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Bolamperti S, Saito H, Heerdmann S, Hesse E, Taipaleenmäki H. Tgif1-deficiency impairs cytoskeletal architecture in osteoblasts by activating PAK3 signaling. eLife 2024; 13:RP94265. [PMID: 38661167 PMCID: PMC11045221 DOI: 10.7554/elife.94265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Osteoblast adherence to bone surfaces is important for remodeling bone tissue. This study demonstrates that deficiency of TG-interacting factor 1 (Tgif1) in osteoblasts results in altered cell morphology, reduced adherence to collagen type I-coated surfaces, and impaired migration capacity. Tgif1 is essential for osteoblasts to adapt a regular cell morphology and to efficiently adhere and migrate on collagen type I-rich matrices in vitro. Furthermore, Tgif1 acts as a transcriptional repressor of p21-activated kinase 3 (Pak3), an important regulator of focal adhesion formation and osteoblast spreading. Absence of Tgif1 leads to increased Pak3 expression, which impairs osteoblast spreading. Additionally, Tgif1 is implicated in osteoblast recruitment and activation of bone surfaces in the context of bone regeneration and in response to parathyroid hormone 1-34 (PTH 1-34) treatment in vivo in mice. These findings provide important novel insights in the regulation of the cytoskeletal architecture of osteoblasts.
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Affiliation(s)
- Simona Bolamperti
- Molecular Skeletal Biology Laboratory, Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Hiroaki Saito
- Molecular Skeletal Biology Laboratory, Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-EppendorfHamburgGermany
- Institute of Musculoskeletal Medicine, LMU University Hospital, LMU MunichMunichGermany
- Musculoskeletal University Center Munich, LMU University Hospital, LMU MunichMunichGermany
| | - Sarah Heerdmann
- Molecular Skeletal Biology Laboratory, Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Eric Hesse
- Molecular Skeletal Biology Laboratory, Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-EppendorfHamburgGermany
- Institute of Musculoskeletal Medicine, LMU University Hospital, LMU MunichMunichGermany
- Musculoskeletal University Center Munich, LMU University Hospital, LMU MunichMunichGermany
| | - Hanna Taipaleenmäki
- Molecular Skeletal Biology Laboratory, Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-EppendorfHamburgGermany
- Institute of Musculoskeletal Medicine, LMU University Hospital, LMU MunichMunichGermany
- Musculoskeletal University Center Munich, LMU University Hospital, LMU MunichMunichGermany
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Kalmet P, Maduro C, Verstappen C, Meys G, van Horn Y, van Vugt R, Janzing H, van der Veen A, Jaspars C, Sintenie JB, Blokhuis T, Evers S, Seelen H, Brink P, Poeze M. Effectiveness of permissive weight bearing in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities: a prospective comparative multicenter cohort study. Eur J Orthop Surg Traumatol 2024; 34:1363-1371. [PMID: 38159217 PMCID: PMC10980603 DOI: 10.1007/s00590-023-03806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The aim of the present study was to investigate the effectiveness of a novel approach involving permissive weight bearing (PWB) in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. METHODS Prospective comparative multicenter cohort study in one level 1 trauma center and five level 2 trauma centers. Surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities were included. Permissive weight bearing (PWB) in comparison to restricted weight bearing (RWB) was assessed over a 26-week post-surgery follow-up period. Patients' self-perceived outcome levels regarding activities of daily living (ADL), quality of life (QoL), pain and weight bearing compliance were used. RESULTS This study included 106 trauma patients (N = 53 in both the PWB and RWB groups). Significantly better ADL and QoL were found in the PWB group compared to the RWB group at 2-, 6-, 12- and 26-weeks post-surgery. There were no significant differences in postoperative complication rates between the PWB and RWB groups. CONCLUSION PWB is effective and is associated with a significantly reduced time to full weight bearing, and a significantly better outcome regarding ADL and QoL compared to patients who followed RWB regimen. Moreover, no significant differences in complication rates were found between the PWB and RWB groups. LEVEL OF EVIDENCE Level II. REGISTRATION This study is registered in the Dutch Trial Register (NTR6077). Date of registration: 01-09-2016.
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Affiliation(s)
- Pishtiwan Kalmet
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cherelle Maduro
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen Verstappen
- Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Guido Meys
- Adelante Rehabilitation Center, Hoensbroek, The Netherlands
| | | | | | | | | | - Coen Jaspars
- Maxima Medical Center, Veldhoven, The Netherlands
| | | | - Taco Blokhuis
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Silvia Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henk Seelen
- Adelante Rehabilitation Center, Hoensbroek, The Netherlands
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Peter Brink
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Martijn Poeze
- Maastricht University Medical Center+, Maastricht, The Netherlands
- Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
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Kammerer A, Hartmann FA, Nau C, Leiblein M, Schaible A, Neijhoft J, Henrich D, Verboket R, Janko M. The Impact of Defect Size on Bone Healing in Critical-Size Bone Defects Investigated on a Rat Femur Defect Model Comparing Two Treatment Methods. Bioengineering (Basel) 2024; 11:287. [PMID: 38534561 DOI: 10.3390/bioengineering11030287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Critical-size bone defects up to 25 cm can be treated successfully using the induced membrane technique established by Masquelet. To shorten this procedure, human acellular dermis (HAD) has had success in replacing this membrane in rat models. The aim of this study was to compare bone healing for smaller and larger defects using an induced membrane and HAD in a rat model. Using our established femoral defect model in rats, the animals were placed into four groups and defects of 5 mm or 10 mm size were set, either filling them with autologous spongiosa and surrounding the defect with HAD or waiting for the induced membrane to form around a cement spacer and filling this cavity in a second operation with a cancellous bone graft. Healing was assessed eight weeks after the operation using µ-CT, histological staining, and an assessment of the progress of bone formation using an established bone healing score. The α-smooth muscle actin used as a signal of blood vessel formation was stained and counted. The 5 mm defects showed significantly better bone union and a higher bone healing score than the 10 mm defects. HAD being used for the smaller defects resulted in a significantly higher bone healing score even than for the induced membrane and significantly higher blood vessel formation, corroborating the good results achieved by using HAD in previous studies. In comparison, same-sized groups showed significant differences in bone healing as well as blood vessel formation, suggesting that 5 mm defects are large enough to show different results in healing depending on treatment; therefore, 5 mm is a viable size for further studies on bone healing.
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Affiliation(s)
- Andreas Kammerer
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Frederik Alexander Hartmann
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Christoph Nau
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Maximilian Leiblein
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Alexander Schaible
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Jonas Neijhoft
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - René Verboket
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Maren Janko
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
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Ma J, Eglauf J, Grad S, Alini M, Serra T. Engineering Sensory Ganglion Multicellular System to Model Tissue Nerve Ingrowth. Adv Sci (Weinh) 2024; 11:e2308478. [PMID: 38113315 PMCID: PMC10953573 DOI: 10.1002/advs.202308478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Indexed: 12/21/2023]
Abstract
Discogenic pain is associated with deep nerve ingrowth in annulus fibrosus tissue (AF) of intervertebral disc (IVD). To model AF nerve ingrowth, primary bovine dorsal root ganglion (DRG) micro-scale tissue units are spatially organised around an AF explant by mild hydrodynamic forces within a collagen matrix. This results in a densely packed multicellular system mimicking the native DRG tissue morphology and a controlled AF-neuron distance. Such a multicellular organisation is essential to evolve populational-level cellular functions and in vivo-like morphologies. Pro-inflammatory cytokine-primed AF demonstrates its neurotrophic and neurotropic effects on nociceptor axons. Both effects are dependent on the AF-neuron distance underpinning the role of recapitulating inter-tissue/organ anatomical proximity when investigating their crosstalk. This is the first in vitro model studying AF nerve ingrowth by engineering mature and large animal tissues in a morphologically and physiologically relevant environment. The new approach can be used to biofabricate multi-tissue/organ models for untangling pathophysiological conditions and develop novel therapies.
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Affiliation(s)
- Junxuan Ma
- AO Research InstituteClavadelerstrasse 8Davos7270Switzerland
| | - Janick Eglauf
- AO Research InstituteClavadelerstrasse 8Davos7270Switzerland
- ETH ZürichRämistrasse 101Zürich8092Switzerland
| | - Sibylle Grad
- AO Research InstituteClavadelerstrasse 8Davos7270Switzerland
| | - Mauro Alini
- AO Research InstituteClavadelerstrasse 8Davos7270Switzerland
| | - Tiziano Serra
- AO Research InstituteClavadelerstrasse 8Davos7270Switzerland
- Complex Tissue Regeneration DepartmentMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht UniversityUniversiteitssingel 40Maastricht6229ETNetherlands
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Neckel N, Neckel PH, Hirt B, Doll C, Hofmann E, Nahles S, Heiland M, Kreutzer K, Koerdt S. A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection: a feasibility study. Surg Radiol Anat 2024; 46:341-352. [PMID: 38361154 PMCID: PMC10960749 DOI: 10.1007/s00276-024-03302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues. METHODS The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case. RESULTS Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan. CONCLUSION The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
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Affiliation(s)
- Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany.
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
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6
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Shimada M, Huang C, Yamakawa S, Fujie H, Murakami S, Kanno N, Hara Y. Biomechanical effects of cranial closing wedge osteotomy on joint stability in normal canine stifles: an ex vivo study. BMC Vet Res 2024; 20:72. [PMID: 38402170 PMCID: PMC10893735 DOI: 10.1186/s12917-024-03923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Cranial closing wedge osteotomy (CCWO) is a functional stabilisation technique for cranial cruciate ligament (CrCL) ruptures. This biomechanical study aimed to evaluate the influence of CCWO on the stability of the stifle joint. Eighteen Beagle stifle joints were divided into two groups: control and CCWO. The stifle joints were analyzed using a six-degree-of-freedom robotic joint biomechanical testing system. The joints were subjected to 30 N in the craniocaudal (CrCd) drawer and proximal compression tests and 1 Nm in the internal-external (IE) rotation test. Each test was performed with an extension position, 135°, and 120° of joint angle. RESULTS The stifle joints were tested while the CrCLs were intact and then transected. In the drawer test, the CCWO procedure, CrCL transection, and stifle joint flexion increased CrCd displacement. The CCWO procedure and CrCL transection showed an interaction effect. In the compression test, the CCWO procedure decreased and CrCL transection and stifle joint flexion increased displacement. In the IE rotation test, CCWO, CrCL transection, and stifle joint flexion increased the range of motion. CONCLUSIONS CCWO was expected to provide stability against compressive force but does not contribute to stability in the drawer or rotational tests. In the CCWO-treated stifle joint, instability during the drawer test worsened with CrCL transection. In other words, performing the CCWO procedure when the CrCL function is present is desirable for stabilizing the stifle joint.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan.
| | - Chenxu Huang
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Satoshi Yamakawa
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiromichi Fujie
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Sawako Murakami
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
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7
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Kumabe Y, Kalbas Y, Halvachizadeh S, Teuben M, Cesarovic N, Weisskopf M, Hülsmeier A, Hornemann T, Cinelli P, Pape HC, Pfeifer R. Occult hypoperfusion and changes of systemic lipid levels after severe trauma: an analysis in a standardized porcine polytrauma model. Eur J Trauma Emerg Surg 2024; 50:107-114. [PMID: 35819473 PMCID: PMC10924008 DOI: 10.1007/s00068-022-02039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Occult hypoperfusion describes the absence of sufficient microcirculation despite normal vital signs. It is known to be associated with prolonged elevation of serum lactate and later complications in severely injured patients. We hypothesized that changes in circulating lipids are related to responsiveness to resuscitation. The purpose of this study is investigating the relation between responsiveness to resuscitation and lipidomic course after poly trauma. METHODS Twenty-five male pigs were exposed a combined injury of blunt chest trauma, liver laceration, controlled haemorrhagic shock, and femoral shaft fracture. After 1 h, animals received resuscitation and fracture stabilization. Venous blood was taken regularly and 233 specific lipids were analysed. Animals were divided into two groups based on serum lactate level at the end point as an indicator of responsiveness to resuscitation (<2 mmol/L: responder group (R group), ≧2 mmol/L: occult hypoperfusion group (OH group)). RESULTS Eighteen animals met criteria for the R group, four animals for the OH group, and three animals died. Acylcarnitines showed a significant increase at 1 h compared to baseline in both groups. Six lipid subgroups showed a significant increase only in R group at 2 h. There was no significant change at other time points. CONCLUSIONS Six lipid groups increased significantly only in the R group at 2 h, which may support the idea that they could serve as potential biomarkers to help us to detect the presence of occult hypoperfusion and insufficient resuscitation. We feel that further study is required to confirm the role and mechanism of lipid changes after trauma.
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Affiliation(s)
- Yohei Kumabe
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Yannik Kalbas
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Nikola Cesarovic
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Miriam Weisskopf
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Andreas Hülsmeier
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
| | - Thorsten Hornemann
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
| | - Paolo Cinelli
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland.
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland.
