Hasil untuk "Osteopathy"

Anton Sokhan, Markus A. Hartmann, Stéphane Blouin et al.

Methotrexate (MTX) play an important role in oncology, where it is used in high-dose therapy regimens. However, its associated dose-dependent toxicity, including MTX-osteopathy, poses a serious clinical problem, particularly in pediatric oncology. Even in patients with inflammatory rheumatic diseases receiving low doses, rare cases of MTX-osteopathy have been reported. This review provides an updated discussion of the side effects of high-dose MTX (HD-MTX), with the aim of improving understanding of the pathophysiology underlying its effects on bone, identifying potential supportive treatments, and highlighting new areas of research that could enhance the understanding and management of chemotherapy-related adverse effects. Methodology: A review of the available literature was conducted to analyse the impact of HD-MTX on bone tissue. Results: MTX disrupts bone homeostasis and microarchitecture through a variety of cell-specific mechanisms. These effects trigger a cascade of negative outcomes, including abnormalities in macrometric and structural bone histomorphometric parameters, as well as impaired bone healing. Few studies have evaluated the protective effects of adjunctive therapies, and those that do exist demonstrate only partial protection. This highlights the need for further research to develop more effective strategies to prevent MTX-induced bone toxicity. Conclusions: Available data suggest that the effects of HD-MTX involve multiple mechanisms that disrupt bone homeostasis, including impaired osteoblast function, enhanced osteoclastogenesis, altered osteocyte viability, increased bone marrow adipogenesis, and endothelial damage. These changes lead to reduced bone density, compromised microarchitecture, and impaired healing. This highlights the importance of multi-targeted strategies to prevent MTX-induced bone damage and improve skeletal outcomes.

Christophe Raspaud, Laurence Culine, Joanne Velazquez et al.

Objective: This large-scale survey aimed to investigate the use of Complementary and Integrative Medicine (CIM) across France. Design: Observation multicentric study. Setting: This survey study was conducted from October 10, 2022 to October 28, 2022 in medical, surgical, and obstetric clinics across France. Self-administered questionnaires specifically designed for the study were used to collect data related to subjects’ prior use of CIM (type of therapy used, reasons for use, cost, duration, who recommended the therapy) and patient demographic data. The questionnaires were made available at the admissions office, secretary’s office, or waiting rooms of clinics. Results: A total of 1178 questionnaires collected in 26 multipurpose clinics were analyzed. Two-thirds of patients (65%) reported having used at least one CIM, with a mean of four therapies used per patient. Osteopathy, massage, homeopathy, acupuncture, and psychotherapy were the most frequently reported therapies. More women than men declared using these therapies, and users were significantly younger than nonusers. Therapies were used for a variety of health conditions, but were most commonly used to treat pain (32%), anxiety (11%), cancer (9%), well-being (8%), and stress (7%). Patients mainly discussed use with family members (53%), doctors (52%), and/or partners (45%). Friends (29%), doctors (26%), or family members (18%) most commonly recommended therapies. Patients estimated spending a median of €330 over a median duration of 24 months. Depending on the therapy, 71%–92% of patients would recommend CIM to others. Conclusions: A substantial number of patients seen in French multipurpose clinics, particularly female and young adults, report using CIM. Patients have a positive opinion of these therapies, report using them long term, and devote a significant budget to them.

Takashi Tanaka, Midori Tanaka, Tomoyuki Tezuka et al.

An eight-year-old spayed female Abyssinian cat presented with lameness. Palpation revealed swelling, heat, and a reduced range of motion in the stifle and tarsal joints in both hind limbs. A radiographic examination of both hind limbs revealed periosteal proliferation from the distal tibia to the tarsal and metatarsal bones, which suggested hypertrophic osteopathy. Thorax and abdominal radiographic examinations were performed to identify the primary disease. Complete blood count and routine serum biochemistry tests revealed no abnormalities. No obvious anomalies were evident in the thoracic radiograph; however, a mass was observed near the left kidney on an abdominal radiograph. An abdominal ultrasound was performed, which revealed a hypoechoic renal mass located in the caudal pole of the left kidney. The left nephrectomy was performed after exploration of the abdominal cavity confirmed an abnormality in the left kidney. A histopathological examination revealed renal cell carcinoma. The cat was subsequently fed on a renal prescription diet but received no additional treatment. The periosteal lesion in the distal tibia regressed over time, but the lesions remained in the talus and metatarsal bones. At 1670 days following surgery, blood tests indicated that urea nitrogen and creatinine were above the normal range. In addition, urinalysis revealed an isosthenuria. However, the cat survived over 4500 days following surgery.

