Camila Leite Rodrigues, Guilherme Peres Pereira, Mariana Mika Fujimura
et al.
Background: Craniomandibular osteopathy (CMO) is a self-limiting condition that causes bone proliferation predominantly, mainly affecting tympanic bullae, branches of the jaws and temporomandibular joints. The disease appears to most commonly affect specific dog breeds between three and eight months of age, with Terrier breeds being predisposed due to potential recessive genetic factors. While its exact etiology remains elusive, associations with viral or bacterial infections have been documented in other breeds. Clinical manifestations typically include pain, fever, facial edema, dysphagia, anorexia, dehydration, excessive salivation, and weight loss. Diagnosis relies on clinical signs, radiographic imaging, and histological examination, with visualization of generalized thickening of the bone trabeculae. Pain control is crucial to improving the prognosis of the disease, and usually involves anti-inflammatory and/or opioid medications for pain control, alongside nutritional support. Prognosis varies widely, with euthanasia being a consideration in severe cases. This paper aims to present a detailed clinical case of craniomandibular osteopathy in an American Bully dog, outlining its clinical evolution, diagnostic findings, therapeutic interventions, and the longitudinal monitoring of clinical, radiographic and laboratory parameters over approximately one year.
Abstract Background There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11). Methods A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty. Results 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P 25, P 75)age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460–6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively. Conclusions The FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty.
Ana Balseiro, Gloria Herrero-García, Luis J. Royo
et al.
Dolphins are marine mammals that often live in coastal habitats. Common causes of severe skeletal disorders among wild dolphins are congenital vertebral anomalities, collisions with sea vessels, trauma, hunting-related injury, infectious diseases, environmental pollution, and tumors.A free-ranging male, 3-year-old common dolphin (Delphinus delphis) was found dead in the coast of Asturias in northern Spain. Postmortem examination revealed lordosis in the caudal vertebral column, while X-ray imaging and computer tomography showed well-organized palisade-like periosteal proliferation, appearing as florid-like accretions, along the spinous apophysis of 26 lumbar-caudal vertebrae. The transverse apophysis was affected on only a few caudal vertebrae. The cortical layer remained intact. Histology of vertebra tissue showed periosteal proliferation of cancellous bone. The animal was diagnosed with hypertrophic osteopathy. The lungs showed diffuse parasitic granulomatous bronchointerstitial pneumonia caused by Halocercus delphini, consolidation of the pulmonary tissue, congestion, and alveolar edema. The animal was also afflicted by parasitic granulomatous gastritis caused by Anisakis simplex sensu lato and tattoo skin disease.The dolphin suffered from hypertrophic osteopathy associated with pulmonary Halocercus delphini infestation. This syndrome, known as hypertrophic pulmonary osteopathy, has been described in diverse terrestrial mammals, including domestic animals, wildlife and humans, but not in dolphins. This case reports the first description of hypertrophic osteopathy associated to a pulmonary disorder in dolphin, and it provides insights into factors that can induce column malformation in dolphins, suggesting the importance of taking thoracic lesions into account during differential diagnosis.
Timur T. Tsoriev, Zhanna E. Belaya, Tatiana O. Chernova
et al.
BACKGROUND:Patients with endogenous hypercortisolism have reduced bone mineral density (BMD) and trabecular bone score (TBS) that are the causes of secondary osteoporosis and low-traumatic fractures. It is well known that radical treatment (neurosurgery or radiosurgery) of Cushings disease leads to a decline of cortisol levels in all body fluids to normal values. However, it is still uncertain whether bone tissue structure, and particularly its microarchitecture, does recover in remission of the disease.
AIMS:To evaluate an influence of hormone activity (presence or absence of remission) in patients with Cushing's disease on changes of bone structure measurements in accordance with DXA values (TBS, BMD, T- and Z-scores), as well as significance of such changes in 12 and 24 months after neurosurgical treatment.
