Hasil untuk "Diseases of the musculoskeletal system"

Chenchen Li, He Gong, Haipeng Cen et al.

Abstract Background While exercise is widely recognized to enhance bone mass, the underlying molecular and cellular mechanisms remain incompletely elucidated. The present study was designed to investigate the effect of moderate-intensity exercise on skeletal quality, morphological characteristics, and metabolic homeostasis in adult Sprague-Dawley (SD) rats. Methods An animal treadmill exercise model was established using 16-week-old male specific pathogen-free SD rats. Following the 6-week moderate-intensity exercise, bilateral tibiae were harvested for analysis. Body indices of obesity and glucose metabolism were evaluated after the training period. Micro-computed tomography scanning was used to assess three-dimensional bone microarchitecture, while hematoxylin and eosin staining was employed to characterize bone morphological features. RNA sequence and reverse transcription-quantitative PCR identified and validated differentially expressed mRNAs in bone, with bioinformatics analyses predicting their target signaling pathways. Additionally, immunohistochemical staining quantified protein expression of osteogenic, osteoclastic, key pathway and mechanosensitive markers. The apoptosis rate was determined by TdT-mediated dUTP nick end labeling staining. Serum bone turnover markers and inflammatory cytokines were measured after exercise intervention via ELISA kits. Results Compared with the Control group, exercised rats showed decreasing trends in body weight, Lee’s index, and BMI, with a tendency toward increased tibial length. No significant difference was observed in fasting blood glucose between two groups. Micro-CT analysis revealed that exercise significantly increased trabecular bone volume fraction (BV/TV) and trabecular number (Tb.N). At the molecular level, exercise upregulated osteogenic proteins (COL1, OCN) and serum P1NP, while downregulating bone resorption markers (Sclerostin, RANKL, TRAP) and serum CTX. Further, differentially expressed genes were detected, and functional enrichment analyses revealed that the p53/Caspase-3 pathway and inflammatory factors were significantly down-regulated in the Exercise group. Apoptosis rate was significantly decreased after exercise in bone tissue. Treadmill training also resulted in increased protein expression of Piezo1. Conclusions Moderate-intensity treadmill exercise enhanced tibial cancellous bone microstructure and bone quality in adult SD rats by improving the balance of bone remodeling via p53/Caspase-3 signaling pathway. Furthermore, the alteration of p53 signaling pathway may be driven by the activation of mechanosensitive markers. These findings provide mechanistic insights into exercise-induced improvement of bone quality. Clinical trial number Not applicable.

Jingye Hu, Xin Huang

Abstract Background Intermedullary nailing (IMN) is the gold standard for the surgical treatment of extra-articular tibial fractures. The suprapatellar (SP) nailing approach offers several advantages over the conventional infrapatellar (IP) approach. However, most existing evidence is derived from retrospective observational studies. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of the SP and IP approaches in extra-articular tibial fracture management. Methods RCTs were searched in PubMed, EMBASE, Web of Science, ClinicalTrials.gov, the Cochrane Library, and Google Scholar through December 31, 2024. Perioperative outcomes, visual analog scale (VAS) pain score, knee function metrics, and postoperative complications were compared using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence interval (CI). The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results RCTs were searched in PubMed, EMBASE, RCTs were searched in PubMed, EMBASE, SP approach was associated with significantly shorter operative time (WMD=-13.19 min, 95%CI: -24.37 to -2.02, p=0.021) and fluoroscopy time (WMD=-20.23, 95%CI:-39.74 to -0.71, p=0.042). Additionally, the SP approach resulted in lower VAS pain score (WMD=-1.10, 95%CI: -1.90 to -0.31, p=0.007) and improved Lysholm knee score (WMD=4.22, 95%CI: 2.34 to 6.10, p<0.001) and KUJALA score (WMD=12.95, 95%CI: 10.78 to 15.13, p<0.001). No significant differences were observed in intraoperative blood loss, length of hospital stay, range of motion, union time, or complication rates (delayed union, nonunion, infection, secondary operation). Conclusions The SP nailing approach is a safe and effective alternative to the traditional IP approach and may be recommended for the surgical treatment of extra-articular tibial fractures.