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8
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Canseco JA, Paziuk T, Schroeder GD, Dvorak MF, Öner CF, Benneker LM, Vialle E, Rajasekaran S, El-Sharkawi M, Bransford RJ, Kanna RM, Holas M, Muijs S, Popescu EC, Dandurand C, Tee JW, Camino-Willhuber G, Aly MM, Joaquim AF, Keynan O, Chhabra HS, Bigdon S, Spiegl UJ, Schnake K, Vaccaro AR. Interobserver Reliability in the Classification of Thoracolumbar Fractures Using the AO Spine TL Injury Classification System Among 22 Clinical Experts in Spine Trauma Care. Global Spine J 2024; 14:17S-24S. [PMID: 38324600 PMCID: PMC10867533 DOI: 10.1177/21925682231202371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations. OBJECTIVES To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier. METHODS Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms. RESULTS Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = .466; 95% CI .458 - .474; P < .001) demonstrated moderate agreement. Similarly, the average intraclass correlation coefficient (ICC) amongst A3 and A4 injuries was excellent (ICC = .934; 95% CI .919 - .947; P < .001) and the ICC between individual measures was moderate (ICC = .403; 95% CI .351 - .461; P < .001). The overall agreement on the utilization of the M1 modifier amongst A3 and A4 injuries was fair (K = .161; 95% CI .151 - .171; P < .001). The ICC for PLC status in A3 and A4 injuries averaged across all measures was excellent (ICC = .936; 95% CI .922 - .949; P < .001). The M1 modifier suggests respondents are nearly 40% more confident that the PLC is injured amongst all injuries. The M1 modifier was employed at a higher frequency as injuries were classified higher in the classification system. CONCLUSIONS The reliability of surgeons differentiating between A3 and A4 injuries in the AOSpine TLICS is substantial and the utilization of the M1 modifier occurs more frequently with higher grades in the system.
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Affiliation(s)
- Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Cumhur F Öner
- University Medical Centers, Utrecht, the Netherlands
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Medical School, Assiut, Egypt
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | | | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Jin W Tee
- Department of Neurosurgery, National Trauma Research Institute (NTRI), The Alfred Hospital, Melbourne, VIC, Australia
| | - Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Andrei Fernandes Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Ory Keynan
- Rambam Health Care Campus, Haifa, Israel
| | | | - Sebastian Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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9
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Kohler FC, Hallbauer J, Herrmann L, Ullrich BW, Biedermann U, Wildemann B, Hofmann GO, Ramm R, Lenz M, Marintschev I, Schenk P. Standardized analysis of syndesmosis stability in ankle trauma with an innovative syndesmosis-test-tool: a biomechanical study. Sci Rep 2024; 14:1659. [PMID: 38238396 PMCID: PMC10796637 DOI: 10.1038/s41598-024-51872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100 N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0 mm depending on the instability, while the range was lower with the HT (1.1 to 2.3 mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2 mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.
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Affiliation(s)
- Felix Christian Kohler
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany.
| | - Jakob Hallbauer
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Lea Herrmann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Bernhard Wilhelm Ullrich
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Uta Biedermann
- Institute of Anatomy I, Jena University Hospital, Friedrich Schiller University Jena, 07743, Jena, Germany
| | - Britt Wildemann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Gunther Olaf Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Roland Ramm
- Fraunhofer Institute for Applied Optics and Precision Engineering (IOF), Albert-Einstein-Str. 7, 07745, Jena, Germany
| | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Ivan Marintschev
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
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10
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Marais LC, Hungerer S, Eckardt H, Zalavras C, Obremskey WT, Ramsden A, McNally MA, Morgenstern M, Metsemakers WJ. Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2024; 144:259-268. [PMID: 37921993 PMCID: PMC10774153 DOI: 10.1007/s00402-023-05073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice.Level of evidence Level V.
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Affiliation(s)
- Leonard C Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sven Hungerer
- Department of Joint Surgery and Arthroplasty, Trauma Center Murnau, Murnau Germany and Paracelsus Medical University (PMU) Salzburg, Salzburg, Austria
| | - Henrik Eckardt
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Charalampos Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex Ramsden
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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11
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Ristaniemi A, Šećerović A, Grad S, Ferguson SJ. A Novel Fiber-Reinforced Poroviscoelastic Bovine Intervertebral Disc Finite Element Model for Organ Culture Experiment Simulations. J Biomech Eng 2023; 145:121006. [PMID: 37773639 DOI: 10.1115/1.4063557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Abstract
Intervertebral disc (IVD) degeneration and methods for repair and regeneration have commonly been studied in organ cultures with animal IVDs under compressive loading. With the recent establishment of a novel multi-axial organ culture system, accurate predictions of the global and local mechanical response of the IVD are needed for control system development and to aid in experiment planning. This study aimed to establish a finite element model of bovine IVD capable of predicting IVD behavior at physiological and detrimental load levels. A finite element model was created based on the dimensions and shape of a typical bovine IVD used in the organ culture. The nucleus pulposus (NP) was modeled as a neo-Hookean poroelastic material and the annulus fibrosus (AF) as a fiber-reinforced poroviscoelastic material. The AF consisted of 10 lamella layers and the material properties were distributed in the radial direction. The model outcome was compared to a bovine IVD in a compressive stress-relaxation experiment. A parametric study was conducted to investigate the effect of different material parameters on the overall IVD response. The model was able to capture the equilibrium response and the relaxation response at physiological and higher strain levels. Permeability and elastic stiffness of the AF fiber network affected the overall response most prominently. The established model can be used to evaluate the response of the bovine IVD at strain levels typical for organ culture experiments, to define relevant boundaries for such studies, and to aid in the development and use of new multi-axial organ culture systems.
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Affiliation(s)
- Aapo Ristaniemi
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Amra Šećerović
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelerstrasse 8, Davos 7270, Switzerland
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zürich, Hönggerbergring 64, Zürich 8093, Switzerland
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12
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Roland M, Diebels S, Orth M, Pohlemann T, Bouillon B, Tjardes T. Reappraisal of clinical trauma trials: the critical impact of anthropometric parameters on fracture gap micro-mechanics-observations from a simulation-based study. Sci Rep 2023; 13:20450. [PMID: 37993727 PMCID: PMC10665421 DOI: 10.1038/s41598-023-47910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023] Open
Abstract
The evidence base of surgical fracture care is extremely sparse with only few sound RCTs available. It is hypothesized that anthropometric factors relevantly influence mechanical conditions in the fracture gap, thereby interfering with the mechanoinduction of fracture healing. Development of a finite element model of a tibia fracture, which is the basis of an in silico population (n = 300) by systematic variation of anthropometric parameters. Simulations of the stance phase and correlation between anthropometric parameters and the mechanical stimulus in the fracture gap. Analysis of the influence of anthropometric parameters on statistical dispersion between in silico trial cohorts with respect to the probability to generate two, with respect to anthropometric parameters statistically different trial cohorts, given the same power assumptions. The mechanical impact in the fracture gap correlates with anthropometric parameters; confirming the hypothesis that anthropometric factors are a relevant entity. On a cohort level simulation of a fracture trial showed that given an adequate power the principle of randomization successfully levels out the impact of anthropometric factors. From a clinical perspective these group sizes are difficult to achieve, especially when considering that the trials takes advantage of a "laboratory approach ", i.e. the fracture type has not been varied, such that in real world trials the cohort size have to be even larger to level out the different configurations of fractures gaps. Anthropometric parameters have a significant impact on the fracture gap mechanics. The cohort sizes necessary to level out this effect are difficult or unrealistic to achieve in RCTs, which is the reason for sparse evidence in orthotrauma. New approaches to clinical trials taking advantage of modelling and simulation techniques need to be developed and explored.
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Affiliation(s)
- Michael Roland
- Chair of Applied Mechanics, Saarland University, Campus A4 2, 1. OG, 66123, Saarbrücken, Germany.
| | - Stefan Diebels
- Chair of Applied Mechanics, Saarland University, Campus A4 2, 1. OG, 66123, Saarbrücken, Germany
| | - Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Bertil Bouillon
- Chair for Orthopedic Surgery, Trauma Surgery and Sportstraumatology, Department of Orthopedic Surgery, Trauma Surgery and Sportstraumatology, Cologne Merheim Medical Center, University Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Cologne, Germany
| | - Thorsten Tjardes
- Chair for Orthopedic Surgery, Trauma Surgery and Sportstraumatology, Department of Orthopedic Surgery, Trauma Surgery and Sportstraumatology, Cologne Merheim Medical Center, University Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Cologne, Germany
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13
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Pastor T, Zderic I, Drenchev L, Skulev HK, Berk T, Beeres FJP, Link BC, Gueorguiev B, Stoffel K, Knobe M. Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates? J Orthop Res 2023. [PMID: 37975265 DOI: 10.1002/jor.25730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Dual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. The aim of this study is to investigate the biomechanical competence of an augmented lateral locking compression plate distal femur (LCP-DF) using an additional straight versus a helically shaped medial LCP of the same length. Ten pairs of human cadaveric femora were instrumented with a lateral anatomical 15-hole LCP-DF. Following, they were pairwise instrumented with either an additional medial straight 14-hole LCP (group 1) or a 90°-helical shape LCP (group 2). All specimens were biomechanically tested under quasi-static and progressively increasing combined cyclic axial and torsional loading until failure. Initial interfragmentary axial displacement and flexion under static compression were significantly smaller in group 1 (0.11 ± 0.12 mm and 0.21 ± 0.10°) versus group 2 (0.31 ± 0.14 mm and 0.68 ± 0.16°), p ≤ 0.007. Initial varus deformation under static compression remained not significantly different between group 1 (0.57 ± 0.23°) and group 2 (0.75 ± 0.34°), p = 0.085. Flexion movements during dynamic loading were significantly bigger in group 2 (2.51 ± 0.54°) versus group 1 (1.63 ± 1.28°), p = 0.015; however, no significant differences were observed in terms of varus, internal rotation, and axial and shear displacements between the groups, p ≥ 0.204. Cycles to failure and load at failure were higher in group 2 (25,172 ± 6376 and 3017 ± 638 N) compared to group 1 (22,277 ± 4576 and 2728 ± 458 N) with no significant differences between them, p = 0.195. From a biomechanical perspective, helical double plating may be considered a useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Ludmil Drenchev
- Bulgarian Academy of Sciences, Institute of Metal Science "Acad. A. Balevski", Sofia, Bulgaria
| | - Hristo K Skulev
- Bulgarian Academy of Sciences, Institute of Metal Science "Acad. A. Balevski", Sofia, Bulgaria
| | - Till Berk
- AO Research Institute Davos, Davos, Switzerland
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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14
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Fan Y, To MKT, Yeung EHK, Kuang GM, Liang R, Cheung JPY. Electromyographic Discrepancy in Paravertebral Muscle Activity Predicts Early Curve Progression of Untreated Adolescent Idiopathic Scoliosis. Asian Spine J 2023; 17:922-932. [PMID: 37690987 PMCID: PMC10622813 DOI: 10.31616/asj.2023.0199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
STUDY DESIGN This study adopted a prospective cohort study design. PURPOSE This study aimed to examine electromyogram (EMG) discrepancy in paravertebral muscle activity and scoliosis progression, determine how vertebral morphology and EMG discrepancy evolve during scoliosis progression, and identify differences in EMG activity between individuals with and without adolescent idiopathic scoliosis (AIS). OVERVIEW OF LITERATURE Higher EMG activity is observed in the convex side of scoliotic curves, but not in populations without scoliosis, suggesting that higher EMG activity is a causative factor for curve progression. METHODS In this study, 267 matched pairs of AIS and controls were recruited. The participants underwent EMG measurements at their first presentation and did not receive any treatment for 6 months at which point they underwent EMG and radiographs. Early curve progression was defined as >5° in Cobb angle at 6 months. The root mean square of the EMG (rms-EMG) signal was recorded with the participants in sitting and back extension. The rms-EMG ratio at the upper end vertebrae, apical vertebrae (AV), and lower end vertebrae (LEV) of the major curve was calculated. RESULTS The rms-EMG ratio in the scoliosis cohort was high compared with that in the controls (sitting: 1.2±0.3 vs. 1.0±0.1, p<0.01; back extension: 1.1±0.2 vs. 1.0±0.1, p<0.01). An AV rms-EMG ratio in back extension, with a cutoff threshold of ≥1.5 in the major thoracic curve and ≥1.3 in the major lumbar curve, was a risk factor for early curve progression after 6 months without treatment (odds ratio, 4.1; 95% confidence interval, 2.8-5.9; p<0.01). Increases in side deviation (SD) (distance between the AV and the central sacral line) were related to a higher rms-EMG ratio in LEV of the major thoracic curve (baseline: rs=0.2, p=0.03; 6 months: rs=0.3, p<0.01). CONCLUSIONS An EMG discrepancy was detected in the scoliosis cohort, which was related to increases in SD in the major thoracic curve. The AV rms-EMG ratio in back extension was correlated with curve progression after 6 months of no treatment.
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Affiliation(s)
- Yunli Fan
- Department of Physiotherapy, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
China
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR,
China
| | - Michael Kai-Tsun To
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR,
China
- Department of Orthopaedics, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
China
| | - Eric Hiu Kwong Yeung
- Department of Physiotherapy, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
China
| | - Guan-Ming Kuang
- Department of Orthopaedics, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
China
| | - Ruixin Liang
- Laboratory for Artificial Intelligence in Design, Hong Kong SAR,
China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR,
China
- Department of Orthopaedics, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
China
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15
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Rothrock NE, Wilson SA, Heng M, Hodor A, Joeris A, Kaat AJ, McKelvey K, Schalet BD, Vrahas M. Using bookmarking methods with orthopedic clinicians and patients with fractures produces score interpretation labels for patient-reported outcome measures. Qual Life Res 2023; 32:2779-2787. [PMID: 37227662 PMCID: PMC10474193 DOI: 10.1007/s11136-023-03439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to determine the patient-reported outcome measure (PROM) score ranges associated with descriptive labels (i.e., within normal limits, mild, moderate, severe) by using bookmarking methods with orthopedic clinicians and patients who have experienced a bone fracture. STUDY DESIGN AND SETTING We created vignettes comprised of six items and responses from the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Function, Physical Function, and Pain Interference item banks reflecting different levels of severity. Two groups of patients with fractures (n = 11) and two groups of orthopedic clinicians (n = 16) reviewed the vignettes and assigned descriptive labels independently and then discussed as a group until reaching consensus via a videoconference platform. RESULTS PROMIS Physical Function and Pain Interference thresholds (T = 50, 40, 25/30 and T = 50/55, 60, 65/70, respectively) for patients with bone fractures were consistent with the results from other patient populations. Upper Extremity thresholds were about 10 points (1 SD) more severe (T = 40, 30, 25/20) compared to the other measures. Patient and clinician perspectives were similar. CONCLUSION Bookmarking methods generated meaningful score thresholds for PROMIS measures. These thresholds between severity categories varied by domain. Threshold values for severity represent important supplemental information to interpret PROMIS scores clinically.