MATERIALS AND METHODS:In patients with confirmed active Cushing's disease (ACTH-producing pituitary adenoma) (n = 44) and in control group of healthy volunteers (n = 40), BMD in lumbar spine (L1-L4) and simultaneously TBS, in cut-off points before neurosurgical treatment (in both groups) and in 12 and 24 months after it (only in patients), were assessed. We diagnosed presence or absence of disease remission at cut-offs. All measurements were performed using a GE iDXA device (GE Healthcare Lunar, Madison, Wisconsin, USA). The TBS was calculated simultaneously from taken BMD scans, blinded to clinical outcome using TBS iNsight software v2.1 (Medimaps, Merignac, France). The activity of Cushings disease was evaluated using late-night salivary cortisol (LNSC, at 23:00). To determine the differences in DXA and TBS values before and after neurosurgical intervention depending on remission occurrence, covariate analysis (ANCOVA) was applied.
RESULTS:There were found significant changes in TBS, BMD and T-score values in 12 months after neurosurgical treatment associated with presence or absence of disease remission (p = 0.039, 0.046 and 0.048, respectively). No differences in Z-score as well as in all measurements in 24 months, that might be associated with remission occurrence, were revealed. The gain in all DXA measurements (including TBS) during 24 months of observation period was statistically significant when analyzing data using Students paired t-test. However, the values corresponding to the age references had not been achieved for the specified time interval.
CONCLUSIONS:Patients with Cushings disease have lower TBS values. In remission conditions TBS is getting significantly higher. The increase in BMD and TBS occurs during 24 months after achieving remission of Cushings disease but doesnt lead to a full restoration of normal bone mass and microstructure throughout observation period of 24 months.
Abstract Objectives To examine first year osteopathic students' use and perceptions of complementary video-based learning in an osteopathic examination and management unit. Design Mixed-method sequential explanatory design. Setting Tertiary education facility Melbourne, Victoria, Australia. Participants First year osteopathy students. Main outcome measures Questionnaire-based surveys and focus groups were used to examine use of video resources and student perceptions. Surveys were analysed based on the frequency of responses made on a 4-point scale. Thematic analysis was performed on long-answer survey and focus group transcripts. Results Seventy-four (n = 74) students completed the surveys and 12 students took part in the focus groups. Participants reported the online videos had a positive effect on their learning experience in the unit (100%). Themes that emerged from the focus groups included improved understanding, increased exam study and performance, increased exam confidence, decreased exam anxiety, and minor technical difficulties. Conclusion Video-based learning appears to be an effective approach in decreasing first year osteopathy students' perceived exam anxiety, and increasing perceived exam confidence and performance. These perceptions are thought to be due to the adoption of a structured learning approach and the reduction in surface learning.
Introducción: Los pacientes con artritis reumatoide presentan mayor prevalencia de osteoporosis, en parte por el uso de glucocorticoides; sin embargo, existen otros factores causales.
Material y métodos: Se estudiaron 122 mujeres con el diagnóstico de artritis reumatoide. Se determinaron las concentraciones séricas de hemoglobina y se realizó densitometría ósea por medio de absorciometría de rayos X de energía dual. Se utilizó un modelo de regresión logística multivariante para determinar la asociación de las variables estudiadas.
Resultados: El 32,8% de las mujeres estudiadas presentó hemoglobina <12 g/dL. La media de la T-score en columna lumbar fue -1,8±1,5; el 36,9% presentó una masa ósea baja, el 32,8% criterio de osteoporosis y el 30,3% T-score normal. La media de la T-score de fémur fue -0,6±1,4; el 63,9% fue con valor normal, el 23,8%, presentó masa ósea baja y el 12,3% criterio de osteoporosis. Se encontró relación entre hemoglobina ≥12 g/dL y una densidad mineral ósea (DMO) de fémur normal (p=0,003), y entre una hemoglobina <12 g/dL y DMO de fémur con osteoporosis (p<0,000). Existió una asociación independiente entre la osteoporosis y el índice de masa corporal <30 kg/m2 (OR=4,1; IC 95%: 1,4-11,4; p=0,009) y la presencia de anemia (OR=8,9; IC 95%: 3,7-22,4; p=0,001).