Sumedh D Chaudhary, Akshay Phupate, Nilesh S Sakharkar et al.

Introduction: Fractures involving the supracondylar or distal end radius are the most common fracture in pediatric population. Although they have similar mechanisms of injury, i.e., hyperextension, they occur in isolation and combined supracondylar and distal end radius injuries in the same limb are extremely uncommon. We are reporting an extremely rare clinical presentation of a child with ipsilateral supracondylar fracture with fracture of distal end radius and ulna associated with acute compartment syndrome (ACS). Case Report: A 13-year-old male had sustained trauma to left upper limb due to fall from tree. He was initially treated elsewhere with suturing of wound over his forearm and was brought to our emergency room after 12 h with complaints of swelling and severe pain in left arm, forearm, and hand. On clinical examination, there was tense swelling over the left arm, forearm, and hand. Passive stretch pain was present. Limb was warm, there were multiple blisters present over the flexor aspect over anti-cubital fossa of the left limb. On vascular and neurological evaluation, sensation was decreased compared to other limb over the volar aspect of the hand and forearm, also the pulses were feeble. The patient was immediately sent for Doppler of the left upper limb which showed biphasic flow. X-rays revealed ipsilateral left supracondylar humerus fracture (Type 4 according to Gartland Classification) with distal end radius and distal ulna fracture. As the patient had developed ACS which was evident from the tense swelling and passive stretch pain, we decided to urgently operate the patient with fasciotomy followed by fracture fixation. Wound was closed by shoelace suturing technique, and then, split-thickness skin grafting was done. K-wires were after a period of 6 weeks and gradual range of motion exercises was started. Conclusion: Ipsilateral supracondylar with distal end radius with ACS is a rare entity. ACS should be given priority and fasciotomy must be done properly so as to ensure adequate decompression of intercompartmental pressure. This should be followed by fixation of the fractures. If appropriate intervention is done urgently, good results can be achieved even in such challenging injuries.

Omnia A. Abubakr, Amira R. El Mahdi, Mahy El- Bassiouny et al.

Abstract Background Psoriatic arthritis (PsA) is a long-term immune mediated condition. That can develop in individuals with psoriasis, often before any obvious symptoms appear. These asymptomatic individuals, classified as having occult PsA, may already have joint involvement detectable only through imaging, making early diagnosis difficult. Timely identification is essential to avoid permanent structural damage. This study investigates the possible use of hematological inflammatory markers in identifying hidden or undiagnosed PsA. Methods A case–control study involved 60 patients with psoriasis. were divided into two groups: 30 with imaging-confirmed occult psoriatic arthritis (PsA) and 30 with psoriasis only, all without clinical arthritis. Hematological inflammatory biomarkers including neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), and platelet-to-monocyte ratio (PMR) were assessed from venous blood samples. Musculoskeletal ultrasonography was performed to detect subclinical joint involvement. Results Patients with occult PsA showed significantly elevated levels of white blood cells, neutrophils, and monocytes. In addition, inflammatory markers such as the NLR, dNLR, MLR, SII, SIRI, and AISI were also notably increased, while PMR was decreased (all p < 0.001). NLR and dNLR demonstrated perfect diagnostic accuracy (AUC = 1.000). WBC > 6.7, MLR > 0.17, and PMR ≤ 503 were independently associated with occult PsA. Conclusion Hematological markers, especially NLR, dNLR, and MLR, may serve as effective, low-cost tools for early identification of occult PsA in psoriasis patients, enabling earlier intervention and improved outcomes.

Jiahao Sun, Zhipeng Li, Shaowei Liu et al.