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Affiliation(s)
- Nan E Rothrock
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA.
| | - Sandra A Wilson
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Marilyn Heng
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
- Orthopaedic Trauma Service, Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Aleksandra Hodor
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Alexander Joeris
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Aaron J Kaat
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Karma McKelvey
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin D Schalet
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Mark Vrahas
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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16
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Wilke H, Betz VM, Kienle A. Biomechanical in vitro evaluation of the kangaroo spine in comparison with human spinal data. J Anat 2023; 243:128-137. [PMID: 36929138 PMCID: PMC10273331 DOI: 10.1111/joa.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/12/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023] Open
Abstract
On the basis of the kangaroo's pseudo-biped locomotion and its upright position, it could be assumed that the kangaroo might be an interesting model for spine research and that it may serve as a reasonable surrogate model for biomechanical in vitro tests. The purpose of this in vitro study was to provide biomechanical properties of the kangaroo spine and compare them with human spinal data from the literature. In addition, references to already published kangaroo anatomical spinal parameters will be discussed. Thirteen kangaroo spines from C4 to S4 were sectioned into single-motion segments. The specimens were tested by a spine tester under pure moments. The range of motion and neutral zone of each segment were determined in flexion and extension, right and left lateral bending and left and right axial rotation. Overall, we found greater flexibility in the kangaroo spine compared to the human spine. Similarities were only found in the cervical, lower thoracic and lumbar spinal regions. The range of motion of the kangaroo and human spines displayed comparable trends in the cervical (C4-C7), lower thoracic and lumbar regions independent of the motion plane. In the upper and middle thoracic regions, the flexibility of the kangaroo spine was considerably larger. These results suggested that the kangaroo specimens could be considered to be a surrogate, but only in particular cases, for biomechanical in vitro tests.
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Affiliation(s)
- Hans‐Joachim Wilke
- Institute of Orthopaedic Research and BiomechanicsTrauma Research Centre Ulm, University of UlmUlmGermany
| | - Volker Michael Betz
- Institute of Orthopaedic Research and BiomechanicsTrauma Research Centre Ulm, University of UlmUlmGermany
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17
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Isenmann M, Stoddart MJ, Schmelzeisen R, Gross C, Della Bella E, Rothweiler RM. Basic Principles of RNA Interference: Nucleic Acid Types and In Vitro Intracellular Delivery Methods. Micromachines (Basel) 2023; 14:1321. [PMID: 37512632 PMCID: PMC10383872 DOI: 10.3390/mi14071321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Since its discovery in 1989, RNA interference (RNAi) has become a widely used tool for the in vitro downregulation of specific gene expression in molecular biological research. This basically involves a complementary RNA that binds a target sequence to affect its transcription or translation process. Currently, various small RNAs, such as small interfering RNA (siRNA), micro RNA (miRNA), small hairpin RNA (shRNA), and PIWI interacting RNA (piRNA), are available for application on in vitro cell culture, to regulate the cells' gene expression by mimicking the endogenous RNAi-machinery. In addition, several biochemical, physical, and viral methods have been established to deliver these RNAs into the cell or nucleus. Since each RNA and each delivery method entail different off-target effects, limitations, and compatibilities, it is crucial to understand their basic mode of action. This review is intended to provide an overview of different nucleic acids and delivery methods for planning, interpreting, and troubleshooting of RNAi experiments.
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Affiliation(s)
- Marie Isenmann
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Martin James Stoddart
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
| | - Elena Della Bella
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - René Marcel Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
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Troeltzsch M, Zeiter S, Arens D, Nehrbass D, Probst FA, Liokatis P, Ehrenfeld M, Otto S. Chronic Periodontal Infection and Not Iatrogenic Interference Is the Trigger of Medication-Related Osteonecrosis of the Jaw: Insights from a Large Animal Study (PerioBRONJ Pig Model). Medicina (Kaunas) 2023; 59:medicina59051000. [PMID: 37241232 DOI: 10.3390/medicina59051000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Antiresorptive drugs are widely used in osteology and oncology. An important adverse effect of these drugs is medication-induced osteonecrosis of the jaw (MRONJ). There is scientific uncertainty about the underlying pathomechanism of MRONJ. A promising theory suspects infectious stimuli and local acidification with adverse effects on osteoclastic activity as crucial steps of MRONJ etiology. Clinical evidence showing a direct association between MRONJ and oral infections, such as periodontitis, without preceding surgical interventions is limited. Large animal models investigating the relationship between periodontitis and MRONJ have not been implemented. It is unclear whether the presence of infectious processes without surgical manipulation can trigger MRONJ. The following research question was formulated: is there a link between chronic oral infectious processes (periodontitis) and the occurrence of MRONJ in the absence of oral surgical procedures? Materials and Methods: A minipig large animal model for bisphosphonate-related ONJ (BRONJ) using 16 Göttingen minipigs divided into 2 groups (intervention/control) was designed and implemented. The intervention group included animals receiving i.v. bisphosphonates (zoledronate, n = 8, 0.05 mg/kg/week: ZOL group). The control group received no antiresorptive drug (n = 8: NON-ZOL group). Periodontitis lesions were induced by established procedures after 3 months of pretreatment (for the maxilla: the creation of an artificial gingival crevice and placement of a periodontal silk suture; for the mandible: the placement of a periodontal silk suture only). The outcomes were evaluated clinically and radiologically for 3 months postoperatively. After euthanasia a detailed histological evaluation was performed. Results: Periodontitis lesions could be induced successfully in all animals (both ZOL and NON-ZOL animals). MRONJ lesions of various stages developed around all periodontitis induction sites in the ZOL animals. The presence of MRONJ and periodontitis was proven clinically, radiologically and histologically. Conclusions: The results of this study provide further evidence that the infectious processes without prior dentoalveolar surgical interventions can trigger MRONJ. Therefore, iatrogenic disruption of the oral mucosa cannot be the decisive step in the pathogenesis of MRONJ.
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Affiliation(s)
- Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstraße 2a, 80337 Munich, Germany
- Center for Oral, Maxillofacial and Facial Reconstructive Surgery, Maximilianstraße 5, 91522 Ansbach, Germany
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Daniel Arens
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Dirk Nehrbass
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstraße 2a, 80337 Munich, Germany
- MKG Probst, Sendlingerstraße 31, 80331 Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstraße 2a, 80337 Munich, Germany
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstraße 2a, 80337 Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstraße 2a, 80337 Munich, Germany
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Chen J, Cuevas P, Dworan J, Dawid I, Turkkahraman H, Tran K, Delgado-Calle J, Bellido T, Gorski J, Liu B, Brunski J, Helms J. Wnt/β-catenin Signaling Controls Maxillofacial Hyperostosis. J Dent Res 2022; 101:793-801. [PMID: 35114849 PMCID: PMC10850863 DOI: 10.1177/00220345211067705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The roles of Wnt/β-catenin signaling in regulating the morphology and microstructure of craniomaxillofacial (CMF) bones was explored using mice carrying a constitutively active form of β-catenin in activating Dmp1-expressing cells (e.g., daβcatOt mice). By postnatal day 24, daβcatOt mice exhibited midfacial truncations coupled with maxillary and mandibular hyperostosis that progressively worsened with age. Mechanistic insights into the basis for the hyperostotic facial phenotype were gained through molecular and cellular analyses, which revealed that constitutively activated β-catenin in Dmp1-expressing cells resulted in an increase in osteoblast number and an increased rate of mineral apposition. An increase in osteoblasts was accompanied by an increase in osteocytes, but they failed to mature. The resulting CMF bone matrix also had an abundance of osteoid, and in locations where compact lamellar bone typically forms, it was replaced by porous, woven bone. The hyperostotic facial phenotype was progressive. These findings identify for the first time a ligand-independent positive feedback loop whereby unrestrained Wnt/β-catenin signaling results in a CMF phenotype of progressive hyperostosis combined with architecturally abnormal, poorly mineralized matrix that is reminiscent of craniotubular disorders in humans.
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Affiliation(s)
- J. Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - P.L. Cuevas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J.S. Dworan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
- Medical University of Vienna, Department of Anatomy, Center for Anatomy and Cell Biology, Vienna, Austria
| | - I. Dawid
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - H. Turkkahraman
- Indiana University School of Dentistry, Department of Orthodontics & Oral Facial Genetics, Indianapolis, IN, USA
| | - K. Tran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J. Delgado-Calle
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - T. Bellido
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J.P. Gorski
- Department of Oral and Craniofacial Sciences, School of Dentistry, and Center of Excellence in Mineralized Tissue Research, University of Missouri–Kansas City, Kansas City, MO, USA
| | - B. Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J.B. Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J.A. Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
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Davies BM, Yanez Touzet A, Mowforth OD, Lee KS, Khan D, Furlan JC, Fehlings MG, Harrop JS, Zipser CM, Rodrigues-Pinto R, Milligan J, Sarewitz E, Curt A, Rahimi-Movaghar V, Aarabi B, Boerger TF, Tetreault L, Chen R, Guest JD, Kalsi-Ryan S, Sadler I, Widdop S, McNair AGK, Kwon BK, Kotter MRN. Development of a core measurement set for research in degenerative cervical myelopathy: a study protocol (AO Spine RECODE-DCM CMS). BMJ Open 2022; 12:e060436. [PMID: 35680260 PMCID: PMC9185555 DOI: 10.1136/bmjopen-2021-060436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Progress in degenerative cervical myelopathy (DCM) is hindered by inconsistent measurement and reporting. This impedes data aggregation and outcome comparison across studies. This limitation can be reversed by developing a core measurement set (CMS) for DCM research. Previously, the AO Spine Research Objectives and Common Data Elements for DCM (AO Spine RECODE-DCM) defined 'what' should be measured in DCM: the next step of this initiative is to determine 'how' to measure these features. This protocol outlines the steps necessary for the development of a CMS for DCM research and audit. METHODS AND ANALYSIS The CMS will be developed in accordance with the guidance developed by the Core Outcome Measures in Effectiveness Trials and the Consensus-based Standards for the selection of health Measurement Instruments. The process involves five phases. In phase 1, the steering committee agreed on the constructs to be measured by sourcing consensus definitions from patients, professionals and the literature. In phases 2 and 3, systematic reviews were conducted to identify tools for each construct and aggregate their evidence. Constructs with and without tools were identified, and scoping reviews were conducted for constructs without tools. Evidence on measurement properties, as well as on timing of assessments, are currently being aggregated. These will be presented in phase 4: a consensus meeting where a multi-disciplinary panel of experts will select the instruments that will form the CMS. Following selection, guidance on the implementation of the CMS will be developed and disseminated (phase 5). A preliminary CMS review scheduled at 4 years from release. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Cambridge (HBREC2019.14). Dissemination strategies will include peer-reviewed scientific publications; conference presentations; podcasts; the identification of AO Spine RECODE-DCM ambassadors; and engagement with relevant journals, funders and the DCM community.
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Affiliation(s)
- Benjamin M Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Oliver D Mowforth
- Department of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Danyal Khan
- Academic Neurosurgery Unit, University College London, London, UK
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - James S Harrop
- Thomas Jefferson University, Jefferson Health System, St Louis, Missouri, USA
| | | | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - James Milligan
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Armin Curt
- University Hospital Balgrist, Zürich, Switzerland
| | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran, Iran
| | - Bizhan Aarabi
- Division of Neurosurgery, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Timothy F Boerger
- Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Lindsay Tetreault
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University College Cork, Cork, Ireland
| | - Robert Chen
- Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - James D Guest
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | | | - Angus G K McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, Avon, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia, Canada
| | - Mark R N Kotter
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, Cambridge, UK
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Teuben MPJ, Pfeifer R, Horst K, Simon TP, Heeres M, Kalbas Y, Blokhuis T, Hildebrand F, Koenderman L, Pape HC, Leenen L. Standardized porcine unilateral femoral nailing is associated with changes in PMN activation status, rather than aberrant systemic PMN prevalence. Eur J Trauma Emerg Surg 2022; 48:1601-1611. [PMID: 34114052 PMCID: PMC9192391 DOI: 10.1007/s00068-021-01703-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/13/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE Intramedullary nailing (IMN) of fractures is associated with increased rates of inflammatory complications. The pathological mechanism underlying this phenomenon is unclear. However, polymorphonuclear granulocytes (PMNs) seem to play an important role. We hypothesized that a femur fracture and standardized IMN in pigs is associated with altered appearance of PMNs in circulation and enhanced activation status of these cells. METHODS A porcine model including a femur fracture and IMN was utilized. Animals were randomized for control [anesthesia + mechanical ventilation only (A/MV)] and intervention [A/MV and unilateral femur fracture (FF) + IMN] conditions. PMN numbers and responsiveness, integrin (CD11b), L-selectin (CD62L) and Fcγ-receptor (CD16 and CD32)-expression levels were measured by flowcytometry of blood samples. Animals were observed for 72 h. RESULTS Circulatory PMN numbers did not differ between groups. Early PMN-responsiveness was retained after insult. PMN-CD11b expression increased significantly upon insult and peaked after 24 h, whereas CD11b in control animals remained unaltered (P = 0.016). PMN-CD16 expression levels in the FF + IMN-group rose gradually over time and were significantly higher compared with control animals, after 48 h (P = 0.016) and 72 h (P = 0.032). PMN-CD62L and CD32 expression did not differ significantly between conditions. CONCLUSION This study reveals that a femur fracture and subsequent IMN in a controlled setting in pigs is associated with enhanced activation status of circulatory PMNs, preserved PMN-responsiveness and unaltered circulatory PMN-presence. Indicating that monotrauma plus IMN is a specific and substantial stimulus for the cellular immune system. Early alterations of circulatory PMN receptor expression dynamics may be predictive for the intensity of the post traumatic response.
