The effect of combined drug therapy in lateral fragility fractures of the femur: a prospective observational study

OBJECTIVE

Due to a growing number of lateral fragility fractures, and their high economic and social impact, we evaluated the combined drug therapy effectiveness in lateral fragility femur fractures treated by intramedullary nailing surgery comparing the clinical and radiological results of two groups of patients.

PATIENTS AND METHODS

From May 2019 to March 2020, we carried out a prospective observational study comparing the results of patients with femoral lateral fractures treated by the same intramedullary nail (PFNA Synthes®) using Clodronic acid and Vitamin D (study group, 25 patients) compared to patients with the same fractures treated with Vitamin D alone (control group, 25 patients). The evaluations were based on bone biochemical markers (serum calcium level, serum phosphate level, parathyroid hormone, Vitamin D, serum C-terminal telopeptide), Visual Analogic Scale and HHS (Harris Hip Score) score, and femur densitometric views. In order to evaluate the femur neck mineral bone density (BMD), two areas have been identified on the Anterior-Posterior view: the Region of Interest (ROI)1 (under the head screw) and the ROI2 (above the femoral screw). The BMD has been calculated using femur densitometric views at T0 (1st day post-surgery) and at T1 (12 months later).

RESULTS

As far as the BMD average of ROI1 is concerned, we found a significant statistical increase at T1 in the study group (0.93±0.07 gr/cm2) vs. control group (0.88±0.08 gr/cm2), p=0.04. Both biochemical and densitometric values were statistically increased in the study group from T0 to T1 (p<0.05), while control group showed an improvement in the biochemical values only.

CONCLUSIONS

Thanks to a one year follow-up, we are able to demonstrate that the administration of an adequate drug therapy after surgery can lead to a better control of the bone remodeling and reabsorption process.

A Prospective Observational Clinical and Radiological Study of a Modular Bridging External Fixator for Unstable Distal Radius Fractures

Introduction:

Distal Radius Fractures (DRFs), with a reported annual incidence of 600,000, are common injuries treated by trauma surgeons. This prospective observational study aims to assess the efficacy of a modular external fixation system in the treatment of unstable distal radius fractures at 12-months follow-up.

Materials and methods:

Between December 2014 and December 2016, 35 patients (female: 21, male:14; mean age: 62.5), with unstable DRFs, treated with modular external fixation system, were selected for this prospective observational study. All the patients underwent clinical and radiological reviews at follow-up.

Results:

At 12-month follow-up, a mean DASH score of 15.73 and a mean PRWE score 20.10 were recorded. Mean radial inclination was 19.92°; mean ulnar variance was 1.12 mm and mean palmar inclination was 9.76°.

Conclusion:

Modular external fixator system revealed clinically and radiologically effective in the treatment of unstable and comminuted DRFs. Additional K-wires should be used to complement the fracture fixation, when there is unacceptable fragment reduction only with external fixator.

Induced membrane by silver-coated knee megaprosthesis: keep or toss?

In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the alleged Masquelet technique consisting of segmental bone loss two-stage reconstruction. The induced membrane creates advantageous local conditions that promote bone graft remodeling and osteointegration. The aim of our study was to describe the first two cases in Literature of induced membrane observed following silver-coated knee megaprosthesis reconstruction. In addition, it was our interest to evaluate their histological features.

Biomechanical study of shaft fracture with the butterfly fragment: software simulation

The specific traumatic mechanism that leads to the formation of the butterfly fragment is debated in literature. The aim of the present study is to analyze the biomechanics of fractures with a "butterfly" fragment, using a software that simulates the movement of the lines of force (and related iso-displacement points) that occur on the bone, when traumatic forces are applied on it. We have shown that the formation of the butterfly fragment derives from the application of three forces (compression, torsion and bending) with the bending force that acts by increasing the curvature of the long bone.

Serum biomarkers in the diagnosis of periprosthetic joint infection: consolidated evidence and recent developments

Periprosthetic Joint Infection (PJI) represents one of the leading causes of revision prosthetic surgery, accounting for 25% of failed Total Knee Replacement (TKR) and 15% of failed Total Hip Replacement (THR). The search for a biomarker that, together with clinical and radiological findings, could improve the management of such a kind of patients is currently a big challenge for orthopaedic surgeons. This review aims (1) to assess the accuracy and the limitations of the traditional (Serum Erythrocytes Sedimentation Rate, C-reactive Protein, Procalcitonin, Interleukin 6, Tumor Necrosis Factor alpha), (2) and to analyse the emerging serum biomarkers (Presepsin, Toll-like Receptor 2, soluble urokinase-type Plasminogen Activator Receptor, Chemokine Ligand 2 and Osteopontin) in the diagnosis of PJI. A special attention will be given to the emerging serum biomarkers, that could play an important role as first-line investigations, in the screening of PJI in a close future.