Abstract Background The use of degradable magnesium screws to fix the bone flap implanted in the treatment of femoral head necrosis has achieved preliminary good therapeutic results. However, there is no conclusive evidence in the study to demonstrate whether biodegradable magnesium screws promote angiogenesis and no comparison has been made between degradable magnesium screws and traditional screws. Objective To investigate the clinical efficacy and safety of biodegradable magnesium screws in pedicled vascularized iliac bone graft transfer (PVIBGT) for osteonecrosis of the femoral head (ONFH). Materials and methods A total of thirty-six patients (37 hips) with ONFH were recruited from March 2020 to July 2022. The study used a single-blind method, and patients who underwent PVIBGT were randomized into three groups: 12 patients (12 hips) were fixed with biodegradable magnesium screws (Group A), 12 patients (13 hips) were fixed with titanium screws (Group B), 12 patients (12 hips) were directly embedded (Group C). The operating time and the length of stay were recorded. Harris scores, radiological examinations (X-ray, CT, DCE-MRI), blood and serum tests were conducted before and after surgery. The gas yield and degradation rates of the magnesium screws were measured at the 3-months and 6-months post-operative follow-ups in Group A. Results There was no statistically significant difference among these three groups in terms of types, gender, age, course of disease, surgical side, operation time, the length of stay (P > 0.05). All patients were followed up for 6 months. The mean Harris scores were higher in all groups 6 months after surgery (P < 0.05). The rates of excellent and good outcomes were 66.7%, 46.2%, and 33.3% in Groups A, B, and C, respectively. PVIBGT and magnesium screws can improve the blood supply of the femoral head via DCE-MRI evaluation. Two patients with poor incision healing received prompt treatment and subsequently recovered well. No adverse events, such as hip infection or deep vein thrombosis, were reported in the patients. The patients had good biocompatibility of magnesium screws, and no fracture of the magnesium screws was observed in Group A. Liver and kidney functions (including serum magnesium) were within normal ranges. The area of the intermuscular air space was 0 cm2 in follow-ups. The degradation rate of the biodegradable magnesium screws was approximately 10.32% at the 3-months follow-up and 13.72% at the 6-months follow-up. Conclusions PVIBGT has a positive effect, especially with regard to improving blood supply of the femoral head. The fixation of biodegradable magnesium screws is reliable and safe in PVIBGT, and promote angiogenesis.

Yong Jae Kwon, Young Cheol Yoon, Hyun Su Kim et al.

Abstract Background We investigated the prognostic significance of body mass index in small‐cell lung cancer and explored whether skeletal muscle status affects the body mass index–survival relationship. Methods This retrospective study evaluated data from patients who underwent platinum‐etoposide chemotherapy for small‐cell lung cancer between March 2010 and December 2021. Skeletal muscle status was assessed using non‐contrast computed tomography images of baseline positron‐emission tomography‐computed tomography, with the skeletal muscle index defined as the cross‐sectional area of skeletal muscle divided by height squared, and the average attenuation values of skeletal muscle. Cox proportional hazards regression analysis was used to determine the correlations of body mass index, skeletal muscle metrics, and overall survival. Results We analysed the data of 1146 Asian patients (1006 men and 140 women, with a median age of 67 years [interquartile range: 61–72 years]), including 507 and 639 patients with limited and extensive disease, respectively. Being underweight, defined as a body mass index <18.5 kg/m2, was associated with shorter overall survival, independent of clinical covariates in both the limited‐disease (hazard ratio, 1.77; 95% confidence interval, 1.01–3.09) and extensive‐disease (hazard ratio, 1.71; 95% confidence interval, 1.18–2.48) groups. The prognostic value of being underweight remained significant after additional adjustment for skeletal muscle index and attenuation in both limited‐disease (hazard ratio, 1.96; 95% confidence interval, 1.09–3.51) and extensive‐disease (hazard ratio, 1.75; 95% confidence interval, 1.17–2.61) groups. Conclusions Being underweight is an independent poor prognostic factor for shorter overall survival in Asian patients with small‐cell lung cancer, regardless of skeletal muscle status.