Yuan Liang, Pei Zhang, Wei Pan et al.

Young-Rok Kim, Jung-Hyun Kim

A 13-year-old spayed female cocker spaniel was presented with a 2-month history of swelling in several digits and intermittent hindlimb lameness. Radiographs revealed marked soft-tissue swelling and periosteal new bone formation without cortical bone destruction, characteristic of hypertrophic osteopathy (HO), in the distal parts of all extremities except for the right forelimb. However, no notable findings were detected in thoracic radiographs. An ultrasonography indicated cranial bladder wall thickening, which resolved following antibiotic therapy. Computed tomographic angiography identified a potential underlying cause as an aberrant right subclavian artery (ARSA) originating from the aortic arch, compressing the esophagus and causing mild esophageal cranial dilation to the aberrant vessel. No other intrathoracic or neoplastic lesions were observed. Gastrointestinal symptoms, such as regurgitation, were absent. Although an ARSA was likely the cause of HO, surgical correction was declined by the owner. To the best of our knowledge, this is the first reported case of HO concurrent with ARSA in dogs.

Haijing Hao, Lu Xu, Bo Yang et al.

Yuanlin Yao, Shaofeng Wu, Chong Liu et al.

AbstractObjective The identification of spinal tuberculosis subphenotypes is an integral component of precision medicine. However, we lack proper study models to identify subphenotypes in patients with spinal tuberculosis. Here we identified possible subphenotypes of spinal tuberculosis and compared their clinical results.Methods A total of 422 patients with spinal tuberculosis who received surgical treatment were enrolled. Clustering analysis was performed using the K-means clustering algorithm and the routinely available clinical data collected from patients within 24 h after admission. Finally, the differences in clinical characteristics, surgical efficacy, and postoperative complications among the subphenotypes were compared.Results Two subphenotypes of spinal tuberculosis were identified. Laboratory examination results revealed that the levels of more than one inflammatory index in cluster 2 were higher than those in cluster 1. In terms of disease severity, Cluster 2 showed a higher Oswestry Disability Index (ODI), a higher visual analysis scale (VAS) score, and a lower Japanese Orthopedic Association (JOA) score. In addition, in terms of postoperative outcomes, cluster 2 patients were more prone to complications, especially wound infections, and had a longer hospital stay.Conclusion K-means clustering analysis based on conventional available clinical data can rapidly identify two subtypes of spinal tuberculosis with different clinical results. We believe this finding will help clinicians to rapidly and easily identify the subtypes of spinal tuberculosis at the bedside and become the cornerstone of individualized treatment strategies.

Chong Liu, Tuo Liang, Zide Zhang et al.

Abstract Pathological osteogenesis and inflammation possess critical significance in ankylosing spondylitis (AS). The current study aimed to elucidate the mechanisms regarding extracellular vesicle (EV)-packaged microRNA-22-3p (miR-22-3p) from M2 macrophages in the osteogenic differentiation of mesenchymal stem cells (MSCs) in AS. EVs were initially isolated from M2 macrophages, which had been treated with either restored or depleted miR-22-3p. AS-BMSCs were subsequently treated with M2 macrophage-derived EVs to detect osteogenic differentiation in BMSCs using gain- or loss-of-function experiments. The binding affinity among miR-22-3p, period circadian protein 2 (PER2), and Wnt7b was identified. Finally, AS mouse models were established for testing the effects of M2-EV-miR-22-3p on the bone metastatic microenvironment in vivo. miR-22-3p from M2 macrophages could be transferred into BMSCs via EVs, which promoted the osteogenic differentiation of AS-BMSCs. miR-22-3p inhibited PER2, while PER2 blocked the Wnt/β-catenin signaling pathway via Wnt7b inhibition. M2-EV-shuttled miR-22-3p facilitated alkaline phosphatase activity and extracellular matrix mineralization via PER2-regulated Wnt/β-catenin axis, stimulating the BMSC osteogenic differentiation. Taken together, these findings demonstrate that miR-22-3p in M2 macrophage-released EVs downregulates PER2 to facilitate the osteogenesis of MSCs via Wnt/β-catenin axis.

imane Houem, Mina Agrou, Imane Saidi et al.

