Facts and ideas on statins with respect to their lipophilicity: a focus on skeletal muscle cells and bone besides known cardioprotection.

Statins are known to block cholesterol synthesis in the liver. They also exhibit non-lipid pleiotropic effects due to the inhibition of protein prenylation, thereby modulating various signaling pathways of cellular homeostasis and integrity. Both lipid control and pleiotropic action of statins are clinically used, mainly for treatment of hypercholesterolemia and primary and secondary prevention of cardiovascular diseases. Because the prescription of statins is increasing and statin therapy is often lifelong, in particular in patients with other risk factors, safety issues being associated with polymorbidity and polypragmasia as well as the persistence with and adherence to statins are specific points of attention of clinicians and clinical pharmacologists. Furthermore, because skeletal myocytes have a cholesterol inhibitory sensitivity greater than hepatocytes, a choice of an appropriate statin based on its lipophilicity and the associated likelihood of its side effects on skeletal muscle cells and bone is warranted in such polymorbid patients. These approaches can effectively modulate the risk: benefit ratio and highlight a need for personalized therapy as much as possible, thereby minimizing risk of discontinuation of therapy and poor compliance.

Implication of Mesenchymal Stem Cells and Their Derivates for Osteochondral Regeneration.

Healing of articular cartilage defects presents a challenging issue, due to its regenerative shortcomings. Lacking vascularity and innervation of cartilage and low proliferative potential of chondrocytes are the main reasons for the limited healing potential of articular cartilage. Traditional reparative approaches are limited in their efficiency, hence there is a demand for novel reparative treatments. Mesenchymal stromal cells, preferred for clinical uses, can be readily derived from various sources and have been proven to have a therapeutic effect on cartilage and subchondral bone. Therefore, mesenchymal stromal cells, their derivates, and scaffolds have been utilized in research targeting osteochondral regeneration. The present review aims to comprehensively outline and discuss literature considering this topic published within last 5 years.

Adolescent Idiopathic Scoliosis - Future Molecular-Based Diagnostic and Prognostic Testing.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine mainly affecting the younger population. Earlier detection of the disorder leads to appropriate treatment and better outcomes, thus avoiding highly invasive surgical treatments. The currently available tests for the disease identification have lost their reliability and validity with time. In the past few decades, efforts have been directed towards developing a highly reliable prognostic test for AIS. Towards this end, several strategies have been employed including biochemical, biomechanical and gene-based tests. Among the three, the gene-based technology has received much attention in recent past. Notably, this is due to the fact that the human genome project, followed by genome-wide association studies (GWAS), facilitated the identification of candidate genes for disorders like AIS. Several promising biomarker genes have been identified. However, their global validations were disappointing as these genes were shown to be limited to a particular group of people/ethnicities. Such observations limit the development of a reliable global molecular/biochemical test for AIS. The currently used AIS ScoliScoreTM also has several limitations. With continued disappointments in the identification of biomarkers for AIS and lack of appropriate tests, researchers have diverted their efforts towards several alternative avenues. A ray of hope is emerging from recent observations on the association of non-coding microRNAs and epigenetic factors that might arise as future reliable markers for AIS, thus paving the way for appropriate clinical management of this disorder.

Congenital insensitivity to pain in one family.

Congenital insensitivity to pain (CIP) is a rare autosomal recessive genetic disease caused by mutation in several different genes. The diagnosis requires the combined skills and cooperation of pediatricians, neurologists, radiologists, pathologists, and orthopedic surgeons. Orthopedic manifestations of CIP include delayed diagnosis of fractures, nonunions, Charcot arthropathy, avascular necrosis, osteomyelitis, joint dislocations, and heterotopic ossifications. We present case reports of two brothers with CIP with various orthopedic manifestations and methods of surgical treatment with 10 years of follow-up.

Infection in Bone Allograft Transplants.

Bone allografts are widely being used in clinical practice for bone reconstruction. They are considered to be the most preferred alternative to bone autografts, mainly due to their availability and the elimination of donor site morbidity. The risk of bacterial and viral disease transmission, albeit low, is one of the major concerns associated with bone allograft transplant. This review focuses on the epidemiologic and microbiologic aspects of bone allograft infections and the current prevention and treatment options. It also discusses the role of the regulatory authorities in ensuring the safety and efficacy of bone allografts.

Arthroscopic management of anterior instability of the shoulder.

BACKGROUND: The aim of all shoulder joint stabilization surgery is to prevent further dislocation and restore anatomical continuity of the capsule-labral complex to the anterior and inferior edge of the glenoid. In this study, the authors analyzed the results of arthroscopic stabilization techniques using the method of suture anchors in patients with recurrent anterior shoulder instability. MATERIAL AND METHODS: During the reporting period they performed surgery on 91 patients with anterior shoulder instability using the method of MITEK GII suture anchors and BIO ANCHOR . The group consisted of 19 women and 72 men with a mean age of 28.6 years (range 16-70 years). RESULTS: In the preoperative evaluation, the mean Rowe score was 37.1 (range 15-55). Postoperatively there was a significant increase (p < 0.000) in the score analysed using Rowe with a mean of 87.4 (range 45-100). When analyzing the results of operations, they evaluated the function as excellent in 65 patients (71.4 %) and 14 patients (15.4 %) were evaluated as good function. A satisfactory function was observed in 12 patients (13.2 %). For five patients, there was recurrence of instability of the shoulders. CONCLUSIONS: Arthroscopic stabilization of post-traumatic shoulder instability using the suture anchor technique is the optimal solution for anterior shoulder instability. In conjunction with comprehensive treatment and subsequent rehabilitation an early return to the preoperative activities can be achieved with a reduction of residual restriction of shoulder movement.