Renée H. Fiechter, Janne W. Bolt, Marleen G. H. van de Sande et al.

Abstract Background Analyses of lymphoid organs are required to further elucidate the pathogenesis of inflammatory diseases like rheumatoid arthritis (RA). Yet, invasive tissue collection methods are scarcely applied, because they are often considered burdensome, although patients do not always consider invasive methods as a high burden. We aimed to investigate the perspectives of study participants undergoing ultrasound-guided inguinal lymph node (LN) needle biopsy sampling and determine the molecular and cellular quantity and quality of LN biopsies. Methods Together with patient research partners, questionnaires were developed to evaluate the motives, expectations, and experiences of participants undergoing a LN biopsy. Healthy controls and RA(-risk) patients were asked to complete these questionnaires before and after the procedure. RNA and lymphocyte yields from obtained LN biopsies were also calculated. Results We included 50 individuals, of which 43 (86%) reported their pre- and post-procedure experiences. The median reported pain on a 5-point Likert scale (1 not to 5 very painful) was 1. Interestingly, almost all (n = 32; 74%) study participants would undergo a second procedure and more than half (n = 23; 54%) would encourage others to take part in the LN biopsy study. Motives for current and future participation were mostly altruistic. Inguinal hematoma occurred frequently, but no other significant or unexpected complications ensued. The LN biopsies yielded sufficient and high-quality RNA and lymphocyte numbers. Conclusions Ultrasound-guided inguinal LN biopsy sampling is well-tolerated, safe, and provides sufficient material for further molecular and cellular analyses. Our participants’ positive experiences endorse the application of this research tool to further elucidate the pathogenesis of RA and other inflammatory diseases.

Ruo-Yan Wu, Ren-Hao Pan, Chiung-Yi Wu et al.

Abstract Background During varied weather conditions, patients with osteoarthritis experience different severity of symptoms and signs. However, weather may also cause barriers or incentives for patients to seek medical services. These factors may result in changes in medical utilisation; however, no studies have investigated whether the probability of physical therapy utilisation among patients with osteoarthritis is associated with changes in meteorological factors. Method By using a secondary data of NHID in Taiwan, we conducted a population-based, retrospective study with case-crossover design for patients initially diagnosed with osteoarthritis between 2000 and 2013. The meteorological factors of months with the lowest treatment rate were used as patients’ own control periods and compared with the parameters of months with high treatment frequency. The risk of exposure to different meteorological factors, including mean temperature, daily highest temperature, daily minimum temperature, diurnal temperature range, relative humidity, and barometric pressure, was estimated and represented by odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 8,130 patients were recruited. Regardless of univariate or multivariable analysis, increased daily highest temperature enhanced the frequency of physical therapy (OR: 1.04; 95% CI: 1.02–1.05; p < 0.01; OR: 1.07; 95% CI: 1.04–1.10; p < 0.01). When the weather was hotter (> 23 °C), higher diurnal temperature range and humidity resulted in an increase in the utilisation of physical therapy. However, when the weather was colder (< 23 °C), reverse effects were observed. Conclusions An increase in temperature increases the probability of physical therapy resource use. Therefore, temperature, along with other meteorological factors, may play a key role in the utilization of physical therapy among patients with osteoarthritis.

Jun Kawamata, MD, Naoki Suenaga, MD, PhD, Naomi Oizumi, MD, PhD et al.