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Affiliation(s)
- Michel Paul Johan Teuben
- Department of Traumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Laboratory for Translational Immunology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Roman Pfeifer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Klemens Horst
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive Care and Intermediate Care, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Marjolein Heeres
- Department of Traumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Laboratory for Translational Immunology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Yannik Kalbas
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Taco Blokhuis
- Department of Surgery, University Hospital Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Leo Koenderman
- Laboratory for Translational Immunology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Pulmonology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Luke Leenen
- Department of Traumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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22
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Abstract
Purpose of Review The objective of this review is to document the advances in non-ionising imaging alternatives to CT for the head and neck. Recent Findings The main alternative to CT for imaging bone of the head and neck region is MRI, particularly techniques which incorporate gradient echo imaging (Black Bone technique) and ultra-short or zero-echo time imaging. Since these techniques can provide high resolution isometric voxels, they can be used to provide multi-planar reformats and, following post processing, 3D reconstructed images of the craniofacial skeleton. As expected, the greatest advancements in recent years have been focused on enhanced image processing techniques and attempts to address the difficulties encountered at air-bone interfaces. Summary This article will review the imaging techniques and recent advancements which are bringing non-ionising alternatives to CT imaging of the bone of the head and neck region into the realm of routine clinical application.
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Affiliation(s)
- Karen A. Eley
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ UK
| | - Gaspar Delso
- MR Applications & Workflow, GE Healthcare, Barcelona, Spain
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23
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Yanez Touzet A, Bhatti A, Dohle E, Bhatti F, Lee KS, Furlan JC, Fehlings MG, Harrop JS, Zipser CM, Rodrigues-Pinto R, Milligan J, Sarewitz E, Curt A, Rahimi-Movaghar V, Aarabi B, Boerger TF, Tetreault L, Chen R, Guest JD, Kalsi-Ryan S, McNair AG, Kotter M, Davies B. Clinical outcome measures and their evidence base in degenerative cervical myelopathy: a systematic review to inform a core measurement set (AO Spine RECODE-DCM). BMJ Open 2022; 12:e057650. [PMID: 35046007 PMCID: PMC8772430 DOI: 10.1136/bmjopen-2021-057650] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research. DESIGN Systematic review DATA SOURCES: MEDLINE and EMBASE were searched through 4 August 2020. ELIGIBILITY CRITERIA Primary clinical research published in English and whose primary purpose was to evaluate the measurement properties or clinically important differences of instruments used in DCM. DATA EXTRACTION AND SYNTHESIS Psychometric properties and clinically important differences were both extracted from each study, assessed for risk of bias and presented in accordance with the Consensus-based Standards for the selection of health Measurement Instruments criteria. RESULTS Twenty-nine outcome instruments were identified from 52 studies published between 1999 and 2020. They measured neuromuscular function (16 instruments), life impact (five instruments), pain (five instruments) and radiological scoring (five instruments). No instrument had evaluations for all 10 measurement properties and <50% had assessments for all three domains (ie, reliability, validity and responsiveness). There was a paucity of high-quality evidence. Notably, there were no studies that reported on structural validity and no high-quality evidence that discussed content validity. In this context, we identified nine instruments that are interpretable by clinicians: the arm and neck pain scores; the 12-item and 36-item short form health surveys; the Japanese Orthopaedic Association (JOA) score, modified JOA and JOA Cervical Myelopathy Evaluation Questionnaire; the neck disability index; and the visual analogue scale for pain. These include six scores with barriers to application and one score with insufficient criterion and construct validity. CONCLUSIONS This review aggregates studies evaluating outcome measures used to assess patients with DCM. Overall, there is a need for a set of agreed tools to measure outcomes in DCM. These findings will be used to inform the development of a core measurement set as part of AO Spine RECODE-DCM.
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Affiliation(s)
- Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Manchester, UK
| | - Aniqah Bhatti
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Esmee Dohle
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Faheem Bhatti
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilita, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James S Harrop
- Thomas Jefferson University, Jefferson Health System, St Louis, Philadelphia, USA
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Bizhan Aarabi
- Division of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Tetreault
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - James D Guest
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Angus Gk McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, Avon, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Mark Kotter
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, Cambridge, UK
| | - Benjamin Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Stenger V, Zeiter S, Buchholz T, Arens D, Spadavecchia C, Schüpbach-Regula G, Rohrbach H. Is a Block of the Femoral and Sciatic Nerves an Alternative to Epidural Analgesia in Sheep Undergoing Orthopaedic Hind Limb Surgery? A Prospective, Randomized, Double Blinded Experimental Trial. Animals (Basel) 2021; 11:2567. [PMID: 34573533 PMCID: PMC8467810 DOI: 10.3390/ani11092567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
Peripheral nerve blocks are commonly used in human and veterinary medicine. The aim of the study was to compare the analgesic efficacy of a combined block of the femoral and sciatic nerves with an epidural injection of ropivacaine in experimental sheep undergoing orthopaedic hind limb surgery. Twenty-five sheep were assigned to two groups (peripheral nerve block; sciatic and femoral nerves (P); epidural analgesia (E)). In group P 10 mL ropivacaine 0.5% was injected around the sciatic and the femoral nerves under sonographic guidance and 10 mL NaCl 0.9% into the epidural space while in group E 10 mL ropivacaine 0.5% was injected into the epidural space and 10 mL NaCl 0.9% to the sciatic and the femoral nerves. During surgery, heart rate, respiratory rate and mean blood pressure were used as indicators of nociception. In the postoperative phase, nociception was evaluated every hour by use of a purposefully adapted pain score until the animal showed painful sensation at the surgical site. The mean duration of analgesia at the surgical wound was 6 h in group P and 8 h in group E. Mean time to standing was 4 h in group P and 7 h in group E. In conclusion time to standing was significantly shorter in group P while the duration of nociception was comparable in both groups. The peripheral nerve block can be used as an alternative to epidural analgesia in experimental sheep.
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Affiliation(s)
- Valentina Stenger
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Tim Buchholz
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Daniel Arens
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Claudia Spadavecchia
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
| | | | - Helene Rohrbach
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
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Monaco G, Ladner YD, El Haj AJ, Forsyth NR, Alini M, Stoddart MJ. Mesenchymal Stromal Cell Differentiation for Generating Cartilage and Bone-Like Tissues In Vitro. Cells 2021; 10:cells10082165. [PMID: 34440934 PMCID: PMC8391162 DOI: 10.3390/cells10082165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 01/22/2023] Open
Abstract
In the field of tissue engineering, progress has been made towards the development of new treatments for cartilage and bone defects. However, in vitro culture conditions for human bone marrow mesenchymal stromal cells (hBMSCs) have not yet been fully defined. To improve our understanding of cartilage and bone in vitro differentiation, we investigated the effect of culture conditions on hBMSC differentiation. We hypothesized that the use of two different culture media including specific growth factors, TGFβ1 or BMP2, as well as low (2% O2) or high (20% O2) oxygen tension, would improve the chondrogenic and osteogenic potential, respectively. Chondrogenic and osteogenic differentiation of hBMSCs isolated from multiple donors and expanded under the same conditions were directly compared. Chondrogenic groups showed a notable upregulation of chondrogenic markers compared with osteogenic groups. Greater sGAG production and deposition, and collagen type II and I accumulation occurred for chondrogenic groups. Chondrogenesis at 2% O2 significantly reduced ALP gene expression and reduced type I collagen deposition, producing a more stable and less hypertrophic chondrogenic phenotype. An O2 tension of 2% did not inhibit osteogenic differentiation at the protein level but reduced ALP and OC gene expression. An upregulation of ALP and OC occurred during osteogenesis in BMP2 containing media under 20% O2; BMP2 free osteogenic media downregulated ALP and also led to higher sGAG release. A higher mineralization was observed in the presence of BMP2 during osteogenesis. This study demonstrates how the modulation of O2 tension, combined with tissue-specific growth factors and media composition can be tailored in vitro to promote chondral or endochondral differentiation while using the same donor cell population.
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Affiliation(s)
- Graziana Monaco
- AO Research Institute Davos, Regenerative Orthopaedics Program, 7270 Davos Platz, Switzerland; (G.M.); (Y.D.L.); (M.A.)
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK;
| | - Yann D. Ladner
- AO Research Institute Davos, Regenerative Orthopaedics Program, 7270 Davos Platz, Switzerland; (G.M.); (Y.D.L.); (M.A.)
- Institute for Biomechanics, ETH Zurich, Lengghalde 5, CH-8008 Zurich, Switzerland
| | - Alicia J. El Haj
- Healthcare Technology Institute, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TT, UK;
| | - Nicholas R. Forsyth
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK;
| | - Mauro Alini
- AO Research Institute Davos, Regenerative Orthopaedics Program, 7270 Davos Platz, Switzerland; (G.M.); (Y.D.L.); (M.A.)
| | - Martin J. Stoddart
- AO Research Institute Davos, Regenerative Orthopaedics Program, 7270 Davos Platz, Switzerland; (G.M.); (Y.D.L.); (M.A.)
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK;
- Correspondence:
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Schade AT, Mbowuwa F, Chidothi P, MacPherson P, Graham SM, Martin C, Harrison WJ, Chokotho L. Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning. PLoS One 2021; 16:e0255052. [PMID: 34347803 PMCID: PMC8336825 DOI: 10.1371/journal.pone.0255052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements. OBJECTIVE To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings. DESIGN Multicentre prospective registry study. SETTING Two large referral centres and two district hospitals in Malawi. PARTICIPANTS All patients with a fracture (confirmed by radiographs)-including patients with multiple fractures-were eligible to be included in the registry. EXPOSURE All fractures that presented to two urban central and two rural district hospitals in Malawi over a 3.5-year period (September 2016 to March 2020). MAIN OUTCOME(S) AND MEASURE(S) Demographics, characteristics of injuries, and treatment outcomes were collected on all eligible participants. RESULTS Between September 2016 and March 2020, 23,734 patients were enrolled with a median age of 15 years (interquartile range: 10-35 years); 68.7% were male. The most common injuries were radius/ulna fractures (n = 8,682, 36.8%), tibia/fibula fractures (n = 4,036, 17.0%), humerus fractures (n = 3,527, 14.9%) and femoral fractures (n = 2,355, 9.9%). The majority of fractures (n = 21,729, 91.6%) were treated by orthopaedic clinical officers; 88% (20,885/2,849) of fractures were treated non-operatively, and 62.7% were treated and sent home on the same day. Open fractures (OR:53.19, CI:39.68-72.09), distal femoral fractures (OR:2.59, CI:1.78-3.78), patella (OR:10.31, CI:7.04-15.07), supracondylar humeral fractures (OR:3.10, CI:2.38-4.05), ankle fractures (OR:2.97, CI:2.26-3.92) and tibial plateau fractures (OR:2.08, CI:1.47-2.95) were more likely to be treated operatively compared to distal radius fractures. CONCLUSIONS AND RELEVANCE The current model of fracture care in Malawi is such that trained orthopaedic surgeons manage fractures operatively in urban referral centres whereas orthopaedic clinical officers mainly manage fractures non-operatively in both district and referral centres. We recommend that orthopaedic surgeons should supervise orthopaedic clinical officers to manage non operative injuries in central and district hospitals. There is need for further studies to assess the clinical and patient reported outcomes of these fracture cases, managed both operatively and non-operatively.
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Affiliation(s)
- Alexander Thomas Schade
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | | - Peter MacPherson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, Blantyre, United Kingdom
| | - Simon Matthew Graham
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom
| | | | - William James Harrison
- AO-Alliance Foundation, Blantyre, Malawi
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom
- Countess of Chester NHS Foundation Trust, Blantyre, Malawi
| | - Linda Chokotho
- AO-Alliance Foundation, Blantyre, Malawi
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
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Abstract
PURPOSE OF REVIEW Fracture fixation aims to provide stability and promote healing, but remains challenging in unstable and osteoporotic fractures with increased risk of construct failure and nonunion. The first part of this article reviews the clinical motivation behind finite element analysis of fracture fixation, its strengths and weaknesses, how models are developed and validated, and how outputs are typically interpreted. The second part reviews recent modeling studies of the femur and proximal humerus, areas with particular relevance to fragility fractures. RECENT FINDINGS There is some consensus in the literature around how certain modeling aspects are pragmatically formulated, including bone and implant geometries, meshing, material properties, interactions, and loads and boundary conditions. Studies most often focus on predicted implant stress, bone strain surrounding screws, or interfragmentary displacements. However, most models are not rigorously validated. With refined modeling methods, improved validation efforts, and large-scale systematic analyses, finite element analysis is poised to advance the understanding of fracture fixation failure, enable optimization of implant designs, and improve surgical guidance.
