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Robles AS, Piple AS, DeSanto DJ, Lamb A, Gibbs SJ, Heckmann ND, Marecek GS. Standard versus low-dose computed tomography for assessment of acetabular fracture reduction using novel step and gap measurement technique. Eur J Orthop Surg Traumatol 2023; 33:3703-3709. [PMID: 37311829 PMCID: PMC10651530 DOI: 10.1007/s00590-023-03616-9] [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] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Quality of reduction is of paramount importance after acetabular fracture and is best assessed on computed tomography (CT). A recently proposed measurement technique for assessment of step and gap displacement is reproducible but has not been validated. The purpose of this study is to validate a well-established measurement technique against known displacements and to determine if it can be used with low dose CT. METHODS Posterior wall acetabular fractures were created in 8 cadaveric hips and fixed at known step and gap displacements. CT was performed at multiple radiation doses for each hip. Four surgeons measured step and gap displacement for each hip at all doses, and the measurements were compared to known values. RESULTS There were no significant differences in measurements across surgeons, and all measurements were found to have positive agreement. Measurement error < 1.5 mm was present in 58% of gap measurements and 46% of step measurements. Only for step measurements at a dose of 120 kVp did we observe a statistically significant measurement error. There was a significant difference in step measurements made by those with greater and those with fewer years in practice. CONCLUSION Our study suggests this technique is valid and accurate across all doses. This is important as it may reduce the amount of radiation exposure for patients with acetabular fractures.
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Affiliation(s)
- Abrianna S Robles
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Amit S Piple
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Donald J DeSanto
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ashley Lamb
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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2
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Elorza SP, O'Donnell E, Nedopil AJ, Howell SM, Hull ML. A new tibial insert design with ball-in-socket medial conformity and posterior cruciate ligament retention closely restores native knee tibial rotation after unrestricted kinematic alignment. J Exp Orthop 2023; 10:115. [PMID: 37964140 PMCID: PMC10646131 DOI: 10.1186/s40634-023-00671-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE In total knee arthroplasty (TKA) with posterior cruciate ligament (PCL) retention, the medial and lateral insert conformity that restores in vivo native (i.e., healthy) knee tibial rotation and high function without causing stiffness is unknown. The purpose was to determine whether a ball-in-socket (B-in-S) medially conforming (MC) and flat lateral insert implanted with unrestricted kinematic alignment (KA) TKA and PCL retention restores tibial rotation to native. METHODS One group of 25 patients underwent unrestricted KA TKA with manual instruments. Another group of 25 patients had native knees. Single-plane fluoroscopy imaged each knee while patients performed step-up and chair rise activities. Following 3D model-to-2D image registration, anterior-posterior (A-P) positions of the femoral condyles were determined. Changes in A-P positions with flexion were used to determine tibial rotation. RESULTS At maximum flexion, mean tibial rotations of KA TKA knees were comparable to native knees (Step up: 12.3° ± 4.4° vs. 13.1° ± 12.0°, p = 0.783; Chair Rise: 12.7° ± 6.2° vs. 12.6° ± 9.5º, p = 0.941). However, paths of rotation differed in that screw home motion was less evident in KA TKA knees. At 8 months follow-up, the median Forgotten Joint Score was 69 points (range 65 to 85), the median Oxford Knee Score was 43 points (range 40 to 46), and mean knee flexion was 127º ± 8°. CONCLUSIONS The ball-in-socket medial, flat lateral insert and PCL retention implanted with unrestricted KA TKA restored in vivo native knee tibial rotation at maximum flexion for each activity and high function without stiffness. Providing high A-P stability, this implant design might benefit patients desiring to return to demanding work and recreational activities. LEVEL OF EVIDENCE Therapeutic - Level II.
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Affiliation(s)
- Saúl Pacheco Elorza
- Department of Mechanical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Ed O'Donnell
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, 95817, USA
| | | | - Stephen M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Maury L Hull
- Department of Biomedical Engineering, Department of Mechanical Engineering, Department of Orthopaedic Surgery, University of California Davis, Davis, CA, 95616, USA.