Evaluation of long-term postoperative outcomes between mini-open and arthroscopic repair for isolated supraspinatus tears: a retrospective analysis

BACKGROUND

Despite arthroscopic repair of the rotator cuff is an increasingly popular procedure, the mini-open (MO) repair still remains a viable and appreciated technique. The purpose of the study was to analyze the long-term clinical outcomes of patients with isolated supraspinatus tear undergoing MO or arthroscopic surgery (AS) repair.

PATIENTS AND METHODS

Forty-six patients underwent supraspinatus repair with anchors: 24 with MO technique and 22 with AS procedure. They were evaluated postoperatively at 3, 6, 12 months and 2 years.

RESULTS

The mean surgery time, the mean hospital stay and the average costs were shorter in the MO patients respect to the AS group. Despite an initial better Disabilities of Arm, Shoulder and Hand and Constant Murley Score in the first 6 months of follow-up in the AS group, no differences were detected at 24 months.

CONCLUSION

This study suggests that isolated supraspinatus tears can be treated with a MO or arthroscopic repair procedure with similar clinical outcome in the long-term postoperative period. The mean surgery time and the average costs are less in the MO group respect to the AS group.

Extracorporeal shockwave therapy versus exercise program in patients with low back pain: short-term results of a randomised controlled trial

The physiotherapy treatment of low back pain (LBP) with physical stimulation offers different possibilities of application. Until now, the physical therapies used in LBP are laser therapy, ultrasonotherapy and currents. We conducted a clinical trial in order to verify whether shockwave therapy, which is very effective in treating tendinopathies and fracture consolidation delays, leads to clinical and electromyographic improvement in patients affected by LBP. We randomized thirty patients affected by LBP treated with shock waves (shockwave group) or a standard protocol characterized by rehabilitative exercises (control group). At one and three months, the patients treated with shockwave therapy showed clinical improvement measured by VAS scales (p=0.002; p= 0.02), and disability evaluated with Roland scales (p=0.002; p=0.002) and Oswestry (p=0.002; p=0.002). At three months, the patients treated with shock waves, showed a significant improvement in terms of values of amplitude of the sensory nerve conduction velocity (SNCV) of the plantar medialis nerve (left: p=0.007; right: p=0.04), the motor nerve muscular conduction (MNCV) of the deep peroneal nerve (left: p=0.28; right: p=0.01) and recruitment of motor units of finger brevis extensor (left: p = 0.02; right: p=0.006). In the control group, there was a trend to increase the clinical and electromyographic results without statistical significance. The preliminary results suggest a good applicability of shockwave therapy in the treatment of LBP, in accordance with the antiinflammatory, antalgic, decontracting effects and remodeling of the nerve fiber damage verified in previous studies conducted on other pathological models. Future research will allow us to verify the integration of this therapy into a rehabilitation protocol combined with other physical therapies.

Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study

Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.

Irisin levels correlate with bone mineral density in soccer players

Irisin, a novel myokine produced in response to physical exercise by skeletal muscle, displays anabolic effect on bone and can improve the bone-loss-induced osteoporosis in hind limb suspended mice. It is well known that muscles positively impact the skeleton and in different sports, including soccer, total body bone mineral density (TB-BMD) is elevated. Therefore, we have investigated the correlation between irisin serum levels and total and bone sub-regional BMD in soccer players never studied before. In this study, Caucasian football players of Bari team have been enrolled. Their sera were collected to measure by ELISA kit irisin levels and by dual-energy X-ray absorptiometry (DEXA) analysis measurements of BMD (g • cm−2) in the whole body and different bone sub-regions (head, arms, legs, ribs, dorsal vertebrae, lumbar vertebrae, pelvis) were performed. The BMC (g) was measured in the whole body. By means of Pearson’s (R) and Cohen’s (d) coefficient we investigated the linear association between the irisin serum levels and BMD. In soccer players, we have found a positive correlation between irisin and TB-BMD as demonstrated by the values of Pearson and Cohen’s (d) coefficient. Furthermore, linear association was detected between irisin and BMD of different bone-site such as right arm, lumbar vertebrae and head. A positive trend was also observed analyzing circulating levels of irisin and bone mineral content as well as total Z-score. In conclusion, we have demonstrated the correlation between irisin and total or bone sub-regional BMD in soccer players for the first time, an additional systemic effect of the “sport-hormone” defined myokine.