Background: In our previous report, glenoid wear (GW) after humeral head replacement for cuff tear arthropathy was classified with modified Goya’s classification (grade 0-3), and, among 3 subtypes of grade 3 (glenoid bone erosion), grade 3B (superior eccentric erosion) showed significantly more pain and limited active flexion postoperatively compared to grade 3C (concentric erosion). The purpose of this study was to detect individual risk factors for the progression to grade 3B GW. Methods: Seventy-nine shoulders in 70 patients who were followed up for a mean of 8.2 years (range, 5.0-13.2 years), including 29 men and 41 women, with a mean age at the surgery of 71.1 years (range, 54-87 years), were reviewed. Atrophy and fatty degeneration of torn cuff muscle, preoperative humeral head displacement (superior translation ratio [STR], anterior translation ratio, and other several parameters) on preoperative magnetic resonance imaging, and other individual factors were analyzed as possible risk factors. Results: GW at the final follow-up was grade 0: 5 shoulders, grade 1: 17, grade 2: 20, and grade 3: 37 (3A: 4, 3B: 22, and 3C: 11). Preoperative higher STR was defined as a risk factor for grade 3 GW (odds ratio, 35.5; 95% confidence interval, 1.8-693.0; P = .018). Comparison among the three subtypes of grade 3 showed that patients with grade 3B GW had larger STR than 3C (41.4 ± 14.2% vs. 23.5 ± 13.3 % P = .006). Conclusion: Patients with preoperative high STR are considered to have a risk for grade 3B GW, which possibly relates to poor clinical outcome and future revision.

Fei Wang, Kai Chen, Tao Ji et al.

Abstract Study design A retrospective case–control study. Objective To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS). Methods Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. Results The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. Conclusions Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.

Marie Schild, Ulrike Müller, Ursula von Schenck et al.

Abstract Background Osteoarthritis (OA) is a common condition that is often associated with chronic pain. Pain often leads patients to seek healthcare advice and treatment. In this retrospective cohort analysis of German longitudinal healthcare claims data, we aimed to explore the healthcare resource utilisation (HRU) and related healthcare costs for patients with OA who develop chronic pain. Methods Patient-level data was extracted from the German Institut für Angewandte Gesundheitsforschung (InGef) database. Insured persons (≥18 years) were indexed between January 2015 and December 2017 with a recent (none in the last 2 years) diagnosis of OA. HRU and costs were compared between patients categorised as with (identified via diagnosis or opioid prescription) and without chronic pain. Unweighted HRU (outpatient physician contacts, hospitalisations, prescriptions for physical therapy or psychotherapy, and incapacity to work) and healthcare costs (medication, medical aid/remedy, psychotherapy, inpatient and outpatient and sick pay in Euros [quartile 1, quartile 3]) were calculated per patient for the year following index. Due to potential demographic and comorbidity differences between the groups, inverse probability of treatment weighting (IPTW) was used to estimate weighted costs and rate ratio (RR; 95% confidence interval) of HRU by negative binomial regression modelling. Results Of 4,932,543 individuals sampled, 238,306 patients with OA were included in the analysis: 80,055 (34%) categorised as having chronic pain (24,463 via opioid prescription) and 158,251 (66%) categorised as not having chronic pain. The chronic pain cohort was slightly older, more likely to be female, and had more comorbidities. During the year following index, unweighted and IPTW-weighted HRU risk and healthcare costs were higher in patients with chronic pain vs those without for all categories. This led to a substantially higher total annual healthcare cost ─ observed mean; €6801 (1439, 8153) vs €3682 (791, 3787); estimated RR = 1.51 (1.36, 1.66). Conclusions German patients with chronic pain and OA have higher healthcare costs and HRU than those with OA alone. Our findings suggest the need for better prevention and treatment of OA in order to reduce the incidence of chronic pain, and the resultant increase in disease burden experienced by patients.

Jin Tao, Hui Chen, Xiaolei Li et al.