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3
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Suematsu Y, Nagoshi N, Shinozaki M, Kase Y, Saijo Y, Hashimoto S, Shibata T, Kajikawa K, Kamata Y, Ozaki M, Yasutake K, Shindo T, Shibata S, Matsumoto M, Nakamura M, Okano H. Hepatocyte growth factor pretreatment boosts functional recovery after spinal cord injury through human iPSC-derived neural stem/progenitor cell transplantation. Inflamm Regen 2023; 43:50. [PMID: 37845736 PMCID: PMC10577910 DOI: 10.1186/s41232-023-00298-y] [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: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Human induced pluripotent stem cell-derived neural stem/progenitor cell (hiPSC-NS/PC)-based cell transplantation has emerged as a groundbreaking method for replacing damaged neural cells and stimulating functional recovery, but its efficacy is strongly influenced by the state of the injured spinal microenvironment. This study evaluates the impact of a dual therapeutic intervention utilizing hepatocyte growth factor (HGF) and hiPSC-NS/PC transplantation on motor function restoration following spinal cord injury (SCI). METHODS Severe contusive SCI was induced in immunocompromised rats, followed by continuous administration of recombinant human HGF protein into the subarachnoid space immediately after SCI for two weeks. Acute-phase histological and RNA sequencing analyses were conducted. Nine days after the injury, hiPSC-NS/PCs were transplanted into the lesion epicenter of the injured spinal cord, and the functional and histological outcomes were determined. RESULTS The acute-phase HGF-treated group exhibited vascularization, diverse anti-inflammatory effects, and activation of endogenous neural stem cells after SCI, which collectively contributed to tissue preservation. Following cell transplantation into a favorable environment, the transplanted NS/PCs survived well, facilitating remyelination and neuronal regeneration in host tissues. These comprehensive effects led to substantial enhancements in motor function in the dual-therapy group compared to the single-treatment groups. CONCLUSIONS We demonstrate that the combined therapeutic approach of HGF preconditioning and hiPSC-NS/PC transplantation enhances locomotor functional recovery post-SCI, highlighting a highly promising therapeutic strategy for acute to subacute SCI.
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Affiliation(s)
- Yu Suematsu
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Munehisa Shinozaki
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yoshitaka Kase
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Department of Clinical Regenerative Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutukake-Cho, Toyoake-Shi, Aichi, 470-1192, Japan
| | - Yusuke Saijo
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takahiro Shibata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keita Kajikawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuhiro Kamata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kaori Yasutake
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tomoko Shindo
- Electron Microscope Laboratory, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinsuke Shibata
- Electron Microscope Laboratory, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Division of Microscopic Anatomy, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata, Niigata, 951-8510, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
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Haonga BT, O'Marr JM, Ngunyale P, Ngahyoma J, Kessey J, Sasillo I, Rodarte P, Belaye T, Berhaneselase E, Eliezer E, Porco TC, Morshed S, Shearer DW. GO-Tibia: a masked, randomized control trial evaluating gentamicin versus saline in open tibia fractures. Trials 2023; 24:406. [PMID: 37322521 PMCID: PMC10268448 DOI: 10.1186/s13063-023-07410-0] [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: 04/05/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The rate of open tibia fractures is rapidly increasing across the globe due to a recent rise in road traffic accidents, predominantly in low- and low-middle-income countries. These injuries are orthopedic emergencies associated with infection rates as high as 40% despite the use of systemic antibiotics and surgical debridement. The use of local antibiotics has shown some promise in reducing the burden of infection in these injuries due to increasing local tissue availability; however, no trial has yet been appropriately powered to evaluate for definitive evidence and the majority of current studies have taken place in a high-resource countries where resources and the bio-burden may be different. METHODS This is a prospective randomized, masked, placebo-controlled superiority trial designed to evaluate the efficacy of locally administered gentamicin versus placebo in the prevention of fracture-related infection in adults (age > 18 years) with primarily closeable Gustillo-Anderson class I, II, and IIIA open tibia fractures. Eight hundred ninety patients will be randomized to receive an injection of either gentamicin (treatment group) or saline (control group) at the site of their primarily closed open fracture. The primary outcome will be the occurrence of a fracture-related infection occurring during the course of the 12-month follow-up. DISCUSSION This study will definitively assess the effectiveness of local gentamicin for the prevention of fracture-related infections in adults with open tibia fractures in Tanzania. The results of this study have the potential to demonstrate a low-cost, widely available intervention for the reduction of infection in open tibia fractures. TRIAL REGISTRATION Clinicaltrials.gov NCT05157126. Registered on December 14, 2021.
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Affiliation(s)
- Billy T Haonga
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Jamieson M O'Marr
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Patrick Ngunyale
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Joshua Ngahyoma
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Justin Kessey
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ibrahim Sasillo
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Patricia Rodarte
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Tigist Belaye
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Eleni Berhaneselase
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Edmund Eliezer
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Travis C Porco
- F.I. Proctor Foundation, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94122, USA
- Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA
| | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - David W Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
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5
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Huang DB, Brothers KM, Mandell JB, Taguchi M, Alexander PG, Parker DM, Shinabarger D, Pillar C, Morrissey I, Hawser S, Ghahramani P, Dobbins D, Pachuda N, Montelaro R, Steckbeck JD, Urish KL. Engineered peptide PLG0206 overcomes limitations of a challenging antimicrobial drug class. PLoS One 2022; 17:e0274815. [PMID: 36112657 PMCID: PMC9481017 DOI: 10.1371/journal.pone.0274815] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/01/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
The absence of novel antibiotics for drug-resistant and biofilm-associated infections is a global public health crisis. Antimicrobial peptides explored to address this need have encountered significant development challenges associated with size, toxicity, safety profile, and pharmacokinetics. We designed PLG0206, an engineered antimicrobial peptide, to address these limitations. PLG0206 has broad-spectrum activity against >1,200 multidrug-resistant (MDR) ESKAPEE clinical isolates, is rapidly bactericidal, and displays potent anti-biofilm activity against diverse MDR pathogens. PLG0206 displays activity in diverse animal infection models following both systemic (urinary tract infection) and local (prosthetic joint infection) administration. These findings support continuing clinical development of PLG0206 and validate use of rational design for peptide therapeutics to overcome limitations associated with difficult-to-drug pharmaceutical targets.