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Affiliation(s)
- Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA.
| | | | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Okesola B, Mendoza-Martinez AK, Cidonio G, Derkus B, Boccorh DK, Osuna de la Peña D, Elsharkawy S, Wu Y, Dawson JI, Wark AW, Knani D, Adams DJ, Oreffo ROC, Mata A. De Novo Design of Functional Coassembling Organic-Inorganic Hydrogels for Hierarchical Mineralization and Neovascularization. ACS Nano 2021; 15:11202-11217. [PMID: 34180656 PMCID: PMC8320236 DOI: 10.1021/acsnano.0c09814] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/27/2021] [Indexed: 05/05/2023]
Abstract
Synthetic nanostructured materials incorporating both organic and inorganic components offer a unique, powerful, and versatile class of materials for widespread applications due to the distinct, yet complementary, nature of the intrinsic properties of the different constituents. We report a supramolecular system based on synthetic nanoclay (Laponite, Lap) and peptide amphiphiles (PAs, PAH3) rationally designed to coassemble into nanostructured hydrogels with high structural integrity and a spectrum of bioactivities. Spectroscopic and scattering techniques and molecular dynamic simulation approaches were harnessed to confirm that PAH3 nanofibers electrostatically adsorbed and conformed to the surface of Lap nanodisks. Electron and atomic force microscopies also confirmed an increase in diameter and surface area of PAH3 nanofibers after coassembly with Lap. Dynamic oscillatory rheology revealed that the coassembled PAH3-Lap hydrogels displayed high stiffness and robust self-healing behavior while gas adsorption analysis confirmed a hierarchical and heterogeneous porosity. Furthermore, this distinctive structure within the three-dimensional (3D) matrix provided spatial confinement for the nucleation and hierarchical organization of high-aspect ratio hydroxyapatite nanorods into well-defined spherical clusters within the 3D matrix. Applicability of the organic-inorganic PAH3-Lap hydrogels was assessed in vitro using human bone marrow-derived stromal cells (hBMSCs) and ex vivo using a chick chorioallantoic membrane (CAM) assay. The results demonstrated that the organic-inorganic PAH3-Lap hydrogels promote human skeletal cell proliferation and, upon mineralization, integrate with the CAM, are infiltrated by blood vessels, stimulate extracellular matrix production, and facilitate extensive mineral deposition relative to the controls.
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Affiliation(s)
- Babatunde
O. Okesola
- Institute
of Bioengineering, Queen Mary University
of London, London E1 4NS, U.K.
- School
of Engineering and Materials Science, Queen
Mary University of London, London E1 4NS, U.K.
| | - Ana Karen Mendoza-Martinez
- Institute
of Bioengineering, Queen Mary University
of London, London E1 4NS, U.K.
- School
of Engineering and Materials Science, Queen
Mary University of London, London E1 4NS, U.K.
| | - Gianluca Cidonio
- Bone
and Joint Research Group, Centre for Human Development, Stem Cells
and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton SO16 6YD, U.K.
- Center
for Life Nano- & Neuro- Science (CL2NS), Fondazione Istituto Italiano di Tecnologia, 00161 Rome, Italy
| | - Burak Derkus
- Institute
of Bioengineering, Queen Mary University
of London, London E1 4NS, U.K.
- School
of Engineering and Materials Science, Queen
Mary University of London, London E1 4NS, U.K.
- Department
of Chemistry, Faculty of Science, Ankara
University, 06560 Ankara, Turkey
| | - Delali K. Boccorh
- Department
of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow G1 1RD, U.K.
| | - David Osuna de la Peña
- School
of Engineering and Materials Science, Queen
Mary University of London, London E1 4NS, U.K.
| | - Sherif Elsharkawy
- Centre for
Oral, Clinical, and Translational Sciences, Faculty of Dentistry,
Oral, and Craniofacial Sciences, King’s
College London, London SE1 1UL, U.K.
| | - Yuanhao Wu
- School
of Pharmacy, University of Nottingham, Nottingham NG7 2RD, U.K.
- Biodiscovery
Institute, University of Nottingham, Nottingham NG7 2RD, U.K.
| | - Jonathan I. Dawson
- Bone
and Joint Research Group, Centre for Human Development, Stem Cells
and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton SO16 6YD, U.K.
| | - Alastair W. Wark
- Department
of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow G1 1RD, U.K.
| | - Dafna Knani
- Department
of Biotechnology Engineering, ORT Braude
College, Karmiel 2161002, Israel
| | - Dave J. Adams
- School
of Chemistry, College of Science and Engineering, University of Glasgow, Glasgow G12 8QQ, U.K.
| | - Richard O. C. Oreffo
- Bone
and Joint Research Group, Centre for Human Development, Stem Cells
and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton SO16 6YD, U.K.
| | - Alvaro Mata
- Institute
of Bioengineering, Queen Mary University
of London, London E1 4NS, U.K.
- School
of Engineering and Materials Science, Queen
Mary University of London, London E1 4NS, U.K.
- School
of Pharmacy, University of Nottingham, Nottingham NG7 2RD, U.K.
- Biodiscovery
Institute, University of Nottingham, Nottingham NG7 2RD, U.K.
- Department
of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, U.K.
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Pearson NA, Tutton E, Joeris A, Gwilym S, Grant R, Keene DJ, Haywood KL. Co-producing a multi-stakeholder Core Outcome Set for distal Tibia and Ankle fractures (COSTA): a study protocol. Trials 2021; 22:443. [PMID: 34247628 PMCID: PMC8273034 DOI: 10.1186/s13063-021-05415-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ankle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome sets have been developed to address this issue and are available for several common fractures, including those of the hip, distal radius, and open tibial fractures. This protocol describes the process to co-produce-with patient partners and other key stakeholders-a multi-stakeholder derived Core Outcome Set for distal Tibia and Ankle fractures (COSTA). The scope of COSTA will be for clinical trials. METHODS The study will have five-stages which will include the following: (i) systematic reviews of existing qualitative studies and outcome reporting in randomised controlled trial studies to inform a developing list of potential outcome domains; (ii) qualitative interviews (including secondary data) and focus groups with patients and healthcare professionals to explore the impact of ankle fracture and the outcomes that really matter; (iii) generation of meaningful outcome statements with the study team, international advisory group and patient partners; (iv) a multi-round, international e-Delphi study to achieve consensus on the core domain set; and (v) an evidence-based consensus on a core measurement set will be achieved through a structured group consensus meeting, recommending best assessment approaches for each of the domains in the core domain set. DISCUSSION Development of COSTA will provide internationally endorsed outcome assessment guidance for clinical trials for distal tibia and ankle fractures. This will enhance comparative reviews of interventions, potentially reducing reporting bias and research waste.
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Affiliation(s)
- Nathan A. Pearson
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | | | - Stephen Gwilym
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Richard Grant
- National Institute for Health Research, Applied Research Collaboration, Coventry, UK
- Warwick Medical School, User Teaching and Research Action Partnership, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal sciences, Fragility Fracture Network, University of Oxford, Oxford, UK
| | - David J. Keene
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kirstie L. Haywood
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Blauth M, Joeris A, Rometsch E, Espinoza-Rebmann K, Wattanapanom P, Jarayabhand R, Poeze M, Wong MK, Kwek EBK, Hegeman JH, Perez-Uribarri C, Guerado E, Revak TJ, Zohner S, Joseph D, Gosch M. Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study. BMJ Open 2021; 11:e039960. [PMID: 33972329 PMCID: PMC8112430 DOI: 10.1136/bmjopen-2020-039960] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes. DESIGN Cohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year. SETTING International (six countries, three continents) multicentre study. PARTICIPANTS 281 patients aged ≥70 with operatively treated proximal femur fractures. INTERVENTIONS Treatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy. OUTCOME MEASURES Primary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life. RESULTS Patients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002). CONCLUSIONS Contrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02297581.
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Affiliation(s)
- Michael Blauth
- Formerly: Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
- Preclinical Clinical Medical, Depuy Synthes, Zuchwil, Switzerland
| | - Alexander Joeris
- AO Innovation Translation Center (AOITC), AO Foundation, Dübendorf, Switzerland
| | - Elke Rometsch
- AO Innovation Translation Center (AOITC), AO Foundation, Dübendorf, Switzerland
| | | | | | | | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Merng K Wong
- Orthopedic Surgery, Singapore General Hospital, Singapore
| | | | | | | | - Enrique Guerado
- Hospital Universitario Costa del Sol, Faculty of Medicine, University of Malaga, Marbella, Spain
| | - Thomas J Revak
- Department of Orthopaedic Surgery, Division of Orthopedic Trauma, Saint Louis University, Saint Louis, Missouri, USA
| | - Sebastian Zohner
- Klinik für Unfallchirurgie und Sporttraumatologie, Kepler Universitätsklinikum Med Campus III, Linz, Austria
| | - David Joseph
- Orthopedics, Elmhurst Hospital Center, Elmhurst, New York, USA
| | - Markus Gosch
- Paracelsus Medizinischen Privatuniversität für Geriatrie, Paracelsus Universitat Nurnberg, Nurnberg, Germany
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Della Bella E, Buetti-Dinh A, Licandro G, Ahmad P, Basoli V, Alini M, Stoddart MJ. Dexamethasone Induces Changes in Osteogenic Differentiation of Human Mesenchymal Stromal Cells via SOX9 and PPARG, but Not RUNX2. Int J Mol Sci 2021; 22:4785. [PMID: 33946412 PMCID: PMC8124248 DOI: 10.3390/ijms22094785] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 01/10/2023] Open
Abstract
Despite the huge body of research on osteogenic differentiation and bone tissue engineering, the translation potential of in vitro results still does not match the effort employed. One reason might be that the protocols used for in vitro research have inherent pitfalls. The synthetic glucocorticoid dexamethasone is commonly used in protocols for trilineage differentiation of human bone marrow mesenchymal stromal cells (hBMSCs). However, in the case of osteogenic commitment, dexamethasone has the main pitfall of inhibiting terminal osteoblast differentiation, and its pro-adipogenic effect is well known. In this work, we aimed to clarify the role of dexamethasone in the osteogenesis of hBMSCs, with a particular focus on off-target differentiation. The results showed that dexamethasone does induce osteogenic differentiation by inhibiting SOX9 expression, but not directly through RUNX2 upregulation as it is commonly thought. Rather, PPARG is concomitantly and strongly upregulated, leading to the formation of adipocyte-like cells within osteogenic cultures. Limiting the exposure to dexamethasone to the first week of differentiation did not affect the mineralization potential. Gene expression levels of RUNX2, SOX9, and PPARG were simulated using approximate Bayesian computation based on a simplified theoretical model, which was able to reproduce the observed experimental trends but with a different range of responses, indicating that other factors should be integrated to fully understand how dexamethasone influences cell fate. In summary, this work provides evidence that current in vitro differentiation protocols based on dexamethasone do not represent a good model, and further research is warranted in this field.
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Affiliation(s)
- Elena Della Bella
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (E.D.B.); (P.A.); (V.B.); (M.A.)
| | - Antoine Buetti-Dinh
- Laboratory of applied microbiology (LMA), Department of Environment, Constructions and Design (DACD), University of Applied Sciences of Southern Switzerland (SUPSI), 6500 Bellinzona, Switzerland;
- Swiss Institute of Bioinformatics, Quartier Sorge—Batiment Genopode, 1015 Lausanne, Switzerland
| | - Ginevra Licandro
- Dalle Molle Institute for Artificial Intelligence (IDSIA), University of Italian Switzerland (USI), 6928 Manno, Switzerland;
- University of Applied Science and Art of Southern Switzerland (SUPSI), 6928 Manno, Switzerland
| | - Paras Ahmad
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (E.D.B.); (P.A.); (V.B.); (M.A.)
| | - Valentina Basoli
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (E.D.B.); (P.A.); (V.B.); (M.A.)
| | - Mauro Alini
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (E.D.B.); (P.A.); (V.B.); (M.A.)
| | - Martin J. Stoddart
- AO Research Institute Davos, 7270 Davos Platz, Switzerland; (E.D.B.); (P.A.); (V.B.); (M.A.)