Abstract Background The over-proliferation of fibroblasts is considered to be the main cause of scar adhesion after joint surgery. Hydroxycamptothecin (HCPT), though as a potent antineoplastic drug, shows preventive effects on scar adhesion. This study aimed to investigate the role of activating transcription factor 6 (ATF-6) in the HCPT-induced inhibition of fibroblast viability. Methods The cell counting kit-8 (CCK-8) assay, western blot analysis, lentivirus-mediated gene silencing, transmission electron microscopy (TEM) analysis, immunofluorescent staining for autophagy-related protein light chain 3 (LC3) were used to explore the effect of HCPT on triggering fibroblast apoptosis and inhibiting fibroblast proliferation, and the involvement of possible signaling pathways. Results It was found that HCPT exacerbated fibroblast apoptosis and repressed its proliferation. Subsequently, endoplasmic reticulum stress (ERS)-related proteins were determined by western blot prior to ATF6 p50 was screened out and reexamined after it was silenced. As a result, ATF6-mediated ERS played a role in HCPT-induced fibroblast apoptosis. Autophagy-related proteins and autophagosomes were detected after the HCPT administration using western blot and TEM analyses, respectively. Autophagy was activated after the HCPT treatment. With the co-treatment of autophagy inhibitor 3-methyladenine (3-MA), both the western blot analysis and the CCK-8 assay showed inhibited autophagy, which indicated that the effect of HCPT on fibroblast proliferation was partially reversed. Besides, the LC3 immunofluorescence staining revealed suppressed autophagy after silencing ATF6 p50. Conclusion Our results demonstrate that HCPT acts as a facilitator of fibroblast apoptosis and inhibitor of fibroblast proliferation for curbing the postoperative scar adhesion, in which the ATF6-mediated ERS pathway and autophagy are involved.

Yusho Ishii, Hiroshi Fujii, Koichiro Sugimura et al.

Systemic sclerosis (SSc) is characterized by skin sclerosis and multiple organ damages which may cause mortality and is usually accompanied with several specific autoantibodies, each of which is associated with characteristic complications. Among them, anticentriole antibody is recently reported to be highly associated with SSc-associated pulmonary arterial hypertension (SSc-PAH). In general, several vasodilators are used as therapeutic drugs for SSc-PAH, whereas immunosuppressive therapies are not. Here, we report the case of a 62-year-old female with anticentriole antibody-positive SSc-PAH treated with immunosuppressants and vasodilators. She presented with two-year exertional dyspnea and was diagnosed with PAH and SSc owing to the centriole staining pattern and other symptoms without digital sclerosis. Oral vasodilators were initially administered but were not sufficiently effective on dyspnea. Immunosuppressants such as prednisolone and cyclophosphamide were started. Both of them improved mean pulmonary arterial pressure and 6-minute walk distance, and the anticentriole antibody also disappeared. In this case, SSc-PAH with anticentriole antibody was properly diagnosed and immunosuppressants and vasodilators improved the hemodynamics of PAH with anticentriole antibody and stably maintained it and, in addition, reduced the titer of anticentriole antibody. This indicates that anticentriole antibody might represent a good responsive group to therapies among subgroups of patients with SSc-PAH.

Hyun Jun Kim, Eun Soo Park, Sang Ho Lee et al.

Cement-augmented pedicle screw instrumentation (CAPSI) is a widely used surgical technique in posterior spondylodesis of osteoporotic patients. Complications related to cement leakage after CAPSI was rarely reported compare to that of vertebroplasty, kyphoplasty and most of them are asymptomatic. Herein the authors report the case of a 67-year-old female who experienced cardiac perforation by string shape cement embolus after CAPSI. She underwent the foreign body removal operation through the 5th intercostal thoracotomy and she was well recovered consequently. Surgeons should be aware of this complication entity when encounter postoperative chest pain to avoid fatal results. The authors also reviewed the case reports for cardiac perforation by cement embolus and preventive modalities for the cement leakage.

Vedavathi Madhu, Abhijit S. Dighe, Quanjun Cui et al.