Autologous lipotransfer versus stromal vascular fraction enriched lipoinjection for diabetic foot wounds healing: a pilot study

Chronic ulcers of the lower limbs represent a significant social and economic burden. Diabetes is a strong risk factor for development of chronic lesions. Adult stem cells and growth factors derived from the adipose tissue are among the most promising therapeutic strategies for hard to heal wounds. Fat grafts have been used for several decades to treat soft tissue deformities, but despite its excellent characteristics, the outcome was unpredictable, due to partial necrosis and resorption of the graft. Stem cells’ enrichment of these grafts or their injection into the edges of the ulcers have shown encouraging results in various experimental settings. In this pilot study, we compared the standard of care to autologous lipotransfer and stromal vascular fraction (SVF) enriched lipoinjection in 30 patients with diabetic foot ulcers, showing clear superiority of SVF enriched lipoinjection in terms of percentage of reduction of ulcers size and healing time.

Short-term effect of shockwave therapy, temperature controlled high energy adjustable multi-mode emission laser or stretching in Dupuytren’s disease: a prospective randomized clinical trial

Dupuytren’s disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-therapy. To date, no study has analyzed the effects of biostimulation with shock-waves (SW) and high energy laser therapy [Temperature controlled High Energy Adjustable multi-mode emission Laser (THEAL)]. We recruited 45 patients, 32 males and 13 females (average age 63.4 years) affected by early or late stage Dupuytren’s disease [33 metacarpophalangeal (MCP) joints, 12 proximal interphalangeal (PIP) joints]. We randomized the patients into three treatment groups: extracorporeal shockwave therapy (ESWT), THEAL and stretching exercises. Follow-ups were at the end of treatment (T1), after 1 month (T2), and after 3 months (T3). The three forms of treatment determined a progressive clinical-functional improvement. The pain relief was statistically significant for SW and THEAL at all follow-ups (FUs) (p</=0.01). The functional recovery was statistically significant in the SW group at all FUs and in the THEAL and Stretching groups at T1 and T2 (p<0.01). Patient satisfaction level was higher for SW at T2 and T3 and for THEAL at T2 (p</=0.01). The extension deficit recovery as regards the MCP and PIP joints was statistically significant in the SW group at T1 and T2 (p</= 0.01) and in the stretching group at T1 (p<0.01). The SW and THEAL treatments appear safe, have good efficacy and are associated with good patient satisfaction in the short and medium terms. Further studies may verify the possibility of repeated cycles and/or combined therapies to improve results.

ACTN3/ACE genotypes and mitochondrial genome in professional soccer players’ performance

Two nuclear genes, ACTN3, encoding for the α-actinin skeletal muscle isoform 3, and ACE encoding the angiotensin-converting enzyme, have both been associated with quantitative physical performance traits in the general population. The purpose of our study was to assess the association between the two nuclear gene variants, R577X (rs1815739) in ACTN3 and I/D (rs4340) in ACE, with elite athletes’ performance and the effect of training on the mitochondrial DNA (mtDNA) content in peripheral blood. We evaluated the genotypes and frequencies of ACTN3 R577X and ACE I/D polymorphisms between soccer players (n = 43) and healthy non-athletic controls (n = 128). Total DNA was extracted from peripheral blood samples using the standard procedure. The genotypes were assessed by PCR-RFLP analysis and mtDNA cellular content by RT-PCR. The soccer players showed a tendency to a prevalence of ACTN3RR and ACEDD genotypes both independently and in co-occurrence. The effect of physical training on the mitochondrial DNA content in the athletic population was reflected strikingly in its increase in peripheral blood. Based on our results, we suggest that the analysis of ACTN3 and ACE genotypes could predict talent in the soccer field and that knowledge of the genetic variants could determine types and training times for soccer players. In addition, the novelty of this work, never before described in the sports literature, is that the increase of mitochondrial content can be correlated with the training load, suggesting that the mtDNA copy number may be considered a viable bioenergetics biomarker.

