Hand-wrist bone age assessment methods are not possible on typical EOS 2D/3D images without body position modifications that may affect spinal position. We aimed to identify and assess lesser known ...bone age assessment alternatives that may be applied retrospectively and without the need for extra imaging.
After review of 2857 articles, nine bone age methods were selected and applied retrospectively in pilot study (thirteen individuals), followed by evaluation of EOS images of 934 4-24-year-olds. Difficulty of assessment and time taken were recorded, and reliability calculated.
Five methods proved promising after pilot study. Risser 'plus' could be applied with no difficulty in 89.5% of scans (836/934) followed by the Oxford hip method (78.6%, 734/934), cervical (79.0%, 738/934), calcaneus (70.8%, 669/934) and the knee (68.2%, 667/934). Calcaneus and cervical methods proved to be fastest at 17.7s (95% confidence interval, 16.0s to 19.38s & 26.5s (95% CI, 22.16s to 30.75s), respectively, with Oxford hip the slowest at 82.0 s (95% CI, 76.12 to 87.88s). Difficulties included: regions lying outside of the image-assessment was difficult or impossible in upper cervical vertebrae (46/934 images 4.9%) and calcaneus methods (144/934 images, 15.4%); position: lower step length was associated with difficult lateral knee assessment & head/hand position with cervical evaluation; and resolution: in the higher stages of the hip, calcaneal and knee methods.
Hip, iliac crest and cervical regions can be assessed on the majority of EOS scans and may be useful for retrospective application. Calcaneus evaluation is a simple and rapidly applicable method that may be appropriate if consideration is given to include full imaging of the foot.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The surgical solution of equinus deformity is one of the most important factors in the treatment of patients with cerebral palsy. We perform open Z achillotenotomy and percutaneus triple hemisection ...routinely in our department.
The goal of our work was to analyze the long-term results of achillotenotomies in patients with cerebral palsy, to look for predisposing factors of major complications, and to compare the results of the performed operative methods.
Between 1990 and 2006, we performed 347 surgical Achilles tendon lengthenings. In 261 cases, the operations were performed percutaneusly, and in 86 cases we performed open Z achillotenotomy. The average follow-up time was 15 years. The long-term outcomes were analyzed based on the age at surgery, the topographic appearance and the severity of cerebral palsy. Analysis regarding functional outcome was based on the widely known Physician Rating Scale system.
Due to recurrent equinus deformity, re-achillotenotomy was performed in 74 cases (21.3%), and in 14 cases (4%) the re-achillotenotomy needed to be performed a second time. We encountered overcorrection and calcaneus deformity in 12 cases (3.5%). Recurrence rate was higher in patients operated at a younger age (<7 years) and in patients with a more severe cerebral palsy (GMFCS II-III, ~26%). Recurrence showed accumulation in patients 9-14 years old.
The major complication we encountered was recurrence of the equinus deformity. The majority of relapses occured in patients who were operated at a younger age and suffered from a more severe form of cerebral palsy. We observed that recurrence showed an association with growth and accumulated in aldolescence. Orv Hetil. 2020; 161(8): 306-312.
The aim of our study was to investigate the effects of a 24-week-long training program on changes in static body posture, as well as the characteristics of anterior shoulder pain in youth swimmers, ...and the relationship between changes in whole-body posture and the frequency and intensity of anterior shoulder pain. Competitive young swimmers (n = 54, 13.9 ± 1.79 years) were divided into experimental group and control group and both groups performed their usual swimming training. In addition, the experimental group performed a 24-week-long whole-body posture correction program. Before and after the implemented training, whole-body posture was analyzed using the PostureScreen (version 13.7) mobile application, and subjective intensity of pain was determined using the swimmer’s functional pain scale. Significant changes were found between the two groups in numerous measured postural parameters. A significant reduction in the prevalence of shoulder pain and score of the pain scale was observed after the posture correction program in the experimental group. Our results may imply that more optimal biomechanical conditions may indirectly reduce the incidence of swimmer’s shoulder in terms of prevention. Analysis and monitoring of body posture of swimmers using an on-field mobile application continuously, and the application of preventive training programs, may help to avoid developing injuries.