Damage to the nervous system can cause devastating diseases or musculoskeletal dysfunctions and transplantation of progenitor stem cells can be an excellent treatment option in this regard. Preclinical studies demonstrate that untreated stem cells, unlike stem cells activated to differentiate into neuronal lineage, do not survive in the neuronal tissues. Conventional methods of inducing neuronal differentiation of stem cells are complex and expensive. We therefore sought to determine if a simple, one-step, and cost effective method, previously reported to induce neuronal differentiation of embryonic stem cells and induced-pluripotent stem cells, can be applied to adult stem cells. Indeed, dual inhibition of activin/nodal/TGF-β and BMP pathways using SB431542 and dorsomorphin, respectively, induced neuronal differentiation of human adipose derived stem cells (hADSCs) as evidenced by formation of neurite extensions, protein expression of neuron-specific gamma enolase, and mRNA expression of neuron-specific transcription factors Sox1 and Pax6 and matured neuronal marker NF200. This process correlated with enhanced phosphorylation of p38, Erk1/2, PI3K, and Akt1/3. Additionally, in vitro subcutaneous implants of SB431542 and dorsomorphin treated hADSCs displayed significantly higher expression of active-axonal-growth-specific marker GAP43. Our data offers novel insights into cell-based therapies for the nervous system repair.

Daniel R. Bonanno, George S. Murley, Shannon E. Munteanu et al.

Abstract Background Foot orthoses are frequently used for the prevention of lower limb overuse injuries but evidence for their effectiveness is limited. The primary aim of this study is to determine if prefabricated foot orthoses reduce the incidence of lower limb overuse injuries in naval recruits undertaking 11 weeks of basic training. Methods This study is a participant and assessor blinded, parallel‐group, randomised controlled trial. The trial will recruit participants undertaking 11 weeks of basic training at the Royal Australian Navy Recruit School, Cerberus, Victoria, Australia. Participants will be randomised to a control group (flat insole) or an intervention group (prefabricated foot orthosis). Over the 11 weeks of basic training, participants will document the presence and location of pain in weekly self‐report diaries. The end‐point for each participant will be the completion of 11 weeks of basic training. The primary outcome measure will be the combined incidence of four lower limb injuries (medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy, and plantar fasciitis/plantar heel pain) which are common among defence members. Secondary outcome measures include: (i) overall incidence of lower limb pain, (ii) severity of lower limb pain, (iii) time to injury, (iv) time to drop‐out due to injury, (v) adverse events, (vi) number of lost training days, (vii) shoe comfort, and (viii) general health status. Data will be analysed using the intention‐to‐treat principle. Discussion This randomised controlled trial will evaluate the effectiveness of prefabricated foot orthoses for the prevention of common lower limb overuse injuries in naval recruits. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.

Gurjot Basra, Praveen Jajoria, Emilio Gonzalez

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. Multiple scientific articles have documented that vaccinations for influenza, MMR, and HBV, to name a few, could be triggers of RA in genetically predisposed individuals. However, there is limited data regarding the association of swine flu vaccine (H1N1) and RA. We report the case of a Mexican American female who developed RA right after vaccination with H1N1 vaccine. Genetically, RA has consistently been associated with an epitope in the third hypervariable region of the HLA-DR 𝛽 chains, known as the “shared epitope”, which is found primarily in DR4 and DR1 regions. The presence of HLA-DRB1 alleles is associated with susceptibility to RA in Mexican Americans. Hence, certain individuals with the presence of the “shared epitope” may develop RA following specific vaccinations. To our knowledge, this is the first reported case of RA following vaccination with the swine flu vaccine.

Nester Christopher J, Williams Anita E, Ravey Michael I

<p/> <p>Background</p> <p>Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not.</p> <p>Method</p> <p>Ten females and three males with RA and experience of wearing specialist footwear were recruited from four National Health Service orthotic services. Semi-structured interviews were carried out in the participants own homes. A hermeneutic phenomenological analysis of the transcripts was carried out to identify themes.</p> <p>Results</p> <p>The analysis revealed two main themes from both the female and male groups. These were the participants' feelings about their footwear and their experiences of the practitioner/s involved in providing the footwear. In addition, further themes were revealed from the female participants. These were feelings about their feet, behaviour associated with the footwear, and their feelings about what would have improved their experience.</p> <p>Conclusion</p> <p>Unlike any other intervention specialist therapeutic footwear replaces something that is normally worn and is part of an individual's body image. It has much more of a negative impact on the female patients' emotions and activities than previously acknowledged and this influences their behaviour with it. The patients' consultations with the referring and dispensing practitioners are pivotal moments within the patient/practitioner relationship that have the potential to influence whether patients choose to wear the footwear or not.</p>

