Vasileios Georgoulas, Ilias Kallistratos, Thomas Apostolou
et al.
<b>Background:</b> Restricted ankle dorsiflexion is common in basketball athletes and has been associated with altered lower-limb mechanics and reduced athletic performance. Although ankle joint mobilization is widely used to improve mobility, its effects on athletic performance remain unclear. The aim of this study was to examine whether adding posterior ankle joint mobilization to a structured exercise-based program incorporating eccentric strengthening and stretching improves ankle mobility and athletic performance in basketball athletes with restricted dorsiflexion. Primary outcomes were dorsiflexion range of motion (DF-ROM) and the Weight-Bearing Lunge Test (WBLT); secondary outcomes included jump performance, hop tests, Reactive Strength Index, Fatigue Index, and maximal isometric strength. <b>Methods:</b> In this randomized controlled trial, 38 basketball athletes (mean age 21.26 ± 2.52 years) with unilateral restricted ankle dorsiflexion were randomly allocated to an exercise-only group (<i>n</i> = 19) or to an exercise plus talocrural mobilization group (n = 19). The intervention lasted 5 weeks, with assessments performed at baseline, post-intervention, and at a 3-month follow-up. <b>Results:</b> Both groups improved ankle dorsiflexion; however, greater gains were observed in the intervention group for both dorsiflexion range of motion (DF-ROM; interaction <i>p</i> < 0.001; mean difference [MD] = 3.52° post-intervention and MD = 5.17° at follow-up) and the Weight-Bearing Lunge Test (WBLT; interaction <i>p</i> < 0.001; MD = 1.39 cm and MD = 1.34 cm, respectively). The intervention group showed superior improvements in countermovement jump and Triple Hop Test performance (both <i>p</i> < 0.001), as well as a small but statistically significant advantage in the Single Hop Test (<i>p</i> = 0.015). No between-group differences were found for the 6 m timed hop test, Reactive Strength Index, Fatigue Index, or maximal isometric strength (<i>p</i> > 0.05). <b>Conclusions:</b> Adding ankle joint mobilization to an eccentric strengthening and stretching program produced greater improvements in dorsiflexion and jump performance than exercise alone, without affecting speed, reactive ability, or maximal strength. Ankle mobilization may be a useful adjunct for improving functional mobility and selected performance outcomes in basketball athletes.
Bone marrow mesenchymal stem cells (BMSCs) are multipotent progenitor cells with the capacity to differentiate into various mesenchymal lineages, including osteogenic, chondrogenic, and adipogenic tissues, rendering them promising candidates for regenerative medicine. This review delves into current foundational and preclinical research concerning BMSCs, with a particular emphasis on the use of genetically modified rat-derived BMSCs expressing green fluorescent protein (GFP) to facilitate in vivo cell tracking during tissue repair. It also examines various administration strategies, including intra-articular injections and magnetically guided cell targeting, to evaluate their therapeutic efficacy. Emerging evidence highlights the pivotal role of BMSCs in regenerating musculoskeletal tissues, including muscle, meniscus, and cartilage. Notably, the application of external magnetic fields (EMF) to direct magnetically labeled BMSCs to injury sites has demonstrated encouraging outcomes in cartilage repair. Furthermore, advances in BMSC culture techniques, single-cell genetic analysis, and tissue engineering methodologies may further augment their therapeutic potential. Preclinical and early-phase clinical studies underscore the promise of BMSCs as a minimally invasive therapeutic modality in orthopedic and regenerative medicine. Further research is essential to refine their applications and optimize delivery strategies, such as the use of internal magnetic fields generated by magnetized material implanted in damaged knee cartilage, to ensure long-term efficacy and safety.
Noboru Kitamura, Yosuke Nagasawa, Kumiko Akiya
et al.