BackgroundParticle-challenged cells release cytokines, chemokines, and eicosanoids, which contribute to periprosthetic osteolysis. The particle-induced activation of macrophages and monocytes has ...been extensively studied, but only limited information is available on the response of osteoblasts to particulate wear debris. This study examines the effects of particulate wear debris, proinflammatory cytokines, and growth factors on osteoblast functions.MethodsMG-63 osteoblasts were treated with metal particles (titanium, titanium alloy, and chromium orthophosphate) or polymeric particles (polyethylene and polystyrene) of phagocytosable sizes or were treated with exogenous cytokines and growth factors. The kinetics of particle phagocytosis and the number of engulfed particles were assessed with use of fluoresceinated particles. Cell proliferation was determined according to H-thymidine incorporation, and cell viability was determined by either fluorescein diacetate uptake or trypan blue exclusion. Expressions of osteoblast-specific genes were quantified with Northern blot hybridization, and the secretions of osteoblast-specific proteins and cytokines were analyzed by enzyme-linked immunosorbent assays.ResultsMG-63 osteoblasts phagocytosed particles and became saturated after twenty-four hours. A maximum of forty to sixty particles per cell were phagocytosed. Each type of particle significantly suppressed procollagen a1I gene expression (p < 0.05), whereas other osteoblast-specific genes (osteonectin, osteocalcin, and alkaline phosphatase) did not show significant changes. Particle-stimulated osteoblasts released interleukin-6 (p < 0.05) and a smaller amount of transforming growth factor-b1. Particles reduced cell proliferation in a dose-dependent manner without affecting cell viability (p < 0.05). Exogenous tumor necrosis factor-a also enhanced the release of interleukin-6 (p < 0.01) and transforming growth factor-b1 (p < 0.05), whereas the secretion of transforming growth factor-b1 was increased by insulin-like growth factor-I and prostaglandin E2 as well. Insulin-like growth factor-I and transforming growth factor-b1 significantly increased procollagen a1I gene expression in osteoblasts (p < 0.05), while tumor necrosis factor-a and prostaglandin E2 significantly suppressed procollagen a1I gene expression (p < 0.01). In contrast, neither exogenous nor endogenous interleukin-6 had any effect on other cytokine secretion, on proliferation, or on procollagen a1I gene expression. The transcription inhibitor actinomycin D reduced both procollagen a1I transcription and interleukin-6 production. Inhibitors of protein synthesis (cyclohexamide) and intracellular protein transport (brefeldin A and monensin) blocked the release of interleukin-6, but none of these compounds influenced the suppressive effect of titanium on procollagen a1I gene expression.ConclusionsMG-63 osteoblasts phagocytose particulate wear debris, and this process induces interleukin-6 production and suppresses type-I collagen synthesis. Osteoblast-derived interleukin-6 may induce osteoclast differentiation and/or activation, but the resorbed bone cannot be replaced by new bone because of diminished osteoblast function (reduced type-I collagen synthesis). Exogenous cytokines (tumor necrosis factor-a and interleukin-1b), growth factors (insulin-like growth factor-I and transforming growth factor-b1), and prostaglandin E2 can modify particulate-induced alterations of osteoblast functions.Clinical RelevanceAltered osteoblast functions probably contribute to the progression of periprosthetic osteolysis. Suppressed osteoblast functions, however, could be compensated for by certain growth factors, such as insulin-like growth factor-I or transforming growth factor-b1. These growth factors, if delivered locally, may have therapeutic potential to prevent or reverse periprosthetic osteolysis.
A Pécsi Tudományegyetem Ortopédiai Klinikáján, 2009 márciusától 2012 végéig 62 Bösch műtétet vizsgáltunk, 9 operatőr által elvégezve, az átlagos utánkövetés 66 hónap volt. Mindannyian enyhe vagy ...középsúlyos hallux valgus deformitással rendelkeztek. A műtét eredményének megítélésére a fenti időszakban műtött betegek adatait a klinikai adatszolgáltató rendszerekből nyertük ki (Medsol, Medview), illetve a betegeket kontrollvizsgálatra visszarendeltük. A betegenként rendelkezésre álló 3 db röntgenfelvételen megmértük a hallux valgus (HV), intermetatarsalis (IM) és distalis metatarsalis ízfelszíni (DMA) szögeket. Továbbá felmértük a szövődményrátát, illetve értékeltük a posztoperatív betegelégedettséget. Mindhárom vizsgált radiológiai szögérték átlagértékei jelentősen csökkentek a preoperatív állapothoz képest, legnagyobb mértékben, szignifikánsan a hallux valgus szög esetében. Az átlag HV szög a preoperatív 37,4 fokról 12,9 fokra javult az utolsó kontrollvizsgálatnál, az átlag IM szög 13,9-ről 6,9 fokra csökkent. A DMA szög átlagértékei preoperatíve 14,2, utolsó kontrollnál 8,2 fok. A vizuális analóg fájdalom skála (VAS) kitöltése alapján, az operált betegek 91%-a nyilatkozott a műtét szubjektív sikerességéről. Szövődményt 9 esetben észleltünk, álízület képződés, korrekcióvesztés, illetve 2 esetben infekció formájában. Összefoglalásként elmondhatjuk a középtávú eredmények tükrében, hogy a Bösch műtét, a hallux valgus deformitás korrekciójára biztonsággal végezhető, megfelelő indikáció mellett jól korrigálja a HV, IM és DMA szögeket.