VITAMIN D DEFICIENCY IN ADULTS: SEARCHING FOR THE PROPER LOADING DOSE

Vitamin D is the main hormone regulating calcium phosphate homeostasis and mineral bone metabolism. Vitamin D deficiency is indeed extremely frequent in musculoskeletal diseases. Recent studies have shown that the treatment of osteoporosis needs to have an optimal vitamin D and calcium supplementation for its efficacy. Actually no agreement exists on the estabilished dose of vitamin D to administer in deficency states. We conducted a prospective study to develop a practical cholecalciferol loading dose regimen that would enable rapid correction of vitamin D deficiency. Sixty post-menopausal age woman were enrolled secondary to a fragility fracture (hip, vertebral, wrist) and screened for 25-hydroxyvitamin D (25(OH)D), calcium, and PTH at baseline (T0), after one month (T1), two months (T2), three months (T3) and six months (T4). Secondary to initial blood values of vitamin D patients were divided into 2 groups; the first group (group A, n=30) included patients with 25(OH)D values between 10-30 ng/ml and the second group (group B, n=30) with values under 10 ng/ml. Each group was then divided in 3 subgroups secondary to the randomized administered dose of 25(OH)D. By this, patients can alternatively receive 25000 UI two times monthly, 100000 UI monthly, 10000 UI (25 drops) weekly. The highest values of mean increase of 25(OH)D were observed in patients treated with 100000 UI. Patients treated with 10000 UI weekly did never achieve the target value. Additionally, as vitamin levels increased, pain intensity decreased. Vitamin D supplementation of 100000 UI monthly seems to be adequate to ensure that serum 25(OH)D values reach the threshold level; by this, it will confer the expected effects without risks of toxicity.

Prognostic factors of extracorporeal shock wave therapy for tendinopathies

INTRODUCTION

Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis.

AIM

The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases.

METHODS

Three hundred fifty-five patients were analyzed 2 months after shock wave treatment for rotator cuff tendinitis, epicondylitis, Achilles tendinopathy, trocanteritis, jumper's knee or plantar fasciitis. We recorded the epidemiological, clinical and treatment protocol, and these data were correlated with treatment outcome.

RESULTS

Clinical improvement was achieved in 45.9 % of these patients. We discovered that laterality different to the dominant limb (p < 0.0001) and repeated shock wave treatments (p = 0.004) are prognostic factors in an unsuccessful therapy, while being male (p = 0.015) and a high body mass index (p = 0.004) are factors for success. We found no differences in relation to age, diet, blood type, work or sport activity, presence of co-morbidities, drugs, type of tendinopathy, density of energy delivered and other physiotherapy treatment. Knowledge of these prognostic factors may lead to improved insight for physicians and physiotherapists to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly.

Is the Zumba fitness responsible for low back pain?

PURPOSE

Zumba fitness requires aerobic repetition exercises, involving the whole body including the spine. Our study is aimed at verifying whether this sport may cause low back pain.

METHODS

Young healthy females were recruited. They were allocated to a "Zumba group" (n = 25) or an "inactivity control group" (n = 25). The Roland-Morris Disability, the Oswestry, the SF-36 and the Spinal Functional Sort Questionaries of all subjects were measured at the baseline (T0) and at 6 months (T1). During this 6-month study, the number of episodes of low back pain was recorded.

RESULTS

At T1, improvements were seen in the "Zumba group." The "inactivity control group" showed worsening in each test at T1. The differences between the two groups were statistically significant for the items Role limitations and physical problems, Physical functioning, Pain and Social activity of SF-36 (p < 0.05). There were no any statistically significant differences in either group of episodes of back pain (p > 0.05).

CONCLUSIONS

We verified that Zumba is not responsible for low back pain. Furthermore, we revealed that Zumba can increase the normal functional activity of the spine. On the basis of this data, we can recommend the practice of this sport on a regular basis for the healthy population, without worrying about the risk of overloading the spine. Further studies are necessary to check whether the patients with chronic spine disease may practice Zumba.

Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study

The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus.