Conclusiones: En nuestro trabajo se observa una asociación entre la anemia y la baja densidad mineral ósea en mujeres con AR principalmente en la región femoral, lo que hace importante el manejo adecuado y oportuno de la anemia en estas pacientes.
BackgroundOsteopathy is an increasingly popular healthcare approach that uses a wide variety of therapeutic manual techniques to address pain and somatic dysfunction. In Quebec, Canada, osteopathy is the complementary medicine most often recommended by family physicians. However, factors fostering the development of interprofessional collaboration (IPC) between physicians and osteopaths are unknown. This study aimed to describe the current situation in terms of IPC among practitioners working with pediatric patients.MethodsA self-administered questionnaire was sent to osteopaths, family physicians, and pediatricians involved with pediatric patients in the province of Quebec. The postal questionnaire captured general knowledge about osteopathy and its practice parameters and role, sources of information, communication aspects including having a professional relationship and referrals, and influence of the upcoming government regulation. Quantitative data from the questionnaires were analyzed using descriptive statistics. Logistic regression model for factors associated with osteopathic referrals and multiple linear regression analyses for the number of correct answers about general osteopathic practice parameters were performed.ResultsA total of 274 physicians (155 family physicians (response rate 13%) and 119 pediatricians (17%)) and 297 osteopaths (42%) completed the survey. According to physicians, osteopathy was most appropriate for musculoskeletal pain (241; 91%) and plagiocephaly (235; 88%). Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and belief in the active role of osteopathy for pediatric conditions (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). The majority of physicians (72%) and osteopaths (62%) considered the upcoming government regulation of osteopathy a positive factor for collaboration.ConclusionSome collaboration already exists among these practitioners, including mutual referrals, but optimizing this collaboration still poses some challenges.
Oxytocin (OT), a hormone most commonly associated with labor and lactation, may have a wide variety of physiological and pathological functions, which makes OT and its receptor potential targets for drug therapy. In this review, we highlight the newly discovered metabolic role of OT in diabetes and its complication, such as diabetic osteopathy. OT may have positive metabolic effects; this is based on the change in glucose metabolism, lipid profile, and insulin sensitivity. It may modify glucose uptake and insulin sensitivity both through direct and indirect effects. It may also cause regenerative changes in diabetic pancreatic islet cells. Moreover, it has an anabolic effect on the bone biology. So, the activation of the OT receptor pathway by infusion of OT, OT analogs, or OT agonists may represent a promising approach for the treatment of diabetes and some of its complications, including diabetic osteopathy.
E S KOSYaKOVA, E G BAKShEEVA, S V VERKhOTUROVA
et al.
Цель. Оценить уровень гормонов участвующих в формировании костной ткани и некоторых биохимических маркеров ее повреждения, а так же значения показателей денситометрии у пациентов с различной стадией остеопороза. Материал и методы. В исследовании принимали участие 45 русских женщин, которые были разделены на 3 группы: 1 группа - 15 условно здоровых, 2 группа - 15 женщин с остеопенией и 3 группа - 15 человек с остеопорозом, в возрасте от 48 до 60 лет. Минеральная плотность костной ткани в шейке бедра и поясничном отделе позвоночника устанавливалась с помощью рентгеновской денситометрии посредством Т-критерия. В сыворотке крови определяли концентрацию кортизола, общего