric surgery, especially gastric bypass.
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The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition: A Multicenter Propensity Score–Matched Study. Plast Reconstr Surg 2020; 145:360e-367e. [DOI: 10.1097/prs.0000000000006465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Due to demographic changes in the population and the development of novel immunosuppressive agents, an increasing number of trauma and orthopedic patients are taking concomitant immunosuppressive medication. These drugs might interfere with the healing process and can possibly retard or prevent wound and fracture healing and lead to a higher risk of infections. In these complex situations a structured and interdisciplinary process during hospital admission should preoperatively evaluate the possibility of interrupting immunosuppressive medications for the perioperative treatment period without risking a relapse of the underlying disease and which surgical approach should be individually selected for the patient.
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Affiliation(s)
- Dagmar Horn
- Apotheke, Universitätsklinikum Münster, Münster, Deutschland
| | - Christoph Klaas
- Apotheke, Universitätsklinikum Münster, Münster, Deutschland
| | - Michael Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Richard Stange
- Abteilung für Regenerative Muskuloskelettale Medizin, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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Hayashi M, Morimoto Y, Iida T, Tanaka Y, Sugiyama S. Risk of Delayed Healing of Tooth Extraction Wounds and Osteonecrosis of the Jaw among Patients Treated with Potential Immunosuppressive Drugs: A Retrospective Cohort Study. TOHOKU J EXP MED 2019; 246:257-264. [PMID: 30568073 DOI: 10.1620/tjem.246.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bone-modifying or antiresorptive agents that target osteoclasts, such as bisphosphonates, are known to cause delayed wound healing and osteonecrosis of the jaw (ONJ) following tooth extraction. However, there are no data on whether such adverse events are also caused by drugs that may suppress the immune system, including corticosteroids, immunosuppressants, biological agents, and disease-modifying anti-rheumatic drugs (DMARDs). The aim of this retrospective study was to examine the incidence of delayed post-extraction wound healing and identify risk factors among patients treated with potential immunosuppressive drugs undergoing tooth extraction. We performed a retrospective cohort study involving 101 patients by reviewing their medical records. The underlying diseases of the enrolled patients included dilated cardiomyopathy, hematological malignancy, sarcoidosis, rheumatoid arthritis, and systemic lupus erythematosus. The sample comprised 131 cases of tooth extraction among the 101 patients; delayed post-extraction wound healing occurred in 10 patients (12 cases, 9.2%), including ONJ in three patients (3 cases, 2.3%). The surgical tooth extraction performed for impacted teeth or a residual root (P = 0.009), the number of surgical tooth extraction (P = 0.012), decreased lymphocyte counts (P = 0.008), and decreased eosinophil counts (P = 0.009) were significantly related to delayed wound healing. Thus, among patients taking corticosteroids, immunosuppressants, biological agents, and/or DMARDs, there is a risk of delayed wound healing and ONJ. Moreover, the significant risk factors are low lymphocyte counts, low eosinophil counts, and surgical extraction. It is of particular importance to prevent surgical site infection, when the high-risk patients undergo tooth extraction.
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Affiliation(s)
- Megumi Hayashi
- Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University.,Special Patient Oral Care Unit, Kyushu University Hospital
| | - Yoshinari Morimoto
- Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University.,Special Patient Oral Care Unit, Kyushu University Hospital.,Department of Dentistry, National Cerebral and Cardiovascular Center
| | - Takatoshi Iida
- Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University
| | - Yohei Tanaka
- Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University
| | - Shuntaro Sugiyama
- Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University
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Identification of the effector domain of biglycan that facilitates BMP-2 osteogenic function. Sci Rep 2018; 8:7022. [PMID: 29728612 PMCID: PMC5935668 DOI: 10.1038/s41598-018-25279-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/09/2018] [Indexed: 01/22/2023] Open
Abstract
We have reported that recombinant biglycan (BGN) core protein accelerates bone formation in vivo by enhancing bone morphogenetic protein (BMP)-2 function. The purpose of the present study was to identify the specific domain (“effector”) within the BGN core protein that facilitates BMP-2 osteogenic function. Thus, we generated various recombinant and synthetic peptides corresponding to several domains of BGN, and tested their effects on BMP-2 functions in vitro. The results demonstrated that the leucine-rich repeats 2–3 domain (LRR2-3) of BGN significantly enhanced the BMP-2 induced Smad1/5/9 phosphorylation, osteogenic gene expression, and alkaline phosphatase activity in myogenic C2C12 cells. Furthermore, addition of LRR2-3 to osteoblastic MC3T3-E1 cells accelerated in vitro mineralization without compromising the quality of the mineral and matrix. These data indicate that LRR2-3 is, at least in part, responsible for BGN’s ability to enhance BMP-2 osteogenic function, and it could be useful for bone tissue regeneration.