The effect of hydroxyapatite coated screw in the lateral fragility fractures of the femur. A prospective randomized clinical study

Due to a growing numbers of lateral fragility fractures of the femur and their high social costs the need to work out an effective strategy in order to find a better solution for these patients is warranted. From January 2010 to July 2011, we carried out a prospective randomized clinical study comparing the results of patients with femoral lateral fractures treated by nail and cephalic hydroxyapatite coated screws (study group including 27 patients) compared to the patients with the same fractures treated with nail and head standard screws (control group including 27 patients). We defined the two parts of the femoral neck as ROI 1 (under the head screw) and ROI 2 (above the femoral screw) on the AP view. The bone density of the two areas was calculated using DEXA at T0 (1st day post-surgery), at T1 (40th day post-surgery), at T2 (3 months later), at T3 (1 year later). The clinical-radiography evaluations were based on the Harris Hip Score (HHS), ADL test and x-ray views of the hip. As far as the bone mineral density average of ROI 1 and ROI 2 is concerned, we found a significant statistical increase at T1 and T3 in the study group, while it was not significant in the control group. We could account for this data through the higher mechanical stability of hydroxyapatite coated screws than standard screws. In fact, this material was responsible for improved implant osteointegration. Thanks to a 1 year follow-up we were able to demonstrate the implant utility associated with augmentation and the importance of densitometry exams such as easily repeatable and low cost diagnostics to prevent the onset of complications linked to screw loosening.

The vertebral biomechanic previous and after kyphoplasty

The biomechanical understanding of increasing anterior column load with progressing kyphosis leading to subsequent vertebral compression fracture (VCF) established the basic rationale for kyphoplasty. The lumbar spine can support an effort of 500 kg in the axis of the vertebral body, and a bending moment of 20 Nm in flexion. Consequently, if this effort is forward deviated of only 10 cm, the acceptable effort will be reduced to 20 kg so it is important to restore the vertebral anterior wall after a VCF: the authors describe the biomechanical modifications in the spine after kyphoplasty.

First case report of vanadium metallosis after ceramic-on-ceramic total hip arthroplasty

The development of metallosis as a complication following rupture of a hip replacement is known to occur as a result of contact with metal components of the prosthesis (1).In such cases, high cobalt (Co), chromium (Cr) and molybdenum (Mo) levels in the blood have been reported by several Authors (2).Recently, it has been stressed that the clinical investigation should focus on general reactions to high circulating metal levels, such as toxicity for the central nervous system (CNS) and the immune system (3).Despite the increasing interest of literature in ceramic-on-ceramic hip arthroplasty (4),little is known about these complications, and in particular of metallosis. To our knowledge this is the first description of a condition of extensive metallosis and radiographic signs presenting as a result of wear of a ceramic-on-ceramic prosthesis.

Heterotopic ossification after total hip arthroplasty: our experience

Heterotopic ossification is a condition characterized by the presence of mature lamellar bone and often bone marrow in soft tissues surrounding a major joint. It represents a common complication after total hip arthroplasty (THA). The etiology and predisposing factors are not completely known, but some authors reported that the implant of a non-cemented prosthesis seems to be associated with a greater incidence of HO. Two hundred and two non-cemented total hip arthroplasties were performed between October 1997 and February 2002. The mean age was 70.2 years. The average follow-up for 181 hips included in the study was 96 months (range, 72-120 months). A standard lateral approach (Hardinge) was performed for the implant of a non-cemented femoral component and a non-cemented acetabular component. Radiographs were done before and after surgery, at 1, 4 and 12 months postop, then every year. The incidence of HO was assessed in the antero-posterior view at each interval and graded according to Brooker classification. Out of 181 implants, HO was observed in 52 hips (28,7%). Heterotopic bone was graded as class I in 32 (17.7%) hips, class II in 14 (7.73%) hips, class III in 6 (3,3%) hips and class IV in none (0%). The mean preoperative Harris hip score was 48; at the last follow-up, the mean postoperative score was preoperatively to a mean of 89 points (range, 76-97 points) in HO Hip and of 91 points (range, 78-100 points) in the other Hip. In our experience, non-cemented THA led to a higher incidence of class I and II HO according to Brooker Classification, the incidence of HO is comparable to the rates reported in recent studies about the HO finding after a non-cemented THA, the importance of clinical symptoms in the presence of HO is very low.