Abstract Background This study examined to examine the relationship of Epstein-Barr virus (EBV) in rheumatoid arthritis (RA) by evaluating disease activity and autoantibody levels in positive and negative cases using the anti-EBV early antigen diffuse type and restricted type (EA-DR) immunoglobulin G (IgG) antibody. Methods Patients undergoing RA treatment at our hospital with anti-EBV EA-DR IgG antibodies were selected. Patient’s age, sex, RA duration, disease activity, laboratory findings, treatment details, and complications in patients with positive or negative anti-EBV EA-DR IgG antibodies were confirmed, and the relationship between RA activity, autoantibody production, and EBV was analyzed. Results anti-EBV EA-DR IgG antibodies were measured in 70 RA cases (30 positive and 40 negative), with a positivity rate of 43.9%. Among the positive cases, 18 underwent EBV deoxyribonucleic acid polymerase chain reaction, with 14 testing positive. Univariate analysis revealed significantly higher levels of disease activity score in 28 joints with C-reactive protein, peripheral blood lymphocyte count, anti-cyclic citrullinated peptide antibody (ACPA), and rheumatoid factor in anti-EBV EA-DR IgG antibody-positive cases. Multivariate analysis identified peripheral blood lymphocyte count and ACPA levels as significant factors. Conclusions Patients with RA who tested positive for anti-EBV EA-Dr IgG antibodies had significantly higher ACPA than those who tested negative.
Abstract Purpose The purpose of this study was to evaluate whether the combination of preoperative planning software combined with arithmetic hip-knee-ankle angle (aHKA) can help patients who underwent uni-compartmental knee arthroplasty (UKA) recover the constitutional alignment of the lower limb, obtain a better prosthetic position, and achieve better early patient-reported outcome measurements (PROMs). Methods A total of 150 patients who underwent UKA (planning group: 50 patients using the preoperative planning software; conventional group: 100 patients using the conventional method) were included in the study. The aHKA was defined as 180° + mechanical medial proximal tibial angle (MPTA) - mechanical distal lateral femoral angle (LDFA). All patients in the planning group underwent UKA according to the planning software with the planned lower limb alignment of aHKA. All patients were divided into three groups: constitutional alignment group (postoperative HKA (post-HKA): aHKA ± 2.0°); overcorrection group (post-HKA > aHKA + 2.0°); under-correction group (post-HKA < aHKA − 2.0°). Comparisons between the planning and conventional groups were conducted: (1) the proportion of post-HKA restored to constitutional alignment group; (2) the postoperative prosthesis position parameter based on the guideline of the Oxford group; (3) the American Knee Society scores (KSS) at six months after surgery. Results The proportion of the constitutional alignment group in the planning group was higher than that in the conventional group (86% vs. 66%) (p = 0.033). There was no significant difference in postoperative prosthesis position parameters between the two groups. No significant difference was found between the KSS clinical score (91.02 ± 4.20 vs. 90.61 ± 4.24) and KSS functional score (86.10 ± 7.23 vs. 84.30 ± 6.82) in six months after surgery between the planning and conventional groups. Conclusion Patients who underwent UKA using preoperative planning software in combination with aHKA were able to recover a higher proportion of the constitutional alignment than those with the conventional method. In addition, the planning group could achieve similar postoperative prosthesis position and short-term PROMs compared to the conventional group. Clinical trial number Not applicable.
Kohei Hirukawa, MD, Koji Sukegawa, MD, PhD, Yukie Metoki, MD
et al.
Background: Cubital tunnel syndrome, the second most common entrapment neuropathy, results from ulnar nerve compression at the medial epicondyle (ME). Conservative treatment often fails, requiring surgery. Transposition is an effective but invasive procedure, necessitating precise anatomical guidelines. We aimed to investigate the optimal anatomical measurements for ulnar nerve transposition to facilitate standardization of the technique. Methods: We examined 12 upper limbs from 6 fresh-frozen cadavers with elbows flexed at 60° and forearms supinated. The optimal transposition distance was defined as the distance from the ME to where the ulnar and median nerves run parallel. We measured this distance; pivot points A and B (where the ulnar nerve's course changes after transposition); crossing points over the medial intermuscular septum and flexors (A′, B′); and ulnar nerve branch positions from the inferior border of the ME. Results: After excluding 3 outliers using the interquartile range method, 10 limbs were analyzed. The transposition distance was 16.6 ± 3.3 mm. Pivot points A and B were 53.8 ± 6.5 mm and 50.2 ± 9.1 mm from the ME. Crossing points A′ and B′ were 39.6 ± 7.9 mm and 40.2 ± 6.7 mm. Nerve branches were 21.1 ± 6.0 mm, 32.4 ± 14.8 mm, and 50.9 ± 24.6 mm from the inferior border of the ME. Conclusion: Anterior transposition shifts the ulnar nerve 17 mm anterior to the ME. To prevent kinking, dissection should extend 54 mm proximally and 50 mm distally, totaling approximately 105 mm. These measurements can guide intraoperative planning and emphasize the need for direct visualization to ensure safe and effective anterior transposition.