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Tatara AM, Kontoyiannis DP, Mikos AG. Drug delivery and tissue engineering to promote wound healing in the immunocompromised host: Current challenges and future directions. Adv Drug Deliv Rev 2018; 129:319-329. [PMID: 29221962 PMCID: PMC5988908 DOI: 10.1016/j.addr.2017.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022]
Abstract
As regenerative medicine matures as a field, more promising technologies are being translated from the benchtop to the clinic. However, many of these strategies are designed with otherwise healthy hosts in mind and validated in animal models without other co-morbidities. In reality, many of the patient populations benefiting from drug delivery and tissue engineering-based devices to enhance wound healing also have significant underlying immunodeficiency. Specifically, patients suffering from diabetes, malignancy, human immunodeficiency virus, post-organ transplantation, and other compromised states have significant pleotropic immune defects that affect wound healing. In this work, we review the role of different immune cells in the regenerative process, highlight the effect of several common immunocompromised states on wound healing, and discuss different drug delivery strategies for overcoming immunodeficiencies.
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Affiliation(s)
- Alexander M Tatara
- Medical Scientist Training Program, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Department of Bioengineering, Rice University, Houston, TX, United States.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States.
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX, United States.
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Pountos I, Giannoudis PV. Drug-eluting implants for the suppression of metastatic bone disease: current insights. Expert Rev Med Devices 2018; 15:301-311. [PMID: 29561689 DOI: 10.1080/17434440.2018.1456336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The fixation of impending or pathologic fractures is challenging and their successful management can have a favourable impact on the quality of life of the patient. The progression of the metastatic bone disease can cause significant pain and disability but also could result in the loosening and subsequent failure of the implants. To prevent the additional local growth, postoperative radiotherapy is often recommended, and many patients receive endocrine or chemotherapy. AREAS COVERED Several reports support the antineoplastic drugs to bone cement as an adjuvant to improve implant stability as well as to prevent local cancer progression and failure of reconstructive devices used to treat patients with pathologic fractures. The aim of the present review is to present our current understanding on the effect of local delivery of antineoplastic drugs at the bone site. EXPERT COMMENTARY Encouraging evidence support the application of bone cement loaded with antineoplastic drugs to fill defects and strengthen the fixation of orthopaedic implants. This is an inexpensive and safe method that can improve implant stability, prevent local cancer progression and failure of reconstructive devices. To fully evaluate its clinical effectiveness randomized clinical studies are needed.