трийодтиронина, пара-тиреоидного гормона, кальцитриола и эстрадиола методом ИФА. Также определяли уровни продуктов распада коллагена: С-концевых телопептидов коллагена I типа и пиридонолина. Статистическую обработку результатов проводили с помощью пакета прикладных программ Statistica 6.0 for Windows. Количественные данные представляли в виде медианы с верхним и нижним квартилями (25-й и 75-й процентили) - Me (25;75). При сравнении количественных показателей, использовали критерии Манна-Уитни. Результаты. Данные денситометрии значительно различались во 2 и 3 группах женщин по сравнению с контролем (p<0,001) и были равны по Т-критерию шейки бедра: 0,90 [0,63; 1,23], -1,65 [-2,28; -0,78], -1,80 [-2,10; -1,20] SD; по T-критерию позвоночника: 0,35 [-0,18; 1,13], -1,95 [-3,50; -1,38], -1,15 [-2,30; 0] SD в 1, 2 и 3 группах соответственно. Лабораторные исследования показали, что у всех обследуемых лиц уровни гормонов были в пределах референсных значений. Содержание эстрадиола, по сравнению с контролем, в группе пациентов с остеопенией было меньше на 15% (p=0,002), а в группе с остеопорозом - на 8,4% (p=0,036). Значения кальцитриола были выше на 107% (p=0,001) во 2 группе и на 43% (p=0,036) - в третьей по сравнению с контролем, и кроме того, во второй выше, чем в третьей на 31% (p=0,045). Концентрации ПТГ также была наибольшей в группе с остеопенией: на 51% (p=0,002) больше чем в контроле. Также были рассчитаны соотношения величин гормонов, участвующих в кальцификации и деминирализации костной ткани, характеризующие связь патологии костно-суставной системы с гормональными изменениями. Наиболее значимые различия выявлены в соотношении уровней эстрадиола и паратиреоидного гормона, которые были в группе с остеопенией на 46% (p=0,006), а в группе с остеопорозом на 41% (p=0,041) ниже, чем в контроле. Наибольшие гормональные изменения регистрируются в группе с остеопенией. Коэффициент отношения эстрадиола к ПТГ гормону в группе контроля составил 1,82 [1,10; 2,33], в группе с остеопенией 0,99 [0,93; 1,06], а с остеопорозом 1,43 [1,01; 1,58]. При проведении многофакторного анализа параметров гормонального статуса и биохимических маркеров повреждения костной ткани к Т-критерию позвоночника и шейки бедра уставили, что соотношение эстрадиола к паратиреодному гормону имеет сильную связь с изменением показателей минеральной плотности позвоночника в различных группах пациентов. Это подтверждает возможность использования данного соотношения в качестве раннего диагностического маркера развития остеопороза. Выводы. Наиболее целесообразно использовать в качестве ранних биохимических маркеров развития остеопороза у женщин уровень паратгормона, эстрадиола и их соотношение. Значения показателей денситометрии по Т-критерию шейки бедра в большей степени соответствуют степени тяжести остеопороза, нежели величины T-критерия позвоночника.
We have previously shown that the expression of the minichromosome maintenance protein 3 (MCM3) gene was upregulated in lymphocytes of patients with skeletal fluorosis. We speculated that increased MCM3 expression may be contribute to osteopathy in patients with skeletal fluorosis. Here, we investigated the effect of fluoride on the proliferation of osteoclasts derived from RAW264.7 cells and the involvement of MCM3. Our MTT assays showed that 0.25 mM NaF markedly stimulated the proliferation of RAW264.7 cells. The RT-PCR and immunoblotting assays revealed that 0.25 mM NaF upregulated MCM3 expression in RAW264.7 cells. The MTT assays additionally demonstrated that stimulation with MCM3 potentiated the effect of fluorine on the proliferation of RAW264.7 cells. These results demonstrated that fluoride at clinical relevant concentration upregulates MCM3 expression in osteoclasts in vitro. We are currently conducting a series of experiments to examine whether increased MCM3 in osteoclasts indeed contributes to osteopathy in skeletal fluorosis.