Orthopedic surgery, Diseases of the musculoskeletal system
Abstract Purpose To explore the role of intraoperative prone lumbar fluoroscopy under anesthesia in guiding lowest instrumented vertebra (LIV) selection in adolescent idiopathic scoliosis (AIS) patients with lumbar structural curves and its subsequent impact on surgical outcomes.pap. Methods This retrospective cohort study included 45 AIS patients with lumbar structural curves who underwent posterior spinal deformity correction surgery at the Scoliosis Center, the Third Affiliated Hospital of Sun Yat-sen University between 2020 and 2022.The reduced group refers to the choice of a more superior LIV based on intraoperative lumbar fluoroscopy in the prone position, resulting in fewer fused levels than the preoperative plan, while the non-reduced group leaves the preoperative plan unchanged.We analyzed the demographic information, radiographic data, surgical parameters (including curve correction rates, coronal and sagittal balance, and LIV-related parameters), and complication rates, with statistical significance set at p < 0.05. Results In the reduced group, 57.8% of patients had a reduced number of fused levels. When compared to the non-reduced group, there were no significant differences in the major curve correction rate (the reduced group: 77.6%, the non-reduced group: 71.7%, p = 0.95), coronal balance at final follow-up (p = 0.97), or sagittal balance at final follow-up (p = 0.64), with at least 2 years of follow-up (average 33.3 ± 15.6 months). Postoperative LIV-related parameters, including tilt angle, rotation, and the distance from the center sacral vertical line (CSVL), showed no significant differences between the two groups (p > 0.05). All patients achieved satisfactory postoperative correction, with no adverse events or revision surgeries required due to distal junctional issues. Conclusion Intraoperative prone lumbar fluoroscopy under anesthesia provides precise guidance for LIV selection, reducing the number of fused levels without compromising curve correction or overall spinal balance. This technique is both safe and effective, helping to optimize AIS surgical outcomes while preserving lumbar mobility. Further multicenter studies are needed to validate these findings and assess their long-term functional impact.
Abstract Introduction Currently, the cause of psoriatic arthritis (PsA) is unknown, and the effectiveness of current drug treatments is unsatisfactory. In March 2019, the US Food and Drug Administration (FDA) approved risankizumab, a humanized immunoglobulin G1 (IgG1) monoclonal antibody targeting the p19 subunit of interleukin (IL)-23, for the treatment of PsA in adults. This study aimed to conduct a meta-analysis of double-blind, randomized, placebo-controlled trials to evaluate the effectiveness and safety of risankizumab in moderate-to-severe PsA. Methods We conducted a thorough search of relevant databases from the establishment of the databases to October 1, 2023. We conducted a meta-analysis using Stata 12.0 and utilized I 2 and Egger tests to assess heterogeneity and publication bias among the studies. Bias assessment was performed using the risk bias map and bias risk summary diagram generated by Revman5.4 software. The review protocols were registered on PROSPERO (CRD42023451894) and adhered to the preferred reporting item of system evaluation (PRISMA) guideline. Results Six randomized controlled trials (RCTs) involving 5038 patients with PsA treated with either risankizumab or placebo were included in the analysis. At 24 weeks, the risankizumab group demonstrated a significantly higher American College of Rheumatology-20 (ACR20) response rate compared to the placebo group (RR 1.760, 95% CI 1.568–1.977, P < 0.001). Additionally, the risankizumab group showed a significantly higher Minimal Disease Activity (MDA) response rate compared to the placebo group (RR 1.827, 95% CI 1.048–3.184, P < 0.05). The risankizumab group also exhibited improvement in Short Form 36 Questionnaire (SF-36) score (SMD 0.51, 95% CI 0.33–0.69, P < 0.001), with significantly lower Health Assessment Questionnaire Disability Index (HAQ-DI) score (SMD − 0.27, 95% CI − 0.37 to − 0.17, P < 0.001) and higher Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score (SMD 0.27, 95% CI 0.20–0.35, P < 0.001) compared to the placebo group. Moreover, the risankizumab group had a significantly lower Psoriasis Area and Severity Index (PASI) score (SMD − 6.12, 95% CI − 10.02 to 2.23, P < 0.001). A study by Mease et al. indicated that patients receiving risankizumab generally demonstrated numerical improvements in the Leeds Enthesitis Index (LEI), although the small sample size limits the evidence. Further research is necessary to provide evidence-based guidelines. There were no significant differences in the incidence of serious adverse events (SAE) and serious treatment-emergent adverse events (STEAE) between the risankizumab and placebo groups (RR 0.76, 95% CI 0.45–1.28, P = 0.31; RR 0.99, 95% CI 0.49–1.99, P = 0.97, respectively), and the overall incidence of adverse events (AE) was not comparable (RR 1.10, 95% CI 0.63–1.94, P = 0.73). Conclusion Risankizumab showed superior efficacy across multiple outcome measures compared to placebo, with no significant increase in adverse events. Our findings endorse risankizumab as an excellent treatment option for PsA, offering valuable insights for clinicians and patients when choosing appropriate therapeutic interventions. Trial Registration Retrospectively registered (CRD42023451894, 16 August 2023).