- Department of Orthopedics and Trauma Surgery, Medical Center—Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany
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Wangler S, Kamali A, Wapp C, Wuertz-Kozak K, Häckel S, Fortes C, Benneker LM, Haglund L, Richards RG, Alini M, Peroglio M, Grad S. Uncovering the secretome of mesenchymal stromal cells exposed to healthy, traumatic, and degenerative intervertebral discs: a proteomic analysis. Stem Cell Res Ther 2021; 12:11. [PMID: 33413584 PMCID: PMC7789679 DOI: 10.1186/s13287-020-02062-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mesenchymal stromal cells (MSCs) have been introduced as promising cell source for regenerative medicine. Besides their multilineage differentiation capacity, MSCs release a wide spectrum of bioactive factors. This secretome holds immunomodulatory and regenerative capacities. In intervertebral disc (IVD) cells, application of MSC secretome has been shown to decrease the apoptosis rate, induce proliferation, and promote production of extracellular matrix (ECM). For clinical translation of secretome-based treatment, characterization of the secretome composition is needed to better understand the induced biological processes and identify potentially effective secretomes. METHODS This study aimed to investigate the proteome released by bone marrow-derived MSCs following exposure to a healthy, traumatic, or degenerative human IVD environment by mass spectroscopy and quantitative immunoassay analyses. Exposure of MSCs to the proinflammatory stimulus interleukin 1β (IL-1β) was used as control. RESULTS Compared to MSC baseline secretome, there were 224 significantly up- or downregulated proteins following healthy, 179 following traumatic, 223 following degenerative IVD, and 160 proteins following IL-1β stimulus. Stimulation of MSCs with IVD conditioned media induced a more complex MSC secretome, involving more biological processes, compared to stimulation with IL-1β. The MSC response to stimulation with IVD conditioned medium was dependent on their pathological status. CONCLUSIONS The MSC secretome seemed to match the primary need of the IVD: homeostasis maintenance in the case of healthy IVDs, versus immunomodulation, adjustment of ECM synthesis and degradation disbalance, and ECM (re) organization in the case of traumatic and degenerative IVDs. These findings highlight the importance of cell preconditioning in the development of tailored secretome therapies. The secretome of human bone marrow-derived mesenchymal stromal cells (MSCs) stimulated with intervertebral disc (IVD) conditioned medium was analyzed by proteomic profiling. Depending on the pathological state of the IVD, the MSC secretome protein composition indicated immunomodulatory or anabolic activity of the secretome. These findings may have implications for tailored secretome therapy for the IVD and other tissues.
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Affiliation(s)
- Sebastian Wangler
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amir Kamali
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Christina Wapp
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Karin Wuertz-Kozak
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Biomedical Engineering, Rochester Institute of Technology (RIT), Rochester, NY, USA
- Schön Clinic Munich Harlaching, Spine Center, Academic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University Salzburg (Austria), Munich, Germany
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Lorin M Benneker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lisbet Haglund
- Department of Surgery, Division of Orthopaedics, Faculty of Medicine, McGill University, Montreal, Canada
| | - R Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Marianna Peroglio
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
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Monaco G, El Haj AJ, Alini M, Stoddart MJ. Ex Vivo Systems to Study Chondrogenic Differentiation and Cartilage Integration. J Funct Morphol Kinesiol 2021; 6:E6. [PMID: 33466400 PMCID: PMC7838775 DOI: 10.3390/jfmk6010006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022] Open
Abstract
Articular cartilage injury and repair is an issue of growing importance. Although common, defects of articular cartilage present a unique clinical challenge due to its poor self-healing capacity, which is largely due to its avascular nature. There is a critical need to better study and understand cellular healing mechanisms to achieve more effective therapies for cartilage regeneration. This article aims to describe the key features of cartilage which is being modelled using tissue engineered cartilage constructs and ex vivo systems. These models have been used to investigate chondrogenic differentiation and to study the mechanisms of cartilage integration into the surrounding tissue. The review highlights the key regeneration principles of articular cartilage repair in healthy and diseased joints. Using co-culture models and novel bioreactor designs, the basis of regeneration is aligned with recent efforts for optimal therapeutic interventions.
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Affiliation(s)
- Graziana Monaco
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland; (G.M.); (M.A.)
- School of Pharmacy & Bioengineering Research, University of Keele, Keele ST5 5BG, UK;
| | - Alicia J. El Haj
- School of Pharmacy & Bioengineering Research, University of Keele, Keele ST5 5BG, UK;
- Healthcare Technology Institute, Translational Medicine, School of Chemical Engineering, University of Birmingham, Birmingham B15 2TH, UK
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland; (G.M.); (M.A.)
| | - Martin J. Stoddart
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland; (G.M.); (M.A.)
- School of Pharmacy & Bioengineering Research, University of Keele, Keele ST5 5BG, UK;
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Barcik J, Ernst M, Dlaska CE, Drenchev L, Zeiter S, Epari DR, Windolf M. Programable Active Fixator System for Systematic In Vivo Investigation of Bone Healing Processes. Sensors (Basel) 2020; 21:E17. [PMID: 33375087 PMCID: PMC7792812 DOI: 10.3390/s21010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
This manuscript introduces a programable active bone fixator system that enables systematic investigation of bone healing processes in a sheep animal model. In contrast to previous systems, this solution combines the ability to precisely control the mechanical conditions acting within a fracture with continuous monitoring of the healing progression and autonomous operation of the system throughout the experiment. The active fixator system was implemented on a double osteotomy model that shields the experimental fracture from the influence of the animal's functional loading. A force sensor was integrated into the fixator to continuously measure stiffness of the repair tissue as an indicator for healing progression. A dedicated control unit was developed that allows programing of different loading protocols which are later executed autonomously by the active fixator. To verify the feasibility of the system, it was implanted in two sheep with different loading protocols, mimicking immediate and delayed weight-bearing, respectively. The implanted devices operated according to the programmed protocols and delivered seamless data over the whole course of the experiment. The in vivo trial confirmed the feasibility of the system. Hence, it can be applied in further preclinical studies to better understand the influence of mechanical conditions on fracture healing.
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Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Constantin E. Dlaska
- Orthopaedic Research Institute of Queensland, 7 Turner Street, Townsville, QLD 4812, Australia;
| | - Ludmil Drenchev
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, Shipchenski prohod 67, 1574 Sofia, Bulgaria;
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
| | - Devakara R. Epari
- Institute of Health and Biomedical Innovation, Queensland University of Technology, George Street 2, Brisbane City, QLD 4000, Australia;
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (M.E.); (S.Z.); (M.W.)
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Zhou L, Gjvm VO, Malda J, Stoddart MJ, Lai Y, Richards RG, Ki-Wai Ho K, Qin L. Innovative Tissue-Engineered Strategies for Osteochondral Defect Repair and Regeneration: Current Progress and Challenges. Adv Healthc Mater 2020; 9:e2001008. [PMID: 33103381 DOI: 10.1002/adhm.202001008] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/19/2020] [Indexed: 12/20/2022]
Abstract
Clinical treatments for the repair of osteochondral defects (OCD) are merely palliative, not completely curative, and thus enormously unfulfilled challenges. With the in-depth studies of biology, medicine, materials, and engineering technology, the conception of OCD repair and regeneration should be renewed. During the past decades, many innovative tissue-engineered approaches for repairing and regenerating damaged osteochondral units have been widely explored. Various scaffold-free and scaffold-based strategies, such as monophasic, biphasic, and currently fabricated multiphasic and gradient architectures have been proposed and evaluated. Meanwhile, progenitor cells and tissue-specific cells have also been intensively investigated in vivo as well as ex vivo. Concerning bioactive factors and drugs, they have been combined with scaffolds and/or living cells, and even released in a spatiotemporally controlled manner. Although tremendous progress has been achieved, further research and development (R&D) is needed to convert preclinical outcomes into clinical applications. Here, the osteochondral unit structure, its defect classifications, and diagnosis are summarized. Commonly used clinical reparative techniques, tissue-engineered strategies, emerging 3D-bioprinting technologies, and the status of their clinical applications are discussed. Existing challenges to translation are also discussed and potential solutions for future R&D directions are proposed.
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Affiliation(s)
- Liangbin Zhou
- Musculoskeletal Research Laboratory of Department of Orthopedics & Traumatology, and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, 999077, China
| | - Van Osch Gjvm
- Department of Orthopedics and Department of Otorhinolaryngology, Erasmus MC, University Medical Center, Rotterdam, 3000 CA, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, 2600 AA, The Netherlands
| | - Jos Malda
- Department of Orthopaedics of University Medical Center Utrecht, and Department of Clinical Sciences of Faculty of Veterinary Medicine, Utrecht University, Utrecht, 3584 CS, The Netherlands
| | - Martin J Stoddart
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, CH 7270, Switzerland
| | - Yuxiao Lai
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, 518000, China
| | - R Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, CH 7270, Switzerland
| | - Kevin Ki-Wai Ho
- Musculoskeletal Research Laboratory of Department of Orthopedics & Traumatology, and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, 999077, China
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopedics & Traumatology, and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, 999077, China
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, 518000, China
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Masters EA, de Mesy Bentley KL, Gill AL, Hao SP, Galloway CA, Salminen AT, Guy DR, McGrath JL, Awad HA, Gill SR, Schwarz EM. Identification of Penicillin Binding Protein 4 (PBP4) as a critical factor for Staphylococcus aureus bone invasion during osteomyelitis in mice. PLoS Pathog 2020; 16:e1008988. [PMID: 33091079 PMCID: PMC7608983 DOI: 10.1371/journal.ppat.1008988] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/03/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
Staphylococcus aureus infection of bone is challenging to treat because it colonizes the osteocyte lacuno-canalicular network (OLCN) of cortical bone. To elucidate factors involved in OLCN invasion and identify novel drug targets, we completed a hypothesis-driven screen of 24 S. aureus transposon insertion mutant strains for their ability to propagate through 0.5 μm-sized pores in the Microfluidic Silicon Membrane Canalicular Arrays (μSiM-CA), developed to model S. aureus invasion of the OLCN. This screen identified the uncanonical S. aureus transpeptidase, penicillin binding protein 4 (PBP4), as a necessary gene for S. aureus deformation and propagation through nanopores. In vivo studies revealed that Δpbp4 infected tibiae treated with vancomycin showed a significant 12-fold reduction in bacterial load compared to WT infected tibiae treated with vancomycin (p<0.05). Additionally, Δpbp4 infected tibiae displayed a remarkable decrease in pathogenic bone-loss at the implant site with and without vancomycin therapy. Most importantly, Δpbp4 S. aureus failed to invade and colonize the OLCN despite high bacterial loads on the implant and in adjacent tissues. Together, these results demonstrate that PBP4 is required for S. aureus colonization of the OLCN and suggest that inhibitors may be synergistic with standard of care antibiotics ineffective against bacteria within the OLCN. Staphylococcus aureus is the most prevalent pathogen in osteomyelitis, and its infection of bone is difficult to cure. S. aureus colonization of the osteocyte lacuno-canalicular network (OLCN) of cortical bone has been identified as a novel pathogenetic mechanism in chronic osteomyelitis. To elucidate factors involved in OLCN invasion, we conducted an in vitro genetic screen that identified pbp4 as a critical gene for S. aureus cell deformation and propagation through nanopores and demonstrated that PBP4 is critical for OLCN colonization in murine osteomyelitis. Thus, PBP4 inhibitors may be novel drugs to treat osteomyelitis in combination with standard of care antibiotics.
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Affiliation(s)
- Elysia A. Masters
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Karen L. de Mesy Bentley
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Ann Lindley Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Stephanie P. Hao
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Chad A. Galloway
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Alec T. Salminen
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Diamond R. Guy
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - James L. McGrath
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani A. Awad
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Steven R. Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
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Jahangir S, Eglin D, Pötter N, Khozaei Ravari M, Stoddart MJ, Samadikuchaksaraei A, Alini M, Baghaban Eslaminejad M, Safa M. Inhibition of hypertrophy and improving chondrocyte differentiation by MMP-13 inhibitor small molecule encapsulated in alginate-chondroitin sulfate-platelet lysate hydrogel. Stem Cell Res Ther 2020; 11:436. [PMID: 33036643 PMCID: PMC7545577 DOI: 10.1186/s13287-020-01930-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mesenchymal stem cells are a promising cell source for chondrogenic differentiation and have been widely used in several preclinical and clinical studies. However, they are prone to an unwanted differentiation process towards hypertrophy that limits their therapeutic efficacy. Matrix metallopeptidase 13 (MMP-13) is a well-known factor regulated during this undesirable event. MMP-13 is a collagen degrading enzyme, which is also highly expressed in the hypertrophic zone of the growth plate and in OA cartilage. Accordingly, we investigated the effect of MMP-13 inhibition on MSC hypertrophy. METHODS In this study, 5-bromoindole-2-carboxylic acid (BICA) was used as an inhibitory agent for MMP-13 expression. After identifying its optimal concentration, BICA was mixed into a hydrogel and the release rate was studied. To prepare the ideal hydrogel, chondroitin sulfate (CS) and platelet lysate (PL) were mixed with sodium alginate (Alg) at concentrations selected based on synergistic mechanical and rheometric properties. Then, four hydrogels were prepared by combining alginate (1.5%w/v) and/or CS (1%w/v) and/or PL (20%v/v). The chondrogenic potential and progression to hypertrophy of human bone marrow-derived mesenchymal stem cell (hBM-MSC)-loaded hydrogels were investigated under free swelling and mechanical loading conditions, in the presence and absence of BICA. RESULTS Viability of hBM-MSCs seeded in the four hydrogels was similar. qRT-PCR revealed that BICA could successfully inhibit MMP-13 expression, which led to an inhibition of Coll X and induction of Coll-II, in both free swelling and loading conditions. The GAG deposition was higher in the group combining BICA and mechanical stimulation. CONCLUSIONS It is concluded that BICA inhibition of MMP-13 reduces MSC hypertrophy during chondrogenesis.
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Affiliation(s)
- Shahrbanoo Jahangir
- Department of Tissue engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - David Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Naomi Pötter
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center Albert-Ludwigs University, Albert-Ludwigs University of Freiburg, Freiburg im Breisgau, Germany
| | - Mojtaba Khozaei Ravari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Martin J Stoddart
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center Albert-Ludwigs University, Albert-Ludwigs University of Freiburg, Freiburg im Breisgau, Germany
| | - Ali Samadikuchaksaraei
- Department of Tissue engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
| | - Mohammadreza Baghaban Eslaminejad
- Department of Stem Cells and Developmental Biology, Cell Science Research Center Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | - Majid Safa
- Department of Tissue engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J, Depypere M, Richards RG, Trampuz A, Verhofstad MHJ, Kates SL, Raschke M, McNally MA, Obremskey WT. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2020; 140:1013-1027. [PMID: 31659475 PMCID: PMC7351827 DOI: 10.1007/s00402-019-03287-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 12/15/2022]
Abstract
Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients' short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group.Level of evidence: Level V.