Introduction Disorders of mineral and bone metabolism are common in dialysis patients and are responsible for an increased risk of fracture, cardiovascular risk and mortality. The mineral and bone disorder most frequently found in peritoneal dialysis (PD) is adynamic osteopathy. The aim of our work is to describe the mineral and bone profile of patients on peritoneal dialysis, to determine the prevalence of hyperparathyroidism in this population and to identify the risk factors associated with it. Material and method This is a cross-sectional study including all our PD patients in whom we analyzed the various clinical, biological, radiological and therapeutic data related to mineral and bone metabolism. We defined hyperparathyroidism by a parathyroid hormone (PTH) ≥ 600pg/ml and we determined the risk factors by comparing two groups : with and without hyperparathyroidism. Results We retained 85 patients whose mean age was 49.18 ± 17.28 years and the sex ratio of 0.77. The seniority in dialysis was 33.31 ± 26.68 months. Median PTH was 668 pg/ml [34-3800] with serum calcium at 87.75±7.52 mg/l, phosphatemia at 54.07±16.69 mg/l and vitamin D at 23.74±11.56 ng/ml. Hyperparathyroidism was found in 60% of patients. The risk factors for hyperparathyroidism noted in our study are: seniority in PD, high PTH before the start of dialysis, and hyperphosphatemia. The short medical follow-up before dialysis seems to play an important role in the development of secondary hyperparathyroidism. Conclusion Hyperparathyroidism is the most frequent mineral and bone disorder in our series. Factors correlated with hyperparathyroidism are length of time on dialysis, hyperphosphatemia and high parathormone levels before the start of dialysis.

Rubert M, Torrubia B, Díaz-Curiel M et al.

Objetivo: Existen en la literatura una serie de trabajos que demuestran que la incidencia de osteoporosis y fracturas asociadas es menor en países en los que la dieta mediterránea es predominante. El aceite de oliva es la principal característica común de toda la dieta mediterránea suponiendo un tercio de la ingesta de grasas vegetales. Se ha realizado una amplia revisión de trabajos que demuestran que la ingesta de aceite de oliva, tanto en animales de experimentación, en especial ratas ovariectomizadas, como en humanos, produce acciones positivas sobre el hueso. Se han revisado los efectos de diferentes componentes del aceite de oliva virgen como la oleuropeína, un compuesto fenólico, y otros alcoholes fenólicos como el tirosol y el hidrotirosol. La oleuropeína no sólo ejerce acciones sobre el hueso de ratas ovariectomizadas, sino que produce acciones sobre la formación de osteoblastos y desciende la formación de células “osteoclasto-like”. Los compuestos fenólicos del aceite de oliva han demostrado ejercer acciones anti-oxidantes in vitro e in vivo. El tirosol y el hidrotirosol ejercen acciones sobre la pérdida de hueso en ratas ovariectomizadas e inhiben la formación de osteoclastos de modo dosis-dependiente. Un trabajo realizado por nuestro grupo ha demostrado que el aceite de oliva virgen ejerce también acciones sobre los parámetros biomecánicos del hueso como el módulo de Young y la dimensión fractal en ratas ovariectomizadas. Los resultados de esta revisión muestran que el aceite de oliva ejerce una acción positiva sobre la salud ósea. Sus componentes poseen propiedades anti-oxidantes y anti-inflamatorias, siendo candidatos potenciales para la prevención de la osteoporosis.

Álvarez Carrión L, Gutiérrez Rojas I, Ardura JA et al.

Objetivo: Analizar el efecto de los secretomas de tumores sólidos organotrópicos hacia el hueso en células de linaje osteogénico, de tipo osteoblástico y osteocítico, en la expresión de genes relacionados con el metabolismo óseo. Material y método: Caracterizamos los cambios en expresión génica por PCR cuantitativa a tiempo real del eje OPG/RANKL, así como de otros genes relacionados con la diferenciación osteoblástica como son Runx2 y osteocalcina, inducidos por los medios condicionados de células tumorales prostáticas, mama y melanoma en pre-osteoblastos MC3T3-E1 y osteocitos MLO-Y4 murinos o en osteoblastos humanos, según correspondiese por especie. Resultados: La estimulación de las células osteocíticas con medios condicionados de células de melanoma o adenocarcinoma prostático indujo un incremento en la expresión génica de OPG y también de RANKL, viéndose incrementado la ratio OPG/RANKL. Únicamente el secretoma de las células de adenocarcinoma prostático alteró la expresión de Runx2 en osteocitos. Los medios condicionados de células de cáncer de mama modificaron únicamente la expresión de RANKL en células osteoblásticas, viéndose disminuido la ratio OPG/RANKL. Conclusión: Los factores solubles tumorales tienen como diana celular a las células osteocíticas, favoreciendo la inducción de un nicho pre-metastásico óseo por modificación de la ratio OPG/RANKL en el entorno óseo, y, con ello, la progresión de tumores organotrópicos óseos como son el melanoma y adenocarcinomas prostático.

