A myofibroblast-mast cell-neuropeptide axis of fibrosis in post-traumatic joint contractures: an in vitro analysis of mechanistic components.

Previous studies have implicated a myofibroblast-mast cell-neuropeptide axis of fibrosis in pathologic joint capsules from post-traumatic contractures. The hypothesis to be tested is that joint capsule cells (JC) from human elbows with post-traumatic contractures and their interactions with mast cells (MC) and neuropeptides in the microenvironment underlie the pathogenesis of contractures. The hypothesis was tested using an in vitro collagen gel contraction model. The JC were isolated from human elbow capsules and mixed with neutralized PureCol collagen I. The gels were treated in various ways, including addition of MC (HMC-1), the neuropeptide substance P (SP), an NK1 receptor (SP receptor) antagonist RP67580 and the mast cell stabilizer ketotifen fumarate (KF). The collagen gels were released from the wells and gel size (contraction) was measured optically at multiple time points. The JC contracted collagen gels in a dose-dependent manner. This was enhanced in the presence of MC and increased further with SP. Increasing concentrations of the SP receptor antagonist, RP67580 or the mast cell stabilizer, KF decreased the magnitude of contraction. These observations identify putative mechanistic components of a myofibroblast-mast cell-neuropeptide axis of fibrosis in the joint capsules in post-traumatic contractures and potential prophylactic or therapeutic interventions.

[Monitoring of the early stages of bone healing process based on serum osteocalcin level changes]. / Monitorowanie wczesnych faz zrostu kostnego na podstawie zmian poziomu osteokalcyny w surowicy krwi.

The aim of this paper was assessment of utility of serum osteocalcin levels in monitoring early stages of bone healing and early detection of bone healing disorders. Serum osteocalcin level and alkaline phosphatase activity was assessed with acute long bone fractures and with delayed bone union and pseudoarthroses. 25 patients underwent the trial. The analysis of the results confirmed the utility of serum osteocalcin level as a prognostic factor in early detecting of union disorders and its correlation to radiological examination.

A review of current literature on physiological tests and soft tissue biomarkers applicable to work-related upper limb disorders.

Work-related upper limb disorders (WRULD) are among the most commonly reported occupational illnesses. Epidemiological evidence of work-relatedness has been reported for a number of conditions, including carpal tunnel syndrome, hand/wrist tendinitis, shoulder tendinitis and hand-arm vibration syndrome. A range of electrodiagnostic techniques and psychophysical tests has been used to assess neurological dysfunction associated with WRULD, whereas only very few studies have examined biochemical markers of soft tissue injury. This report reviews key literature on physiological tests and biochemical markers of musculoskeletal stress/injury, which are applicable to studies of WRULD. The paper concludes by proposing new ways that testing might be implemented during occupational health surveillance to enable early warning of impending problems and to provide more insight into the underlying nature of soft tissue disorders.

Systemic hormonal, electrolyte, and substrate changes after non-thermal limb injury in children.

Relatively little is known regarding the hormonal changes after injury in children. Adult protocols are often applied to children, although the latter often have different physiological responses to trauma. Twenty children with an angulated displaced fracture of the radius and/or ulna (injury severity score 9) were studied prospectively for changes in adrenaline, noradrenaline, cortisol, angiotensin II, arginine vasopressin, urea, electrolytes, and glucose. Two blood samples were taken: one an arrival at the accident and emergency department and one preoperatively several hours later. There were marked increases in adrenaline, noradrenaline, cortisol, and arginine vasopressin above the normal range. Five (25%) cases demonstrated greater early increases in adrenaline than those reported for adult injuries of similar severity. Early hypokalaemia in four cases had corrected towards normal within a few hours, without potassium supplementation.

Wound tissue oxygen tension predicts the risk of wound infection in surgical patients.

OBJECTIVE: To test the hypothesis that subcutaneous wound oxygen tension (PsqO2) has a predictive relation to the development of wound infection in surgical patients. DESIGN: A noninterventional, prospective study. SETTING: A university department of surgery. PATIENTS: One hundred thirty operative general surgical patients at notable risk of infection as predicted by an anticipated Study on the Effect of Nosocomial Infection Control (SENIC) score of 1 or greater. OUTCOME MEASURES: PsqO2 was measured perioperatively. Its relation to the subsequent incidence of surgical wound infection was then determined and compared with the SENIC score as a criterion standard. RESULTS: Although the SENIC score and PsqO2 are inversely correlated, PsqO2 is the stronger predictor of infection. Low PsqO2 identified patients at risk and concentrated them in a cohort that was about half the size of that identified by the SENIC score. CONCLUSIONS: Subcutaneous perfusion and oxygenation are important components of immunity to wound infections. The SENIC score identifies systemic physiological variables that are important to the development of wound infection. Nevertheless, PsqO2 is the more powerful predictor of wound infection. Moreover, PsqO2 can be manipulated by available clinical means, and thus may direct interventions to prevent infection.

[The mechanism of the effect of insulin on the interhormonal relations of androgens and glucocorticoids in the body]. / Mekhanizm vplyvu insulinu na mizhhormonal'ni vidnoshennia androheniv ta hliukokortykoïdov v orhanizmi.

Forty-six essentially healthy persons, 96 patients with carcinoma of the stomach (stage II, III and IV), 26 patients with idiopathic aseptic necrosis of the head of the femur and 42 patients in the time course of their medical condition related to traumata were studied for changes in the excretion of metabolites of androsteroidogenesis and glucocorticoids under the influence of insulin. It has been established that insulin actions on steroidogenesis depend upon interhormonal relations of androgens and glucocorticoids under their values being low, insulin stimulates androsteroidogenesis and reduces the production of glucocorticoids, while their high values are associated with activation of hypothalamic-pituitary-adrenal axis due to insulin hypoglycemia, with the production of glucocorticoids rather that androgens tending to be on the increase. There has been revealed for the first time the ability of insulin to stimulate, under dyscorticism, androsteroidogenesis and lower the production of glucocorticoids, which facts permit recommending the use of insulin to lessen catabolic, contrainsular, and immunodepressive effects of glucocorticoids in the organism.