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Affiliation(s)
- David B. Huang
- Peptilogics, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (DBH); (KLU)
| | - Kimberly M. Brothers
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jonathan B. Mandell
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Masashi Taguchi
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan
| | - Peter G. Alexander
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Dana M. Parker
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | | - Chris Pillar
- Micromyx, Kalamazoo, Michigan, United States of America
| | | | | | | | - Despina Dobbins
- Peptilogics, Pittsburgh, Pennsylvania, United States of America
| | | | - Ronald Montelaro
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | | - Kenneth L. Urish
- Department of Orthopedic Surgery, Arthritis and Arthroplasty Design Group, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- The Bone and Joint Center, Magee Women’s Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (DBH); (KLU)
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6
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Glaeser JD, Ju D, Tawackoli W, Yang JH, Salehi K, Stefanovic T, Kanim LEA, Avalos P, Kaneda G, Stephan S, Metzger MF, Bae HW, Sheyn D. Advanced Glycation End Product Inhibitor Pyridoxamine Attenuates IVD Degeneration in Type 2 Diabetic Rats. Int J Mol Sci 2020; 21:E9709. [PMID: 33352698 PMCID: PMC7766438 DOI: 10.3390/ijms21249709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with advanced glycation end product (AGE) enrichment and considered a risk factor for intervertebral disc (IVD) degeneration. We hypothesized that systemic AGE inhibition, achieved using pyridoxamine (PM), attenuates IVD degeneration in T2DM rats. To induce IVD degeneration, lumbar disc injury or sham surgery was performed on Zucker Diabetic Sprague Dawley (ZDSD) or control Sprague Dawley (SD) rats. Post-surgery, IVD-injured ZDSD rats received daily PM dissolved in drinking water or water only. The resulting groups were SD uninjured, SD injured, ZDSD uninjured, ZDSD injured, and ZDSD injured + PM. Levels of blood glycation and disc degeneration were investigated. At week 8 post-surgery, glycated serum protein (GSP) levels were increased in ZDSDs compared to SDs. PM treatment attenuated this increase. Micro-MRI analysis demonstrated IVD dehydration in injured versus uninjured SDs and ZDSDs. In the ZDSD injured + PM group, IVD dehydration was diminished compared to ZDSD injured. AGE levels were decreased and aggrecan levels increased in ZDSD injured + PM versus ZDSD injured rats. Histological and immunohistochemical analyses further supported the beneficial effect of PM. In summary, PM attenuated GSP levels and IVD degeneration processes in ZDSD rats, demonstrating its potential to attenuate IVD degeneration in addition to managing glycemia in T2DM.
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Affiliation(s)
- Juliane D. Glaeser
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Derek Ju
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wafa Tawackoli
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jae H. Yang
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Korea University Guro Hospital, Seoul 08308, Korea
| | - Khosrowdad Salehi
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Tina Stefanovic
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Linda E. A. Kanim
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Pablo Avalos
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Giselle Kaneda
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Stephen Stephan
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Melodie F. Metzger
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- The Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Hyun W. Bae
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dmitriy Sheyn
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (J.D.G.); (D.J.); (W.T.); (J.H.Y.); (K.S.); (T.S.); (L.E.A.K.); (G.K.); (S.S.); (H.W.B.)