Exposure of human osteoblasts to ultrafine titanium (Ti) particles has been shown to alter osteoblast gene expression. We previously reported that Ti particles can increase IL-6 release and suppress ...the gene expression of procollagens α
1I and α
1III in human osteoblasts. In this study, we now demonstrate that Ti particles can rapidly induce the chemotactic cytokines interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1), two immediate early stress responsive chemokines important for the activation and chemotaxis of neutrophils and macrophages, respectively. In MG-63 osteosarcoma cells and bone marrow derived primary osteoblasts Ti particles selectively increased the steady state levels of IL-8 and MCP-1 mRNA in a time and concentration dependent manner. The increased chemokine mRNA correlated with increased secretion of IL-8 and MCP-1 protein. Actinomycin D, a potent RNA polymerase II inhibitor, blocked the Ti particle induction of IL-8 and MCP-1 mRNA expression, whereas cycloheximide, which inhibits protein synthesis, failed to inhibit chemokine gene expression suggesting Ti particles directly target activation of chemokine gene transcription. Consistent with a transcriptional mechanism not involving new protein synthesis, we demonstrate that Ti particles induce the binding of the p65 and p50 subunits of the latent transcription factor NF-κB to the IL-8 gene promoter. Taken together, these data demonstrate that Ti particles can activate transcription of the stress responsive chemokine genes IL-8 and MCP-1 in human osteoblasts.
Human osteoblasts produce interleukin-6 (IL-6) and respond to IL-6 in the presence of soluble IL-6 receptor (sIL-6R), but the cell surface expression of IL-6R and the mechanism of sIL-6R production ...are largely unknown. Three different human osteoblast-like cell lines (MG-63, HOS, and SaOS-2) and bone marrow-derived primary human osteoblasts expressed both IL-6R and gp130 as determined by flow cytometry and immunoprecipitation. However, the membrane-bound IL-6R was nonfunctional, as significant tyrosine phosphorylation of gp130 did not occur in the presence of IL-6. Phorbol myristate acetate induced a dramatic increase of both IL-6R shedding (i.e. the production of sIL-6R) and IL-6 release in osteoblast cultures, but the cell surface expression of gp130 remained unchanged. IL-6 complexed with sIL-6R, either exogenously introduced or derived from the nonfunctional cell surface form by shedding, induced rapid tyrosine phosphorylation of gp130. This effect was inhibited by neutralizing antibodies to either sIL-6R or gp130, indicating that the gp130 activation was induced by IL-6/sIL-6R/gp130 interaction. Protein kinase C inhibitors blocked phorbol myristate acetate-induced and spontaneous shedding of IL-6R resulting in the absence of sIL-6R in the culture medium, which in turn also prevented the activation of gp130. In conclusion, human osteoblasts express cell surface IL-6R, which is unable to transmit IL-6-induced signals until it is shed into its soluble form. This unique mechanism provides the flexibility for osteoblasts to control their own responsiveness to IL-6 via the activation of an IL-6R sheddase, resulting in an immediate production of functionally active osteoblast-derived sIL-6R.
The targeted disruption of cartilage link protein gene (Crtl1) in homozygous mice resulted in a severe chondrodysplasia and perinatal lethality. This raised the question of whether the abnormalities ...seen in Crtl1 null mice are all caused by the absence of link protein in cartilage or whether the deficiency of the protein in other tissues and organs contributed to the phenotype. To address this question we have generated transgenic mice overexpressing cartilage link protein under the control of a cartilage-specific promoter, and then these transgenic mice were used for a genetic rescue of abnormalities in Crtl1 null mice. While the overexpression of cartilage link protein resulted in no abnormal phenotype, the cartilage-specific transgene expression of link protein could completely prevent the perinatal mortality of link protein-deficient mice and, depending on the level of the link protein expression, rescue skeletal abnormalities. Although link protein was originally isolated from cartilage, we found and determined Crtl1 transcripts and corresponding proteins in every organ tested from mouse embryos to aging animals. We also identified three additional members of the link protein family, all co-localized with hyaluronic acid-binding proteoglycans in the mouse genome. The ubiquitous presence of link protein suggests a general and systemic function of link protein in the organization of extracellular matrix in a number of tissues, possibly interacting with other proteoglycans, such as versican, brevican, and neurocan.
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