Vitalina de Souza Barbosa, Nílzio Antônio da Silva, Regina Maria Bringel Martins

A infecção pelo vírus da hepatite C (HCV) desperta grande interesse em reumatologia por apresentar várias manifestações extra-hepáticas. Diversos estudos mostram associação elevada da infecção pelo HCV com manifestações reumáticas como dores musculares, crioglobulinemia mista, síndrome reumatóide, síndrome de Sjögren, vasculite, glomerulonefrite, fenômeno de Raynaud, poliarterite nodosa, miopatia, auto-anticorpos e outras manifestações de doença difusa do tecido conjuntivo. Em estudos anteriores realizados em nosso meio verificou-se a prevalência de 0,9% em gestantes, 1,4% em doadores de sangue, 1,8% em paciente com hanseníase e 2,0% em trabalhadores da área da saúde. OBJETIVO: determinar a prevalência da infecção pelo HCV em pacientes com lúpus eritematoso sistêmico (LES) atendidos no Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Goiás (HC-FM-UFG). MÉTODOS: foram entrevistados 175 pacientes com LES e amostras sangüíneas coletadas. Inicialmente, pesquisou-se a presença de anticorpos para o HCV (anti-HCV). As amostras anti-HCV positivas foram submetidas à detecção do RNA viral, pela reação em cadeia da polimerase (PCR) com primers complementares à região 5' não codificante do HCV. As amostras positivas foram genotipadas por line probe assay. RESULTADOS: a prevalência encontrada foi de 2,3% (4/175), e a identificação dos genótipos nas amostras RNA-HCV positivas revelou a presença do tipo 1 do HCV em três pacientes (75%) e do tipo 3 em um paciente (25%). Das quatro pacientes infectadas, três apresentaram evolução clínica favorável e uma evoluiu para óbito em razão de insuficiência renal por nefrite lúpica. CONCLUSÕES: a prevalência de HCV em pacientes com LES revelou-se um pouco maior que a encontrada anteriomente em gestantes, doadores de sangue e em hansenianos, comparável à encontrada em trabalhadores da saúde.<br>The hepatitis C virus (HCV) infection is a source of concern in rheumatology because of its extrahepatic manifestations. Many studies have reported association between HCV infection and rheumatological manifestations such as: musculoskeletal pain, essential mixed cryoglobulinemia, rheumatoid arthritis, Sjögren's syndrome, vasculitis, glomerulonephritis, Raynaud's phenomenon, polyarteritis nodosa, myositis, autoantibody and other connective tissue diseases. In previous studies developed in our region, prevalences of 0.9%, 1.4%, 1.8% and 2.0% were detected among pregnant women, blood donors, leprosy patients and health professionals, respectively. OBJECTIVE: to investigate the prevalence of hepatitis C virus infection among patients with systemic lupus erythematosus (SLE) in Goiânia, Brazil. METHODS: 175 patients were interviewed and had blood samples tested for HCV antibodies (anti-HCV) by a third generation enzyme linked immunosorbant assay (ELISA). RNA-HCV was detected by polymerase chain reaction (PCR) with primers complementary the 5' non-coding region of the HCV genoma, in all anti-HCV positive serum samples and genotyped by a line probe assay. RESULTS: an overall HCV infection prevalence of 2.3% (4/175) was found. Genotyping of RNA-HCV positive samples revealed HCV type 1 in 3 (75%) and type 3 in 1 (25%) patient. Clinical course was favorable in all HCV positive patients, except one, who died due to renal insuficiency related to lupus nephritis. CONCLUSIONS: anti-HCV prevalence among patients with SLE was slitghly higher than the prevanlence observed in pregnant women, healthy blood donors and leprosy patients, and similar to health professionals.