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Affiliation(s)
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Olivier Borens
- Orthopedic Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - Geertje A M Govaert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, USA
| | - Michael Raschke
- Department of Trauma Surgery, University Hospital of Münster, Münster, Germany
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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Agarwal-Harding KJ, Chokotho L, Young S, Mkandawire N, Chawinga M, Losina E, Katz JN. Assessing the capacity of Malawi's district and central hospitals to manage traumatic diaphyseal femoral fractures in adults. PLoS One 2019; 14:e0225254. [PMID: 31747420 PMCID: PMC6867700 DOI: 10.1371/journal.pone.0225254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/26/2019] [Indexed: 12/18/2022] Open
Abstract
Background The burden of musculoskeletal trauma is growing worldwide, disproportionately affecting low-income countries like Malawi. However, resources required to manage musculoskeletal trauma remain inadequate. A detailed understanding of the current capacity of Malawian public hospitals to manage musculoskeletal trauma is unknown and necessary for effective trauma system development planning. Methods We developed a list of infrastructure, manpower, and material resources used during treatment of adult femoral shaft fractures–a representative injury managed non-operatively and operatively in Malawi. We identified, by consensus of at least 7 out of 10 experts, which items were essential at district and central hospitals. We surveyed orthopaedic providers in person at all 25 district and 4 central hospitals in Malawi on the presence, availability, and reasons for unavailability of essential resources. We validated survey responses by performing simultaneous independent on-site assessments of 25% of the hospitals. Results No district or central hospital in Malawi had available all the essential resources to adequately manage femoral fractures. On average, district hospitals had 71% (range 41–90%) of essential resources, with at least 15 of 25 reporting unavailability of inpatient ward nurses, x-ray, external fixators, gauze and bandages, and walking assistive devices. District hospitals offered only non-operative treatment, though 24/25 reported barriers to performing skeletal traction. Central hospitals reported an average of 76% (71–85%) of essential resources, with at least 2 of 4 hospitals reporting unavailability of full blood count, inpatient hospital beds, a procedure room, an operating room, casualty/A&E department clinicians, orthopaedic clinicians, a circulating nurse, inpatient ward nurses, electrocardiograms, x-ray, suture, and walking assistive devices. All four central hospitals reported barriers to performing skeletal traction. Operative treatment of femur fracture with a reliable supply of implants was available at 3/4 hospitals, though 2/3 were dependent entirely on foreign donations. Conclusion We identified critical deficiencies in infrastructure, manpower, and essential resources at district and central hospitals in Malawi. Our findings provide evidence-based guidance on how to improve the musculoskeletal trauma system in Malawi, by identifying where and why essential resources were unavailable when needed.
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Affiliation(s)
- Kiran J. Agarwal-Harding
- Harvard Combined Orthopaedic Residency Program, Boston, MA, United States of America
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
| | - Linda Chokotho
- Department of Orthopedics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Sven Young
- Department of Orthopedics, Haukeland University Hospital, Bergen, Norway
- Department of Orthopedics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nyengo Mkandawire
- Department of Orthopedics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mabvuto Chawinga
- Department of Orthopedics, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi
| | - Elena Losina
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Jeffrey N. Katz
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, United States of America
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Teixeira JH, Silva AM, Almeida MI, Bessa-Gonçalves M, Cunha C, Barbosa MA, Santos SG. The Systemic Immune Response to Collagen-Induced Arthritis and the Impact of Bone Injury in Inflammatory Conditions. Int J Mol Sci 2019; 20:E5436. [PMID: 31683648 PMCID: PMC6862543 DOI: 10.3390/ijms20215436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic disease that affects the osteoarticular system, associated with bone fragility and increased risk of fractures. Herein, we aimed to characterize the systemic impact of the rat collagen-induced arthritis (CIA) model and explore its combination with femoral bone defect (FD). The impact of CIA on endogenous mesenchymal stem/stromal cells (MSC) was also investigated. CIA induction led to enlarged, more proliferative, spleen and draining lymph nodes, with altered proportion of lymphoid populations. Upon FD, CIA animals increased the systemic myeloid cell proportions, and their expression of co-stimulatory molecules CD40 and CD86. Screening plasma cytokine/chemokine levels showed increased tumor necrosis factor-α (TNF-α), Interleukin (IL)-17, IL-4, IL-5, and IL-12 in CIA, and IL-2 and IL-6 increased in CIA and CIA+FD, while Fractalkine and Leptin were decreased in both groups. CIA-derived MSC showed lower metabolic activity and proliferation, and significantly increased osteogenic and chondrogenic differentiation markers. Exposure of control-MSC to TNF-α partially mimicked the CIA-MSC phenotype in vitro. In conclusion, inflammatory conditions of CIA led to alterations in systemic immune cell proportions, circulating mediators, and in endogenous MSC. CIA animals respond to FD, and the combined model can be used to study the mechanisms of bone repair in inflammatory conditions.
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Affiliation(s)
- José H Teixeira
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
- Department of Molecular Biology, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
| | - Andreia M Silva
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
- Department of Molecular Biology, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
| | - Maria Inês Almeida
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
| | - Mafalda Bessa-Gonçalves
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
- Department of Molecular Biology, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
| | - Carla Cunha
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
| | - Mário A Barbosa
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
- Department of Molecular Biology, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
| | - Susana G Santos
- i3S-Instituto de Investigação e Inovação em Saúde and INEB-Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal.
- Department of Molecular Biology, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
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Ren X, Zhou Q, Foulad D, Tiffany AS, Dewey MJ, Bischoff D, Miller TA, Reid RR, He TC, Yamaguchi DT, Harley BAC, Lee JC. Osteoprotegerin reduces osteoclast resorption activity without affecting osteogenesis on nanoparticulate mineralized collagen scaffolds. Sci Adv 2019; 5:eaaw4991. [PMID: 31206025 PMCID: PMC6561746 DOI: 10.1126/sciadv.aaw4991] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/03/2019] [Indexed: 05/02/2023]
Abstract
The instructive capabilities of extracellular matrix-inspired materials for osteoprogenitor differentiation have sparked interest in understanding modulation of other cell types within the bone regenerative microenvironment. We previously demonstrated that nanoparticulate mineralized collagen glycosaminoglycan (MC-GAG) scaffolds efficiently induced osteoprogenitor differentiation and bone healing. In this work, we combined adenovirus-mediated delivery of osteoprotegerin (AdOPG), an endogenous anti-osteoclastogenic decoy receptor, in primary human mesenchymal stem cells (hMSCs) with MC-GAG to understand the role of osteoclast inactivation in augmentation of bone regeneration. Simultaneous differentiation of osteoprogenitors on MC-GAG and osteoclast progenitors resulted in bidirectional positive regulation. AdOPG expression did not affect osteogenic differentiation alone. In the presence of both cell types, AdOPG-transduced hMSCs on MC-GAG diminished osteoclast-mediated resorption in direct contact; however, osteoclast-mediated augmentation of osteogenic differentiation was unaffected. Thus, the combination of OPG with MC-GAG may represent a method for uncoupling osteogenic and osteoclastogenic differentiation to augment bone regeneration.
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Affiliation(s)
- Xiaoyan Ren
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
- UCLA Molecular Biology Institute, Los Angeles, CA 90095, USA
| | - Qi Zhou
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
- UCLA Molecular Biology Institute, Los Angeles, CA 90095, USA
| | - David Foulad
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
- UCLA Molecular Biology Institute, Los Angeles, CA 90095, USA
| | - Aleczandria S. Tiffany
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Marley J. Dewey
- Department of Materials Science and Engineering, Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - David Bischoff
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
| | - Timothy A. Miller
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
| | - Russell R. Reid
- Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Tong-Chuan He
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Dean T. Yamaguchi
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
| | - Brendan A. C. Harley
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, USA
- UCLA Molecular Biology Institute, Los Angeles, CA 90095, USA
- Corresponding author.
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Schulte FA, Christen P, Badilatti SD, Parkinson I, Khosla S, Goldhahn J, Müller R. Virtual supersampling as post-processing step preserves the trabecular bone morphometry in human peripheral quantitative computed tomography scans. PLoS One 2019; 14:e0212280. [PMID: 30759159 PMCID: PMC6373954 DOI: 10.1371/journal.pone.0212280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/30/2019] [Indexed: 11/19/2022] Open
Abstract
In the clinical field of diagnosis and monitoring of bone diseases, high-resolution peripheral quantitative computed tomography (HR-pQCT) is an important imaging modality. It provides a resolution where quantitative bone morphometry can be extracted in vivo on patients. It is known that HR-pQCT provides slight differences in morphometric indices compared to the current standard approach micro-computed tomography (micro-CT). The most obvious reason for this is the restriction of the radiation dose and with this a lower image resolution. With advances in micro-CT evaluation techniques such as patient-specific remodeling simulations or dynamic bone morphometry, a higher image resolution would potentially also allow the application of such novel evaluation techniques to clinical HR-pQCT measurements. Virtual supersampling as post-processing step was considered to increase the image resolution of HR-pQCT scans. The hypothesis was that this technique preserves the structural bone morphometry. Supersampling from 82 μm to virtual 41 μm by trilinear interpolation of the grayscale values of 42 human cadaveric forearms resulted in strong correlations of structural parameters (R2: 0.96–1.00). BV/TV was slightly overestimated (4.3%, R2: 1.00) compared to the HR-pQCT resolution. Tb.N was overestimated (7.47%; R2: 0.99) and Tb.Th was slightly underestimated (-4.20%; R2: 0.98). The technique was reproducible with PE%CV between 1.96% (SMI) and 7.88% (Conn.D). In a clinical setting with 205 human forearms with or without fracture measured at 82 μm resolution HR-pQCT, the technique was sensitive to changes between groups in all parameters (p < 0.05) except trabecular thickness. In conclusion, we demonstrated that supersampling preserves the bone morphometry from HR-pQCT scans and is reproducible and sensitive to changes between groups. Supersampling can be used to investigate on the resolution dependency of HR-pQCT images and gain more insight into this imaging modality.
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Affiliation(s)
| | | | | | - Ian Parkinson
- SA Pathology and University of Adelaide, Adelaide, Australia
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Jörg Goldhahn
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- * E-mail:
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Lina IA, Ishida W, Liauw JA, Lo SFL, Elder BD, Perdomo-Pantoja A, Theodros D, Witham TF, Holmes C. A mouse model for the study of transplanted bone marrow mesenchymal stem cell survival and proliferation in lumbar spinal fusion. Eur Spine J 2018; 28:710-718. [PMID: 30511246 DOI: 10.1007/s00586-018-5839-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/21/2018] [Accepted: 11/25/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Bone marrow aspirate has been successfully used alongside a variety of grafting materials to clinically augment spinal fusion. However, little is known about the fate of these transplanted cells. Herein, we develop a novel murine model for the in vivo monitoring of implanted bone marrow cells (BMCs) following spinal fusion. METHODS A clinical-grade scaffold was implanted into immune-intact mice undergoing spinal fusion with or without freshly isolated BMCs from either transgenic mice which constitutively express the firefly luciferase gene or syngeneic controls. The in vivo survival, distribution and proliferation of these luciferase-expressing cells was monitored via bioluminescence imaging over a period of 8 weeks and confirmed via immunohistochemistry. MicroCT imaging was performed 8 weeks to assess fusion. RESULTS Bioluminescence imaging indicated transplanted cell survival and proliferation over the first 2 weeks, followed by a decrease in cell numbers, with transplanted cell survival still evident at the end of the study. New bone formation and increased fusion mass volume were observed in mice implanted with cell-seeded scaffolds. CONCLUSIONS By enabling the tracking of transplanted bone marrow-derived cells during spinal fusion in vivo, this mouse model will be integral to developing a deeper understanding of the biological processes underlying spinal fusion in future studies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ioan A Lina
- Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Jason A Liauw
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Debebe Theodros
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 2M-51, Baltimore, MD, 21287, USA.
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Petrova D, Joeris A, Sánchez MJ, Salamanca-Fernández E, Garcia-Retamero R. How are risk ratios reported in orthopaedic surgery journals? A descriptive study of formats used to report absolute risks. BMJ Open 2018; 8:e025047. [PMID: 30478128 PMCID: PMC6254491 DOI: 10.1136/bmjopen-2018-025047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The numerical format in which risks are communicated can affect risk comprehension and perceptions of medical professionals. We investigated what numerical formats are used to report absolute risks in empirical articles, estimated the frequency of biasing formats and rated the quality of figures used to display the risks. DESIGN Descriptive study of reporting practices. METHOD We randomly sampled articles published in seven leading orthopaedic surgery journals during a period of 13 years. From these, we selected articles that reported group comparisons on a binary outcome (eg, revision rates in two groups) and recorded the numerical format used to communicate the absolute risks in the results section. The quality of figures was assessed according to published guidelines for transparent visual aids design. OUTCOME MEASURES Prevalence of information formats and quality of figures. RESULTS The final sample consisted of 507 articles, of which 14% reported level 1 evidence, 13% level 2 and 73% level 3 or lower. The majority of articles compared groups of different sizes (90%), reported both raw numbers and percentages (64%) and did not report the group sizes alongside (50%). Fifteen per cent of articles used two formats identified as biasing: only raw numbers (8%, '90 patients vs 100 patients') or raw numbers reported alongside different group sizes (7%, '90 out of 340 patients vs 100 out of 490 patients'). The prevalence of these formats decreased in more recent publications. Figures (n=79) had on average two faults that could distort comprehension, and the majority were rated as biasing. CONCLUSION Authors use a variety of formats to report absolute risks in scientific articles and are likely not aware of how some formats and graph design features can distort comprehension. Biases can be reduced if journals adopt guidelines for transparent risk communication but more research is needed into the effects of different formats.