Localization of abasic sites and single-strand breaks in mitochondrial DNA from brain of aged rat, treated or not with caloric restriction diet

According to the "mitochondrial theory of aging" the lifelong accumulation of various kinds of damage to mitochondrial DNA (mtDNA) has been related to the age-dependent mitochondrial bioenergetic dysfunction. Caloric restriction (CR) diet is able to prevent or delay the onset of several age-related damages to mtDNA. The effects of aging and CR on the presence of abasic sites and single-strand breaks of the sugar-phosphate backbone in mtDNA have been analyzed by applying Ligation Mediated-PCR to a H strand region of brain mtDNA from young and old ad libitum-fed and old CR-treated rats. The region, encompassing the Direct Repeat 1 of the 4,834 bp-long deletion, is highly damaged in the old ad libitum-fed animals with respect to the young ones, whereas in the CR rats it shows a much lower extent of damage. The data confirm, at single nucleotide resolution, the protective effect of CR on the age-related mtDNA damage.

Acetyl-l-carnitine feeding to unloaded rats triggers in soleus muscle the coordinated expression of genes involved in mitochondrial biogenesis

The expressional profile of mitochondrial transcripts and of genes involved in the mitochondrial biogenesis pathway induced by ALCAR daily supplementation in soleus muscle of control and unloaded 3-month-old rats has been analyzed. It has been found that ALCAR treatment is able to upregulate the expression level of mitochondrial transcripts (COX I, ATP6, ND6, 16 S rRNA) in both control and unloaded animals. Interestingly, ALCAR feeding to unloaded rats resulted in the increase of transcript level for master factors involved in mitochondrial biogenesis (PGC-1alpha, NRF-1, TFAM). It also prevented the unloading-induced downregulation of mRNA levels for kinases able to transduce metabolic (AMPK) and neuronal stimuli (CaMKIIbeta) into mitochondrial biogenesis. No significant effect on the expressional level of such genes was found in control ALCAR-treated rats. In addition, ALCAR feeding was able to prevent the loss of mitochondrial protein content due to unloading condition. Correlation analysis revealed a strong coordination in the expression of genes involved in mitochondrial biogenesis only in ALCAR-treated suspended animals, supporting a differentiated effect of ALCAR treatment in relation to the loading state of the soleus muscle. In conclusions, we demonstrated the ability of ALCAR supplementation to promote only in soleus muscle of hindlimb suspended rats an orchestrated expression of genes involved in mitochondrial biogenesis, which might counteract the unloading-induced metabolic changes, preventing the loss of mitochondrial proteins.

Acetyl-l-Carnitine Dietary Supplementation to Old Rats Increases Mitochondrial Transcription Factor A Content in Rat Hindlimb Skeletal Muscles

Acetyl-L-carnitine (ALCAR) fed to old rats has been reported to partially restore mitochondrial function and ambulatory activity. The results of the effect of ALCAR dietary supplementation to 28-month-old rats on mitochondrial transcription factor A (TFAM) content of rat hindlimb skeletal muscles are reported.

Adhesion molecules in gonarthrosis and knee prosthesis aseptic loosening follow-up: possible therapeutic implications

The involvement of the synovium is common in phlogistic processes of various joint diseases. Apart from synoviocytes and the other cells in the synovial tissue, circulating cells recruited from peripheral blood also participate in the phlogistic process. The increased expression of adhesion molecules on both circulating and endothelial cell surface may further this recruitment. We studied 15 patients affected by serious gonarthrosis requiring a prosthetic implant (GPI) and 7 with knee prosthesis aseptic loosening (KPL) to evaluate adhesion molecule expression and phlogistic infiltration in the synovium using immunohistochemistry and microscopic analysis. As control we studied 10 subjects affected by degenerative meniscopathies undergoing a selective arthroscopic surgical meniscectomy. Analysis with Kruskal-Wallis test showed no statistical significant differences in the expression of CD54, CD11a, CD11b and CD18 in three groups examined. The model of variance analysis (Friedman test), showed that CD54 expression is greater in patients with GPI and KPL in comparison with the other molecules. Adhesion molecules and their functions are important in arthropathies not only because their evaluation can allow us to identify the degree of inflammation and to predict its evolution, but also because pharmacological control of their expression could have important therapeutic implications.

Rat hindlimb unloading: Soleus and Extensor Digitorum Longus histochemistry, mitochondrial DNA content and mitochondrial DNA deletions

Mitochondrial phenotypic alterations, mitochondrial DNA content and mitochondrial DNA deletions in a slow, Soleus, and a fast, Extensor Digitorum Longus, skeletal muscle of 3- and 15-month-old hindlimb suspended rats have been studied. Cytochrome c oxidase-negative fibers appeared after unloading in all examined animals and their percentage increased with increasing unloading time. After 14 days of suspension the mitochondrial DNA content did not change in 3-month-old but decreased significantly in 15-month-old rats. Soleus was much more affected by unloading than Extensor Digitorum Longus. The mitochondrial DNA deletion of 4834 bp as well as other mtDNA deletions, researched with Long Distance-PCR, were absent in both studied muscles before and after unloading.