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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7
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Le Navéaux F, Larson AN, Labelle H, Aubin CE. Significant variability in surgeons' preferred correction maneuvers and instrumentation strategies when planning adolescent idiopathic scoliosis surgery. Scoliosis Spinal Disord 2018; 13:21. [PMID: 30324149 PMCID: PMC6174067 DOI: 10.1186/s13013-018-0169-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/21/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Increased implant number is thought to provide better control on the scoliotic spine, but there is limited scientific evidence of improved deformity correction and surgical outcomes with high-density constructs. The objective is to assess key anchor points used by experienced spinal deformity surgeons and to evaluate the effect of implant density pattern on correction techniques. METHODS Seventeen experienced spine surgeons reviewed five Lenke 1 adolescent idiopathic scoliosis cases and provided their preferred posterior correction technique (implant pattern, correction maneuvers, and implants used for their execution) and an alternative technique with the minimal implant density they felt would be acceptable (170 surgical plans total). Additionally, for each case, they selected acceptable screw patterns for surgery from seven published implant configurations. Variability in the surgeons' plans was assessed, including instrumentation and correction strategies. RESULTS The preferred correction plan involved an average of 1.65 implants/vertebra, with 88% of the available anchor points at the apex ± 1 vertebra used for the execution of correction maneuvers and only 43% of possible anchor points used proximal and distal to the apical area. The minimal density that surgeons found acceptable was 1.24 implants/vertebra. The minimal density plan involved more in situ rod contouring (53 vs. 41%), fewer vertebral derotation maneuvers (82 vs. 96%), and fewer implants used for compression/distraction maneuvers (1.18 and 1.42 respectively) (p < 0.05). Implant placement at alternate levels or dropout of convex implants above and below the apical area was most frequently considered acceptable (> 70% agreement). CONCLUSIONS Implant position and number affect surgeons correction maneuvers selection. For low implant density constructs, dropout in the convexity and particularly in the periapical region is accepted by surgeons, with minor influence on planned correction maneuvers. Thus, preoperative implant planning must take into account which anchor points are needed for desired correction maneuvers.
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Affiliation(s)
- Franck Le Navéaux
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
- Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC H3T 1C5 Canada
- Canada Research Chair in Orthopedic Engineering, and NSERC/Medtronic Industrial Research Chair in Spine Biomechanics, Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
| | | | - Hubert Labelle
- Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC H3T 1C5 Canada
| | - Carl-Eric Aubin
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
- Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC H3T 1C5 Canada
- Canada Research Chair in Orthopedic Engineering, and NSERC/Medtronic Industrial Research Chair in Spine Biomechanics, Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
| | - Minimize Implants Maximize Outcomes Study Group
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
- Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC H3T 1C5 Canada
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55902 USA
- Canada Research Chair in Orthopedic Engineering, and NSERC/Medtronic Industrial Research Chair in Spine Biomechanics, Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC H3C 3A7 Canada
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Gibbons MC, Fisch KM, Pichika R, Cheng T, Engler AJ, Schenk S, Lane JG, Singh A, Ward SR. Heterogeneous muscle gene expression patterns in patients with massive rotator cuff tears. PLoS One 2018; 13:e0190439. [PMID: 29293645 PMCID: PMC5749784 DOI: 10.1371/journal.pone.0190439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/28/2017] [Accepted: 12/14/2017] [Indexed: 01/26/2023] Open
Abstract
Detrimental changes in the composition and function of rotator cuff (RC) muscles are hallmarks of RC disease progression. Previous studies have demonstrated both atrophic and degenerative muscle loss in advanced RC disease. However, the relationship between gene expression and RC muscle pathology remains poorly defined, in large part due to a lack of studies correlating gene expression to tissue composition. Therefore, the purpose of this study was to determine how tissue composition relates to gene expression in muscle biopsies from patients undergoing reverse shoulder arthroplasty (RSA). Gene expression related to myogenesis, atrophy and cell death, adipogenesis and metabolism, inflammation, and fibrosis was measured in 40 RC muscle biopsies, including 31 biopsies from reverse shoulder arthroplasty (RSA) cases that had available histology data and 9 control biopsies from patients with intact RC tendons. After normalization to reference genes, linear regression was used to identify relationships between gene expression and tissue composition. Hierarchical clustering and principal component analysis (PCA) identified unique clusters, and fold-change analysis was used to determine significant differences in expression between clusters. We found that gene expression profiles were largely dependent on muscle presence, with muscle fraction being the only histological parameter that was significantly correlated to gene expression by linear regression. Similarly, samples with histologically-confirmed muscle distinctly segregated from samples without muscle. However, two sub-groups within the muscle-containing RSA biopsies suggest distinct phases of disease, with one group expressing markers of both atrophy and regeneration, and another group not significantly different from either control biopsies or biopsies lacking muscle. In conclusion, this study provides context for the interpretation of gene expression in heterogeneous and degenerating muscle, and provides further evidence for distinct stages of RC disease in humans.
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Affiliation(s)
- Michael C. Gibbons
- Department of Bioengineering, University of California San Diego, La Jolla, California, United States of America
| | - Kathleen M. Fisch
- Department of Computational Biology, University of California San Diego, La Jolla, California, United States of America
| | - Rajeswari Pichika
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Timothy Cheng
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Adam J. Engler
- Department of Bioengineering, University of California San Diego, La Jolla, California, United States of America
| | - Simon Schenk
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - John G. Lane
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Anshu Singh
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
- Department of Orthopedic Surgery, Kaiser Permanente, San Diego, La Jolla, California, United States of America
| | - Samuel R. Ward
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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