Takashi Ohnishi, Victoria Tran, Kimheak Sao
et al.
Abstract Pathological mineralization of intervertebral disc is debilitating and painful and linked to disc degeneration in a subset of human patients. An adenosine triphosphate efflux transporter, progressive ankylosis (ANK) is a regulator of extracellular inorganic pyrophosphate levels and plays an important role in tissue mineralization. However, the function of ANK in intervertebral disc has not been fully explored. Herein we analyzed the spinal phenotype of Ank mutant mice ( ank / ank ) with attenuated ANK function. Micro-computed tomography and histological analysis showed that loss of ANK function results in the aberrant annulus fibrosus mineralization and peripheral disc fusions with cranial to caudal progression in the spine. Vertebrae in ank mice exhibit elevated cortical bone mass and increased tissue non-specific alkaline phosphatase-positive endplate chondrocytes with decreased subchondral endplate porosity. The acellular dystrophic mineral inclusions in the annulus fibrosus were localized adjacent to apoptotic cells and cells that acquired osteoblast-like phenotype. Fourier transform infrared spectral imaging showed that the apatite mineral in the outer annulus fibrosus had similar chemical composition to that of vertebral bone. Transcriptomic analysis of annulus fibrosus and nucleus pulposus tissues showed changes in several biological themes with a prominent dysregulation of BMAL1/CLOCK circadian regulation. The present study provides new insights into the role of ANK in the disc tissue compartments and highlights the importance of local inorganic pyrophosphate metabolism in inhibiting the mineralization of this important connective tissue.
AbstractLongitudinal bone growth relies on endochondral ossification in the cartilaginous growth plate, where chondrocytes accumulate and synthesize the matrix scaffold that is replaced by bone. The chondroprogenitors in the resting zone maintain the continuous turnover of chondrocytes in the growth plate. Malnutrition is a leading cause of growth retardation in children; however, after recovery from nutrient deprivation, bone growth is accelerated beyond the normal rate, a phenomenon termed catch-up growth. Although nutritional status is a known regulator of long bone growth, it is largely unknown whether and how chondroprogenitor cells respond to deviations in nutrient availability. Here, using fate-mapping analysis in Axin2CreERT2 mice, we showed that dietary restriction increased the number of Axin2+ chondroprogenitors in the resting zone and simultaneously inhibited their differentiation. Once nutrient deficiency was resolved, the accumulated chondroprogenitor cells immediately restarted differentiation and formed chondrocyte columns, contributing to accelerated growth. Furthermore, we showed that nutrient deprivation reduced the level of phosphorylated Akt in the resting zone and that exogenous IGF-1 restored the phosphorylated Akt level and stimulated differentiation of the pooled chondroprogenitors, decreasing their numbers. Our study of Axin2CreERT2 revealed that nutrient availability regulates the balance between accumulation and differentiation of chondroprogenitors in the growth plate and further demonstrated that IGF-1 partially mediates this regulation by promoting the committed differentiation of chondroprogenitor cells.
Rheumatoid arthritis (RA) is the most common rheumatologic disease characterized by inflammation with a definite relationship with heart disease. Impaired immunity, chronic inflammation, genetic susceptibility, autonomic nervous system (ANS) dysfunction, altered metabolic profile have been blamed for ischemic and non-ischemic heart diseases in RA patients. Medications used in RA treatment can also modify the risk of heart diseases by different mechanisms. Understanding the pathogenesis is essential to prevent early cardiac dysfunction in RA patients. Fundamental cellular and molecular mechanisms of pathogenesis await further elucidation. Disease management is of great importance since the cardiovascular (CV) events are known to be reduced with low disease activity. Discovery of new mechanisms will pave the way for the development of novel treatment modalities. This review highlights the epidemiology, pathogenesis, risk factors, diagnosis and screening methods and management of CV comorbidities in RA patients. Besides impact of RA medications and exercise on CV risk are summarized.