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Affiliation(s)
- Ippokratis Pountos
- a Academic Department of Trauma & Orthopaedics, School of Medicine , University of Leeds , Leeds , UK
| | - Peter V Giannoudis
- a Academic Department of Trauma & Orthopaedics, School of Medicine , University of Leeds , Leeds , UK
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Mehrzadi S, Fatemi I, Esmaeilizadeh M, Ghaznavi H, Kalantar H, Goudarzi M. Hepatoprotective effect of berberine against methotrexate induced liver toxicity in rats. Biomed Pharmacother 2017; 97:233-239. [PMID: 29091871 DOI: 10.1016/j.biopha.2017.10.113] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 12/31/2022] Open
Abstract
Hepatotoxicity is one of the major side effects of methotrexate (MTX), which restricts the clinical use of this drug. Berberine (BBR) is a natural compound with multiple pharmacological activities such as antioxidant, antiapoptotic and anti-inflammatory effects. In this study, the effect of BBR on MTX-induced hepatotoxicity was studied. A total number of 28 male Wistar rats were randomly divided into four experimental groups. Rats were pretreated with BBR orally with dose of 100mg/kg for 10 consecutive days and MTX (20mg/kg, intraperitoneally) was administrated on the 9th day. Then on day 11, blood samples were collected to determine serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP). The extracted livers were used for histological examination, biochemical assays and real time PCR studies. Malondialdehyde (MDA), glutathione (GSH), protein carbonyl (PC), nitric oxide (NO) levels, catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and myeloperoxidase (MPO) activities were assessed in hepatic tissue. In addition, the expression of SOD and PGx was measured using real-time PCR method in hepatic tissue. Results showed that MTX administration significantly increases AST, ALT and ALP levels (all p<0.001). It also, increases MDA, PC, NO levels and MPO activity (p<0.001, p<0.01, p<0.05 and p<0.01 respectively). Moreover, MTX decreases hepatic GSH level, SOD, GPx and CAT activities (all p<0.001). Pre-treatment with BBR for 10days prevented some of these changes. Serum levels of AST and ALT decreased (all p<0.001). Hepatic MDA level decreased (p<0.001) and GSH level as well as GPx activity increased (p<0.05 and p<0.01 respectively). Our results indicated that BBR might be useful for prevention of the hepatotoxicity induced by MTX via ameliorative effects on biochemical and oxidative stress indices.
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Affiliation(s)
- Saeed Mehrzadi
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Fatemi
- Department of Physiology and Pharmacology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Physiology-Pharmacology Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahdi Esmaeilizadeh
- Student Research Committee, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | | | - Hadi Kalantar
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Goudarzi
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Hippensteel KJ, Calfee R, Dardas AZ, Gelberman R, Osei D, Wall L. Functional Outcomes of Thumb Trapeziometacarpal Arthrodesis With a Locked Plate Versus Ligament Reconstruction and Tendon Interposition. J Hand Surg Am 2017. [PMID: 28648328 DOI: 10.1016/j.jhsa.2017.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare standardized functional and patient-reported early outcomes following trapeziometacarpal arthrodesis (TMA) using a locking cage plate construct with trapezial excision, ligament reconstruction, and tendon interposition (LRTI). METHODS This prospective cohort enrolled 50 consecutive patients with trapeziometacarpal osteoarthritis undergoing TMA or LRTI. Demographic data, objective measurements, Sollerman function testing, and patient-reported outcomes were collected before surgery and at various time intervals up to 12 months after surgery. The study was powered to detect a minimally clinically important difference on the Michigan Hand Questionnaire between groups at 12 months. To account for selection bias, we performed between-group statistical analysis of the magnitude of change from preoperative to postoperative data. All complications were recorded. RESULTS There were no significant differences in the amount of change in grip or pinch strength, patient-reported outcomes, or functional hand testing between TMA and LRTI. The TMA group had significantly increased thumb tip opposition distance. The TMA group was complicated by a 26% overall nonunion rate of which 8% were symptomatic. The LRTI group (Wagner incision) had a significantly increased incidence of superficial branch of the radial nerve paresthesia. The incidence of complications was similar between operative groups, but revision surgery was more common after TMA. CONCLUSIONS Compared with LRTI, TMA failed to demonstrate superior improvement in strength, standardized functional performance, or patient-reported function and is associated with an increased likelihood of revision surgery in the first 12 months. Trapeziometacarpal arthrodesis with a locking plate and screw construct does not ensure union, although most radiographic nonunions were asymptomatic. Wagner incisions are associated with a significantly increased incidence of superficial branch of the radial nerve paresthesia compared with dorsal trapeziometacarpal exposure. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- K J Hippensteel
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
| | - Ryan Calfee
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Agnes Z Dardas
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Richard Gelberman
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Daniel Osei
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Lindley Wall
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
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