Conclusion. 1. There were no significant differences in the occurrence frequency of allele and genotypes of C1444 locus of CRP gene in patient with osteoporosis. 2. It was founded that T allele and TT genotype of C1846T locus of CRP gene were more common in women with osteoporosis. 3. The determination of gene CRP polymorphism gives a responsibility to realize individual prognosis and to take preventive measures. Цель исследования. Определить полиморфизмы генов OPG, RANKL, VDR, SOST и оценить их взаимосвязь с минеральной плотностью кости (МПК) и переломами для последующей оптимизации диагностики и лечения постменопаузального остеопороза. Материал и методы. В исследование вошли 236 женщин в постменопаузе, проживающих в Москве и Московской области. Основную группу составили 174 пациентки, в возрасте от 50 до 83 лет, с показателями минеральной плотности кости (МПК) < - 2,5 SD по Т-критерию. Группу сравнения составили 62 женщины в постменопаузе с показателями МПК в пределах нормальных значений и отсутствием переломов в анамнезе, в возрасте от 50 до 77 лет. В нашем исследовании всем испытуемым с постменопаузальным остеопорозом и группы контроля с помощью полимеразной цепной реакции проводили молекулярногенетическое проводили с определением полиморфизмов генов VDR(rs10735810, rs1544410), RANKL (rs9594738, rs9594759) и OPG (rs3102735, rs3102735 и rs4355801), SOST (rs1230399). Результаты. При наличии Т аллелей гена RANKL по полиморфизмам rs9594759 и rs9594738 риск снижения МПК в поясничном отделе позвоночника увеличивается в 2 раза. У женщин с гомозиготным генотипом С/С по полиморфизму rs3102735 гена OPG риск развития переломов дистального отдела лучевой кости повышается в 17 раз вне зависимости от показателей МПК. Наличие генотипа G/G по полиморфизму rs1544410 гена VDR у пациенток с постменопаузальным остеопорозом ассоциировано с повышением риска переломов дистального отдела лучевой кости в 3 раза. У пациенток с ПМО гомозиготный генотип С/С по полиморфизму rs1230399 гена SOST обуславливают только различия в индексе массы тела. Заключение. Полиморфизмы генов RANKL (rs9594759 и rs9594738), OPG (rs 3102735) и гена VDR(rs1544410) ассоциированы с риском развития постменопаузального остеопороза и переломов. Ген SOST(rs1230399) не оказывает статистически значимого влияния на МПК и риск переломов.
Arnaiz de las Revillas F, Marcote Ibáñez C, González-Lamuño D
et al.
El tenofovir (TDF), es el único inhibidor de la transcriptasa inversa análogo nucleótido para el tratamiento de la infección por virus de la inmunodeficiencia humana (VIH). Ocasionalmente, puede producir insuficiencia renal aguda y síndrome de Fanconi.
Presentamos el caso de un varón de 64 años con infección por VIH conocida desde hace 22 años, en tratamiento con tenofovir. En las revisiones ambulatorias refería un cuadro progresivo de astenia y dolores óseos difusos. En varias determinaciones se había observado una elevación de la fosfatasa alcalina y la paratohormona (PTH). Durante el último mes empeoró su estado, por lo que fue ingresado en el hospital. Entre los datos analíticos destacaban: glucosuria marcada, hipofosfatemia, hiperfosfaturia e hipouricemia. Todas las alteraciones se resolvieron tras suspender el TDF, lo que ilustra la importancia de que los clínicos incluyan la posibilidad de tubulopatía proximal por TDF en pacientes con dolores óseos, síndrome general o alteraciones del metabolismo mineral.
Nowadays, multifactorial nature of osteoporosis does not raise any doubts. Besides, it should be noted that about 90% disease cases are determined genetically. In 1990-s a number of candidate genes mutations were established which increase the risk of osteoporosis development. VDR, ESR1, ESR2, COLIA1, PTH, CT, CTR, BGP, AR, GCCR, TGFB1, IL-6, IGF1, IL-1ra, OPG were considered to be this kind of genes. New genetic analysis technologies (GWAS, etc.) gave the opportunity to expand our conception about multi genomic pathogenesis of osteoporosis and to point out a new group of genes candidate - a canonical Wnt-signaling pathway genes (CTNNB1, SOST, FOXC2, FOXL1, LRP4, LRP5, WNT1, WNT3, WNT16, DKK1, AXIN1, JAG1, etc.). Extreme importance of canonical Wnt-signaling pathway and genes given above in skeleton formation and its strength necessitate the need for further scientific research and opens perspective to improve osteoporosis diagnostics, treatment and prognosis.