Yasser A Elmotaleb Gazar, Hesham Salah Hamoud, Sherif Mohamed Ismail
Introduction: Mixed connective tissue disease (MCTD) is a systemic autoimmune disease with a high titer of anti-U1 small nuclear ribonucleoprotein particles and a number of clinical pictures, mainly Raynaud's phenomenon. Nailfold capillaroscopy (NFC) is a noninvasive diagnostic tool for patients with different connective tissue diseases that permit detection of local microvascular changes that correlate with systemic vascular involvement.
Aim of the Study: The aim of this study was to compare the results of NFC in patients with systemic sclerosis (SSc) and MCTD to determine the chief characteristics of skin microangiopathy in early MCTD and attempt to describe a characteristic MCTD pattern in Egyptian patients.
Methodology: This cross-sectional study included forty patients diagnosed with MCTD according to Alarcón-Segovia and Villareal criteria and twenty patients with confirmed systemic sclerosis according to the American College of Rheumatology and the European League against Rheumatism classification criteria for Systemic Sclerosis. Nailfold examination for the study subjects was performed describing architectural derangement, capillary density changes, mega capillary and enlarged loops, microhemorrhages, and angiogenesis.
Results: Of the sixty patients studied, 49 (81.7%) patients were females and 11 were males with a mean age of 31 years with a median of 29.5 and range 16–52 years. Three of the twenty patients diagnosed with systemic sclerosis had arthritis. Out of sixty patients, 53.3% had thickened skin, 19 patients exhibited puffy fingers, six patients showed rash, and none had swollen joints. The skin was significantly thicker in systemic sclerosis patients (85%) compared to 37.5% in the MCTD population. Patients presented with various features, the most common of which was fatigue (26.7%) and myositis (23% of patients). There is a significant negative correlation of −0.508 (P = 0.022) between the enlargement scores and illness duration in systemic sclerosis patients. Those patients also exhibited a statistically significant positive correlation of 0.520 (P = 0.019) between hemorrhage score and the number of tender joints. Alternatively, patients diagnosed with MCTD exhibited a significant positive correlation between the architectural changes scores of their joints and both the duration of their illness (0.347; P = 0.028) and the number of swollen joints (0.424; P = 0.006). MCTD patients also showed a significant correlation of 0.423 (P = 0.007) between their hemorrhage scores and their age at the time of the study.
Conclusion: In this study, the results obtained were qualitatively satisfactory for clear delineation of the nailfold capillaries features in MCTD. Therefore, it aids in the recognition of alternations in nailfold capillaries making an early prediction of course of illness in MCTD patients possible and suggests a potential ability to differentiate from early SSc, thus helps in preventing morbidities and sequelae of the disease.
Abstract Background Hidden blood loss (HBL) is of increasing interest to spine surgeons. This retrospective study aimed to evaluate perioperative HBL and its risk factors in patients undergoing one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament (T-OPLL). Method We retrospectively studied 112 patients diagnosed with T-OPLL following posterior circumferential decompression surgery from August 2015 to June 2020. Patient demographics, blood loss-related parameters, surgery-related data and imaging parameters were extracted. Postoperative complications were also recorded. Pearson or Spearman correlation analysis was used to investigate the correlation between patient demographics and HBL. Multivariate linear regression analysis was performed to determine the independent risk factors associated with HBL. Results Forty-five men and 67 women were involved in this research, with an average age of 56.4 ± 10.2 years. The mean HBL was 459.6 ± 275.4 ml, accounting for 56.5% of the total blood loss. Multiple linear regression analysis showed that double-layer sign (P = 0.000), ossification occupancy ratio (OOR) > 60% (P = 0.030), age (P = 0.010), hematocrit (Hct) loss (P = 0.034), and postoperative Hct (P = 0.016) were independent risk factors for HBL. However, OPLL morphology (P = 0.319), operation time (P = 0.587), hemoglobin (Hb) loss (P = 0.644), and postoperative Hb (P = 0.952) were not significantly different from HBL. Conclusion A high proportion of HBL was found after posterior circumferential decompression surgery on T-OPLL during the perioperative period, which should not be overlooked. Double-layer sign, OOR > 60%, age, Hct loss and postoperative Hct are independent risk factors for HBL.