Díaz-Romero Paz R, Reimunde Figueira P

La prevalencia de osteoporosis en pacientes sometidos a cirugía de raquis se ha estimado en el 50% de las mujeres de más de 50 años, cifra superior a la de la población en general ajustada por edad. Consecuentemente, muchos autores recomiendan la evaluación sistemática y el tratamiento oportuno de la osteoporosis en la mayoría de pacientes que se van a someter a una cirugía de artrodesis. La disminución de la densidad mineral ósea (DMO) es el principal factor de riesgo independiente relacionado con el fracaso de la instrumentación en las cirugías de fusión lumbar. Las complicaciones derivadas de la cirugía de fusión vertebral son más frecuentes en pacientes mayores de 65 años y osteoporóticos. Las complicaciones tempranas más frecuentes son el pullout o arrancamiento de los tornillos pediculares, la fractura pedicular y la fractura por mecanismo de compresión en el segmento vertebral adyacente. Después de los 3 meses, las complicaciones más frecuentes son la pseudoartrosis, la fractura o la movilización de las barras, la subsidencia de cajas intersomáticas vertebral y la cifosis de la unión proximal. Existen algunos ensayos clínicos de cirugía de artrodesis de columna con tratamiento perioperatorio con alendronato, ácido zoledrónico, o teriparatida que han demostrado ser efectivos en la mejoría clínica y el incremento de las tasas de fusión. Existen diversas modificaciones en el arsenal quirúrgico que pueden mejorar las tasas de fusión y disminuir las complicaciones quirúrgicas, a destacar la artrodesis con tornillos pediculares cementados y tornillos expansibles. Finalmente existen ensayos clínicos aleatorizados que han demostrado que los tratamientos de refuerzo vertebral en fracturas vertebrales osteoporóticas son claramente beneficiosos a corto y a largo plazo.

A K LEBEDEV, O M LESNYaK, R GALSTYaN et al.

Эпидемиология переломов дистального отдела предплечья (ДОП), проксимального отдела плеча (ПОП) и дистального отдела голени (ДОГ) в Армении, Молдове и Узбекистане ранее не изучалась. В России инцидентность ПОП и ДОГ изучена в единичных работах. Между тем, невертебральные переломы иные, чем переломы проксимального отдела бедренной кости, занимают важное место в структуре остеопоротических переломов (Гладкова Е.Н. и соавт., 2014). Цель исследования: определить инцидентность переломов ДОП, ПОП и ДОГ в Армении, Молдове, Узбекистане, а также в ряде городов России (Якутск, Краснодарский край, Хабаровск, Комсомольск-на-Амуре). Материал и методы. Сбор информации по переломам у людей 50 лет и старше проводился ретроспективно за 2011-2012 гг. на основе информации травматологической службы (стационары, травматологические пункты). Для проведения исследования в каждой стране был выбран район или город с представительной выборкой населения 50 лет и старше, в том числе и по национальному составу. Результаты. Инцидентность переломов ДОП, ПОП и ДОГ в изучаемых центрах в сравнении с ранее опубликованными данными по РФ приведена в таблице. Хотя отмечены существенные колебания по центрам, основные эпидемиологические закономерности переломов сохранялись: инцидентность ПОП и ДОП у женщин была выше, чем у мужчин, и нарастала с возрастом (данные не приведены), инцидентность ДОП не различалась в зависимости от пола и не нарастала с возрастом (данные не приведены). Сравнительная инцидентность переломов в различных центрах исследования ЭВА у людей 50 лет и старше Центр Годовая инцидентность /100.000 Дистальный отдел голени Проксимальный отдел плеча Дистальный отдел предплечья муж +жен муж жен муж +жен муж жен муж +жен муж жен Хабаровск - - - 116 84 136 188 137 220 Комсомольск-на- Амуре 614 572 640 563 282 737 1272 320 1864 Якутск 667 235 943 Краснодар 71 79 66 53 16 77 303 80 448 Узбекистан 198 212 181 21 19 24 546 480 622 Армения 42 40 44 32 12 50 64 27 94 Молдова 319 306 329 156 92 204 367 171 515 Первоуральск* 174 151 188 169 106 209 540 171 787 * данные исследования Гладковой Е.Н. с соавт., (2014) Выводы. Впервые получены данные по эпидемиологии переломов проксимального отдела плеча, дистальных отделов предплечья и голени в Армении, Молдове и Узбекистане. Эпидемиологические характеристики перелома дистального отдела голени отличаются от других типов переломов.