Increased expression of mitochondrial transcription factor A and nuclear respiratory factor-1 in skeletal muscle from aged human subjects

The expression of two factors involved in the nuclear-mitochondrial crosstalk, namely the mitochondrial transcription factor A (TFAM) and the nuclear respiratory factor-1 (NRF-1), was studied in human skeletal muscle biopsies of young and aged subjects. Aged subjects presented a 2.6-fold and an 11-fold increase of the levels of TFAM protein and TFAM mRNA, respectively. The increased expression of TFAM was associated to the doubling of NRF-1 DNA-binding affinity and to a 6-fold increase of NRF-1 mRNA level. The upregulation of TFAM and NRF-1, in aged skeletal muscle, appears involved in the pathway leading to the age-related increase of mitochondrial DNA content.

Age-related mitochondrial genotypic and phenotypic alterations in human skeletal muscle

To have a clearer picture of how mitochondrial damages are associated to aging, a comprehensive study of phenotypic and genotypic alterations was carried out, analyzing with histochemical and molecular biology techniques the same skeletal muscle specimens of a large number of healthy subjects from 13 to 92 years old. Histochemical data showed that ragged red fibers (RRF) appear at about 40 years of age and are mostly cytochrome c oxidase (COX)-positive, whereas they are almost all COX-negative thereafter. Molecular analyses showed that the 4977 bp deletion of mitochondrial DNA (mtDNA(4977)) and the 7436 bp deletion of mtDNA (mtDNA(7436)) are already present in individuals younger than 40 years of age, but their occurrence does not change with age. After 40 years of age the number of mtDNA deleted species, as revealed by Long Extension PCR (LX-PCR), increases, the 10422 bp deletion of mtDNA (mtDNA(10422)) appears, although with a very low frequency of occurrence, and mtDNA content is more than doubled. Furthermore, mtDNA(4977) level directly correlates with that of COX-negative fibers in the same analyzed subjects. These data clearly show that, after 40 years of age, the phenotypic and genotypic mitochondrial alterations here studied appear in human skeletal muscle and that they are closely related.

Aging and mitochondria

Aging is a complex physiological phenomenon and several different theories have been elaborated about its origin. Among such theories, the 'mitochondrial theory of aging', which has gained a large support, indicates the accumulation of somatic mutations of mitochondrial DNA leading to the decline of mitochondrial functionality as one of the driving forces for the process itself. In this review data on rat and man from our laboratory and from recent literature have been thoroughly examined and compared in order to provide the 'state-of-the-art' on the role of mitochondria in aging. Alterations of structure and expression of mitochondrial genome with aging, to find out the eventual relevant changes of mitochondrial biogenesis, have been studied in rat whereas the relationship between cytochrome c oxidase activity and 'common deletion' has been studied in man. Results on the effect of acetyl-L-carnitine on the mitochondrial functionality are also reported.

[Comparative study of echography and conventional radiology in the evaluation of the Insall-Salvati index]

For the study of painful patello-femoral syndromes, the authors suggest the use of US for the evaluation of the so-called Insall-Salvati ratio--i.e., length of patellar ligament/patellar length--whose alteration is suggestive of vertical patello-femoral malalignement (patella alta and patella infera). Ten normal volunteers (20 knees) were examined by means of both US and conventional radiology, and the Insall-Salvati ratio was calculated for each knee. US and radiologic measurements were statistically compared by the correlation-coefficient method: the result was 0.802. US measurements were repeated twice with 0.778 interobserver variability according to the Spearman correlation index. Based on their results, the authors conclude that, in the evaluation of the Insall-Salvati ratio, the diagnostic accuracy of US is almost the same as that of conventional radiology; the former method may even be preferred for it is a simple, quick and repeatable technique not needing ionizing radiations.