Nicole Paland, Haya Hamza, Antonina Pechkovsky
et al.
Rheumatoid diseases, including rheumatoid arthritis, osteoarthritis, and fibromyalgia, are characterized by progressive inflammation in the musculoskeletal system, predominantly affecting the joints and leading to cartilage and bone damage. The resulting pain and ongoing degradation of the musculoskeletal system contribute to reduced physical activity, ultimately impacting quality of life and imposing a substantial socioeconomic burden. Unfortunately, current therapeutics have limited efficacy in slowing disease progression and managing pain. Thus, the development of novel and alternative therapies is imperative. Cannabinoids possess beneficial properties as potential treatments for rheumatoid diseases due to their anti-inflammatory and analgesic properties. Preclinical studies have demonstrated promising results in halting disease progression and relieving pain. However, there is a scarcity of patient clinical studies, and the available data show mixed results. Consequently, there are currently no established clinical recommendations regarding the utilization of cannabis for treating rheumatoid diseases. In this review, we aim to explore the concept of cannabis use for rheumatoid diseases, including potential adverse effects. We will provide an overview of the data obtained from preclinical and clinical trials and from retrospective studies on the efficacy and safety of cannabis in the treatment of rheumatoid diseases.
Roberto Alfonso Guzman, Masahiro Maruyama, Seyedsina Moeinzadeh
et al.
AbstractBackgroundApproximately one third of patients undergoing core decompression (CD) for early-stage osteonecrosis of the femoral head (ONFH) experience progression of the disease, and subsequently require total hip arthroplasty (THA). Thus, identifying adjunctive treatments to optimize bone regeneration during CD is an unmet clinical need. Platelet-derived growth factor (PDGF)-BB plays a central role in cell growth and differentiation. The aim of this study was to characterize mesenchymal stromal cells (MSCs) that were genetically modified to overexpress PDGF-BB (PDGF-BB-MSCs) in vitro and evaluate their therapeutic effect when injected into the bone tunnel at the time of CD in an in vivo rabbit model of steroid-associated ONFH.MethodsIn vitro studies:Rabbit MSCs were transduced with a lentivirus vector carrying the human PDGF-BB gene under the control of either the cytomegalovirus (CMV) or phosphoglycerate (PGK) promoter. The proliferative rate, PDGF-BB expression level, and osteogenic differentiation capacity of unmodified MSCs, CMV-PDGF-BB-MSCs, and PGK-PDGF-BB-MSCs were assessed. In vivo studies: Twenty-four male New Zealand white rabbits received an intramuscular (IM) injection of methylprednisolone 20 mg/kg. Four weeks later, the rabbits were divided into four groups: the CD group, the hydrogel [HG, (a collagen-alginate mixture)] group, the MSC group, and the PGK-PDGF-BB-MSC group. Eight weeks later, the rabbits were sacrificed, their femurs were harvested, and microCT, mechanical testing, and histological analyses were performed.ResultsIn vitro studies:PGK-PDGF-BB-MSCs proliferated more rapidly than unmodified MSCs (P < 0.001) and CMV-PDGF-BB-MSCs (P < 0.05) at days 3 and 7. CMV-PDGF-BB-MSCs demonstrated greater PDGF-BB expression than PGK-PDGF-BB-MSCs (P < 0.01). However, PGK-PDGF-BB-MSCs exhibited greater alkaline phosphatase staining at 14 days (P < 0.01), and osteogenic differentiation at 28 days (P = 0.07) than CMV-PDGF-BB-MSCs. In vivo:The PGK-PDGF-BB-MSC group had a trend towards greater bone mineral density (BMD) than the CD group (P = 0.074). The PGK-PDGF-BB-MSC group demonstrated significantly lower numbers of empty lacunae (P < 0.001), greater osteoclast density (P < 0.01), and greater angiogenesis (P < 0.01) than the other treatment groups.ConclusionThe use of PGK-PDGF-BB-MSCs as an adjunctive treatment with CD may reduce progression of osteonecrosis and enhance bone regeneration and angiogenesis in the treatment of early-stage ONFH.
Abstract Background Postoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown. Methods A retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications. Results A total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications. Conclusions For congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.