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Affiliation(s)
- Dafina Petrova
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Duebendorf, Switzerland
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elena Salamanca-Fernández
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Rocio Garcia-Retamero
- Mind, Brain, and Behavior Reseach Center (CIMCYC), Department of Experimental Psychology, University of Granada, Granada, Spain
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
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Ker DFE, Wang D, Sharma R, Zhang B, Passarelli B, Neff N, Li C, Maloney W, Quake S, Yang YP. Identifying deer antler uhrf1 proliferation and s100a10 mineralization genes using comparative RNA-seq. Stem Cell Res Ther 2018; 9:292. [PMID: 30376879 PMCID: PMC6208050 DOI: 10.1186/s13287-018-1027-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/24/2018] [Accepted: 09/30/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Deer antlers are bony structures that re-grow at very high rates, making them an attractive model for studying rapid bone regeneration. METHODS To identify the genes that are involved in this fast pace of bone growth, an in vitro RNA-seq model that paralleled the sharp differences in bone growth between deer antlers and humans was established. Subsequently, RNA-seq (> 60 million reads per library) was used to compare transcriptomic profiles. Uniquely expressed deer antler proliferation as well as mineralization genes were identified via a combination of differential gene expression and subtraction analysis. Thereafter, the physiological relevance as well as contributions of these identified genes were determined by immunofluorescence, gene overexpression, and gene knockdown studies. RESULTS Cell characterization studies showed that in vitro-cultured deer antler-derived reserve mesenchyme (RM) cells exhibited high osteogenic capabilities and cell surface markers similar to in vivo counterparts. Under identical culture conditions, deer antler RM cells proliferated faster (8.6-11.7-fold increase in cell numbers) and exhibited increased osteogenic differentiation (17.4-fold increase in calcium mineralization) compared to human mesenchymal stem cells (hMSCs), paralleling in vivo conditions. Comparative RNA-seq identified 40 and 91 previously unknown and uniquely expressed fallow deer (FD) proliferation and mineralization genes, respectively, including uhrf1 and s100a10. Immunofluorescence studies showed that uhrf1 and s100a10 were expressed in regenerating deer antlers while gene overexpression and gene knockdown studies demonstrated the proliferation contributions of uhrf1 and mineralization capabilities of s100a10. CONCLUSION Using a simple, in vitro comparative RNA-seq approach, novel genes pertinent to fast bony antler regeneration were identified and their proliferative/osteogenic function was verified via gene overexpression, knockdown, and immunostaining. This combinatorial approach may be applicable to discover unique gene contributions between any two organisms for a given phenomenon-of-interest.
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Affiliation(s)
- Dai Fei Elmer Ker
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Dan Wang
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
- Department of Stomatology, Tenth People’s Hospital of Tongji University, 301 Yanchang Road, Shanghai, 200072 China
| | - Rashmi Sharma
- Department of Bioengineering, Stanford University, Shriram Center 443 Via Ortega, Stanford, CA 94305 USA
| | - Bin Zhang
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Ben Passarelli
- Scientific Computing Core, Calico Life Sciences LLC, 1170 Veterans Blvd., South San Francisco, CA 94080 USA
| | - Norma Neff
- Department of Bioengineering, Stanford University, Shriram Center 443 Via Ortega, Stanford, CA 94305 USA
| | - Chunyi Li
- State Key Lab for Molecular Biology of Special Economic Animals, 4899 Juye Street, Changchun, 130112 Jilin China
| | - William Maloney
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Stephen Quake
- Department of Bioengineering, Stanford University, Shriram Center 443 Via Ortega, Stanford, CA 94305 USA
- Department of Applied Physics, Stanford University, 348 Via Pueblo Mall, Stanford, CA 94305 USA
- Howard Hughes Medical Institute, 4000 Jones Bridge Road, Chevy Chase, MD 20815 USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
- Department of Bioengineering, Stanford University, Shriram Center 443 Via Ortega, Stanford, CA 94305 USA
- Department of Material Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, CA 94305 USA
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Gao L, Goebel LKH, Orth P, Cucchiarini M, Madry H. Subchondral drilling for articular cartilage repair: a systematic review of translational research. Dis Model Mech 2018; 11:dmm034280. [PMID: 29728409 PMCID: PMC6031351 DOI: 10.1242/dmm.034280] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/26/2018] [Indexed: 12/09/2022] Open
Abstract
Articular cartilage defects may initiate osteoarthritis. Subchondral drilling, a widely applied clinical technique to treat small cartilage defects, does not yield cartilage regeneration. Various translational studies aiming to improve the outcome of drilling have been performed; however, a robust systematic analysis of its translational evidence was still lacking. Here, we performed a systematic review of the outcome of subchondral drilling for knee cartilage repair in translational animal models. A total of 12 relevant publications studying 198 animals was identified, detailed study characteristics were extracted, and methodological quality and risk of bias were analyzed. Subchondral drilling led to improved repair outcome compared with defects that were untreated or treated with abrasion arthroplasty for cartilage repair in multiple translational models. Within the 12 studies, considerable subchondral bone changes were observed, including subchondral bone cysts and intralesional osteophytes. Furthermore, extensive alterations of the subchondral bone microarchitecture appeared in a temporal pattern in small and large animal models, together with specific topographic aspects of repair. Moreover, variable technical aspects directly affected the outcomes of osteochondral repair. The data from this systematic review indicate that subchondral drilling yields improved short-term structural articular cartilage repair compared with spontaneous repair in multiple small and large animal models. These results have important implications for future investigations aimed at an enhanced translation into clinical settings for the treatment of cartilage defects, highlighting the importance of considering specific aspects of modifiable variables such as improvements in the design and reporting of preclinical studies, together with the need to better understand the underlying mechanisms of cartilage repair following subchondral drilling.
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Affiliation(s)
- Liang Gao
- Center of Experimental Orthopedics, Saarland University, D-66421 Homburg, Germany
| | - Lars K H Goebel
- Center of Experimental Orthopedics, Saarland University, D-66421 Homburg, Germany
- Department of Orthopaedic Surgery, Saarland University Medical Center, D-66421 Homburg, Germany
| | - Patrick Orth
- Center of Experimental Orthopedics, Saarland University, D-66421 Homburg, Germany
- Department of Orthopaedic Surgery, Saarland University Medical Center, D-66421 Homburg, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopedics, Saarland University, D-66421 Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopedics, Saarland University, D-66421 Homburg, Germany
- Department of Orthopaedic Surgery, Saarland University Medical Center, D-66421 Homburg, Germany
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Joeris A, Knoll C, Kalampoki V, Blumenthal A, Gaskell G. Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons. BMJ Open 2018; 8:e020629. [PMID: 29895649 PMCID: PMC6009470 DOI: 10.1136/bmjopen-2017-020629] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs. DESIGN Online survey. PARTICIPANTS Surgeons who are members of the AO Foundation. MEASURES Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ2 tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage. RESULTS 1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine. CONCLUSIONS Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.
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Affiliation(s)
- Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Christian Knoll
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Andrea Blumenthal
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - George Gaskell
- Department of Methodology, London School of Economics, London, UK
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Joeris A, Hurtado-Chong A, Hess D, Kalampoki V, Blauth M. Evaluation of the geriatric co-management for patients with fragility fractures of the proximal femur (Geriatric Fracture Centre (GFC) concept): protocol for a prospective multicentre cohort study. BMJ Open 2017; 7:e014795. [PMID: 28706089 PMCID: PMC5734300 DOI: 10.1136/bmjopen-2016-014795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Treatment of fractures in the elderly population is a clinical challenge due partly to the presence of comorbidities. In a Geriatric Fracture Centre (GFC), patients are co-managed by a geriatrician in an attempt to improve clinical outcomes and reduce morbidity and mortality. Until now the beneficial effect of orthogeriatric co-management has not been definitively proven. The primary objective of this study is to determine the effect of GFC on predefined major adverse events related to a hip fracture compared to usual care centres (UCC). The secondary objectives include assessments in quality of life, patient-reported outcomes and cost-effectiveness. METHODS AND ANALYSIS Two hundred and sixty-six elderly patients diagnosedwith hip fracture and planned to be treated with osteosynthesis or endoprosthesis in either a GFC or UCC study site will be recruited, 133 per type of centre. All procedures and management will be done according to the site's standard of care. Study-related visits will be performed at the following time points: preoperative, intraoperative, discharge from the orthopaedic/trauma department, discharge to definite residential status, 12 weeks and 12 months postsurgery. Data collected include demographics, residential status, adverse events, patient-reported outcomes, fall history, costs and resources related to treatment. The risk of major adverse events at 12 months will be calculated for each centre type; patient-reported outcomes will be analysed by mixed effects regression models to estimate differences in mean scores between baseline and follow-ups whereas cost-effectiveness will be assessed using the incremental cost-effectiveness ratio. ETHICS AND DISSEMINATION Ethics approval for this study was granted from the local Ethics Committees or Institutional Review Board from each of the participating sites prior to patient enrolment. The results of this study will be published in peer-reviewed journals and presented at different conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02297581; pre-results.
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Affiliation(s)
- Alexander Joeris
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Anahí Hurtado-Chong
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Denise Hess
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Michael Blauth
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Abstract
INTRODUCTION A considerable number of clinical studies experience delays, which result in increased duration and costs. In multicentre studies, patient recruitment is among the leading causes of delays. Poor site selection can result in low recruitment and bad data quality. Site selection is therefore crucial for study quality and completion, but currently no specific guidelines are available. MATERIAL AND METHODS Selection of sites adequate to participate in a prospective multicentre cohort study was performed through an open call using a newly developed objective multistep approach. The method is based on use of a network, definition of objective criteria and a systematic screening process. ILLUSTRATIVE EXAMPLE OF THE METHOD AT WORK Out of 266 interested sites, 24 were shortlisted and finally 12 sites were selected to participate in the study. The steps in the process included an open call through a network, use of selection questionnaires tailored to the study, evaluation of responses using objective criteria and scripted telephone interviews. At each step, the number of candidate sites was quickly reduced leaving only the most promising candidates. Recruitment and quality of data went according to expectations in spite of the contracting problems faced with some sites. CONCLUSION The results of our first experience with a standardised and objective method of site selection are encouraging. The site selection method described here can serve as a guideline for other researchers performing multicentre studies. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02297581.
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Affiliation(s)
- Anahí Hurtado-Chong
- AOClinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Alexander Joeris
- AOClinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Denise Hess
- AOClinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland
| | - Michael Blauth
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Baron K, Neumayer B, Amerstorfer E, Scheurer E, Diwoky C, Stollberger R, Sprenger H, Weinberg AM. Time-Dependent Changes in T1 during Fracture Healing in Juvenile Rats: A Quantitative MR Approach. PLoS One 2016; 11:e0164284. [PMID: 27832068 PMCID: PMC5104481 DOI: 10.1371/journal.pone.0164284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023] Open
Abstract
Quantitative magnetic resonance imaging (qMRI) offers several advantages in imaging and determination of soft tissue alterations when compared to qualitative imaging techniques. Although applications in brain and muscle tissues are well studied, its suitability to quantify relaxation times of intact and injured bone tissue, especially in children, is widely unknown. The objective observation of a fracture including its age determination can become of legal interest in cases of child abuse or maltreatment. Therefore, the aim of this study is the determination of time dependent changes in intact and corresponding injured bones in immature rats via qMRI, to provide the basis for an objective and radiation-free approach for fracture dating. Thirty-five MR scans of 7 Sprague-Dawley rats (male, 4 weeks old, 100 ± 5 g) were acquired on a 3T MRI scanner (TimTrio, Siemens AG, Erlangen, Germany) after the surgical infliction of an epiphyseal fracture in the tibia. The images were taken at days 1, 3, 7, 14, 28, 42 and 82 post-surgery. A proton density-weighted and a T1-weighted 3D FLASH sequence were acquired to calculate the longitudinal relaxation time T1 of the fractured region and the surrounding tissues. The calculation of T1 in intact and injured bone resulted in a quantitative observation of bone development in intact juvenile tibiae as well as the bone healing process in the injured tibiae. In both areas, T1 decreased over time. To evaluate the differences in T1 behaviour between the intact and injured bone, the relative T1 values (bone-fracture) were calculated, showing clear detectable alterations of T1 after fracture occurrence. These results indicate that qMRI has a high potential not only for clinically relevant applications to detect growth defects or developmental alterations in juvenile bones, but also for forensically relevant applications such as the dating of fractures in cases of child abuse or maltreatment.
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Affiliation(s)
- Katharina Baron
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
- * E-mail:
| | - Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Eva Amerstorfer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Eva Scheurer
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- Institute of Forensic Medicine, University of Basel – Health Department Basel, Basel, Switzerland
| | - Clemens Diwoky
- Institute of Molecular Biosciences, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Hanna Sprenger
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Annelie M. Weinberg
- Department of Orthopedics and Orthopedic Surgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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