[The normal aspect of the suprapatellar bursa in echography of the knee]

Sonography is suitable to recognize fluids in the suprapatellar bursa, which can represent an indirect sign of intra-articular knee effusion. In order to obtain the physiologic parameters of suprapatellar bursa, 50 healthy volunteers, 38 sedentary and 12 sportsmen, were evaluated by means of US. The bursa was recognizable in 8/50 cases (16%) with quadriceps in prolapse (mean thickness: 1.8 mm, mean length: 20.5 mm), and in 23/50 cases (46%) with quadriceps in contraction (mean thickness: 2.6 mm, mean length: 22.6 mm). Suprapatellar bursal thickness ranged 1-4 mm, and its length ranged 12-44 mm. The suprapatellar bursa appeared as a well-defined hypoechoic band, cranial to patella, anterior to the distal femoral shaft, and posterior to quadriceps tendon. Quadriceps contraction increases both thickness and length of bursal swelling (1 and 2 mm, respectively, on the average). When sportsmen were compared with sedentary subjects, suprapatellar bursa diameters were observed not to change, but the bursal itself was evident in 3/12 (25%) and in 8/12 (66%) of cases, according to whether the quadriceps was in prolapse or in contraction. Bursal contents were homogeneously anechoic and bursal outline smooth and regular in all cases (23/23). Bursal morphology was symmetric, in 23/23 cases, in length, regularity of outline, and echogenicity of contents. Thickness alone resulted asymmetrical in 2/23 subjects (8%), even though variations were less than or equal to 2 mm. In conclusion, we can consider as pathologic features: thickness greater than 3-4 mm, asymmetry greater than 2 mm, irregular outline, and inhomogeneous contents. These parameters must be examined in pathologic subjects and further research is mandatory.

[Non-A, non-B post-transfusion hepatitis. Serological survey of 85 patients with acute hepatitis following blood transfusion]

In a serological survey of 85 adult patients hospitalized for an episode of transfusion-associated hepatitis, 45 were reactive for hepatitis B surface antigen and therefore diagnosed as having hepatitis B. Forty HBsAg non reactive patients were examined for development of antibody to hepatitis A and B antigens, cytomegalovirus and Epstein-Barr virus. Three patients showed serologic evidence of hepatitis B and one for hepatitis A. None of the remaining 36 subjects developed serologic evidence of acute infection with the viruses tested during the study period, so that they were classified as having so-called NANB hepatitis. As reported in other studies, analysis of the incubation period showed that two subgroups of NANB hepatitis may be identified with short and long incubation period, so that it appears likely that at least two agents are implicated in NANB hepatitis. Our data confirm that also in our area a large proportion of transfusion-associated hepatitis is related to NANB agent(s) requiring additional measures for its prevention.

[Role of chronic HBsAg carriers in intrafamilial diffusion of hepatitis B virus infection]

To assess the hepatitis B virus infection risk to household contacts exposed to HBsAg-positive chronic carriers, 169 family members of 20 healthy carriers of HBsAg and of 12 with chronic hepatitis were followed up prospectively for two to five years. All family members are investigated for the presence of serum HBsAg/antiHBs system and for the presence of liver disease. Our results indicate that the family contacts of HBsAg carriers with evidence of chronic liver disease are at greater risk of exposure to HBV than the contacts of healthy carriers and that acquisition of HBsAg is more common among males than among females. Evidence of exposure to HBsAg is very frequent in young age with a striking rise between 10 and 20 years. On the contrary acquisition of anti-HBsAg is more common after 40 years of age. These data suggest that persistent circulation of HBV in a family of chronic HBsAg carrier increases the risk of infection in household contacts and that HBV is eliminated in a more infective form from the carriers with chronic liver disease.

[Epidemiologic study of chronic hepatitis in relation to heptatis B virus infections (author's transl)]

In order to evaluate the role of hepatitis B virus (HBV) in the etiology of chronic liver diseases, paired sera of 143 patients with biopsy-documented chronic hepatitis were tested for HBsAg and anti-HBs by radioimmunoassay method. HBsAg was detected in 67.3% of patients with a preceding verified eipsode of acute hepatitis, and in 26.7% of patients with a cryptogenic form of chronic hepatitis. HBsAg was not found in any of patients with alcoholic chronic hepatitis and in only two of 18 patients with other forms of chronic liver disease. No significant difference in the incidence of anti-HBs was observed in all groups of patients. According to previous studies our results confirm the higher prevalence of HBV infection in etiology of chronic persistent and aggressive hepatitis and indicate that this prevalence may be observed especially in Middle and South Italy. The presence of HBsAg in the serum of 37.2% of our patients with cirrhosis compared with 9% of reported cases in North Italy suggest that HBV plays an important role in the etiology of cirrhosis of the liver in our area.