I A ShAFIEVA, S V BULGAKOVA

Золедроновая кислота - препарат антирезорбтивного действия для лечения системного остеопороза (ОП). Цель: изучить переносимость препарата золедроновой кислоты (резокластина), его влияние на показатели минеральной плотности костной ткани (МПКТ) у больных с системным ОП в течение через 1 год после применения. Материал и методы. Исследование проводилось в Самарском областном межведомственном центре профилактики остеопороза. МПКТ определялась методом двухэнергетической рентгеновской денситометрии (DEXA). Группу наблюдения составили 29 пациенток в постменопаузе (не менее 5 лет) с впервые выявленным тяжелым постменопаузальным ОП (средний возраст - 62,41±1,26 лет) с одним или несколькими переломами в анамнезе. Золедроновая кислота вводилась внутривенно согласно инструкции однократно. Дополнительно все пациентки принимали кальций 1000 мг и витамин Д3 800 МЕ ежедневно. Результаты. Через 3 месяца лечения 92% пациенток отметили улучшение общего самочувствия и снижение интенсивности боли в спине, определяемых по пятибалльной шкале с 4,4±0,6 до 2,1±0,4 (р<0,05). Через 12 месяцев по результатам DEXA прирост МПКТ шейки бедра составил 2,6% (р<0,05), тел позвонков - 8,7% (р<0,05). Снижения МПКТ, повторных переломов выявлено не было. Побочные эффекты: повышение температуры тела, гриппоподобное состояние, миалгии, артралгии наблюдались у 4 пациенток и были купированы в течении 3-4 дней приемом нестероидных противовоспалительных препаратов. Выводы. Таким образом, минимум побочных эффектов, существенное снижение болевого синдрома через 3 месяца лечения, значимый прирост костной плотности шейки бедра и тел позвонков через 12 месяцев делают золедронат (резокластин) препаратом выбора для лечения постменопаузального ОП у женщин пожилого возраста.

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Torrijos Eslava A

O M Lesnyak, E N Khoseva, L V Menshikova et al.

To assess the influence of informing patients with postmenopausal osteoporosis about the their probability of 10-year absolute fracture risk calculated by FRAX tool on the patient ’s decision to start treatment and their adherence to therapy during 3 years of follow-up. Materials and Methods. Multicenter open randomized trial included 417 women (mean age 65.9 years). Patients of the 1 group (n=191) were informed about the value of their absolute risk of fracture by FRAX. Patients of the 2 group (the control; n=196) got usual advice and recommendations without calculating FRAX. All patients were recommended to take alendronate in a standard dose (70 mg a week) and calcium/vitamin D supplements. Results. During the first three months after initial visit 96.4% of patients started their treatment. The adherence to treatment at sixth month was 7% higher in the group 1; the compliance in the group 1 was 8% higher, than in the control group. 6.4% of patients developed adverse drug reactions, which led to cancellation of therapy in only 2.9% of patients.

Fernández Moreno A, Donnay Candil S, Beamud Lagos M

Objetivos: Estudios previos demuestran una elevada prevalencia de deficiencia de vitamina D [25(OH)D] en distintos sectores de población de nuestro país. Sin embargo, pocos trabajos muestran la influencia de los cambios estacionales sobre las concentraciones de vitamina D. El objetivo del presente trabajo fue conocer la influencia estacional sobre el status de vitamina D en pacientes atendidos en una consulta de Atención Primaria. Material y métodos: Estudio longitudinal prospectivo de una cohorte de 82 pacientes. Se determinaron valores séricos de calcio, 25(OH)D y PTH durante los meses de enero, febrero y marzo (Período 1), y septiembre y octubre (Período 2). Resultados: Los valores de calcio fueron similares en ambos períodos. Durante el Período 1, el 50,6% de los pacientes mostró valores de 25(OH)D < 15 ng/ml y en el 3,65% fue > 30 ng/ml. Durante el Período 2, aumentaron los valores de 25(OH)D (31,88 vs. 15,75 ng/ml, p < 0,001), disminuyó el porcentaje de pacientes con valores de 25(OH)D < 15 ng/ml (2,7 vs. 50,6%, p < 0,001) y se incrementó el porcentaje con valores de 25(OH)D > 30 ng/ml (50.68 vs. 3,65%, p < 0,001). En ambos períodos los valores de 25(OH)D se correlacionaron de forma inversa con los de PTH. Conclusiones: Más de la mitad de los pacientes atendidos en un Centro de Salud presenta deficiencia de vitamina D durante el invierno, con notable mejoría tras el verano. Sin embargo, solo la mitad alcanza valores óptimos de vitamina D. Nuestros resultados sugieren la necesidad de políticas sanitarias que optimicen el status de vitamina D en la población general.

Jörg-Robert Leheste, F. Melsen, M. Wellner et al.

V. Capriles, L. Martini, J. Arěas