Design of poly(vinyl pyrrolidone) and poly(ethylene glycol) microneedle arrays for delivering glycosaminoglycan, chondroitin sulfate, and hyaluronic acid.

Osteoarthritis (OA) is a prevalent joint disorder characterized by cartilage and bone degradation. Medical therapies like glucosaminoglycan (GAG), chondroitin sulfate (CS), and hyaluronic acid (HA) aim to preserve joint function and reduce inflammation but may cause side effects when administered orally or via injection. Microneedle arrays (MNAs) offer a localized drug delivery method that reduces side effects. Thus, this study aims to demonstrate the feasibility of delivering GAG, CS, and HA using microneedles in vitro. An optimal needle geometry is crucial for the successful application of MNA. To address this, here we employ a multi-objective optimization framework using the non-dominated sorting genetic algorithm II (NSGA-II) to determine the ideal MNA design, focusing on preventing needle failure. Then, a three-step fabrication approach is followed to fabricate the MNAs. First, the master (male) molds are fabricated from poly(methyl methacrylate) using mechanical micromachining based on optimized needle geometry. Second, a micro-molding with Polydimethylsiloxane (PDMS) is used for the fabrication of production (female) molds. In the last step, the MNAs were fabricated by microcasting the hydrogels using the production molds. Light microscopy (LIMI) confirms the accuracy of the MNAs manufactured, and in vitro skin insertion tests demonstrate failure-free needle insertion. Subsequently, we confirmed the biocompatibility of MNAs by evaluating their impact on the L929 fibroblast cell line, human chondrocytes, and osteoblasts.

Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?

OBJECTIVES: This study aimed to investigation of the effects of the Cognitive Exercise Therapy Approach (Bilissel Egzersiz Terapi Yaklasimi-BETY), a supervised biopsychosocial model-based exercise intervention, on functionality, muscle strength, vascularization, anti-inflammatory and biopsychosocial status in Systemic Sclerosis (SSc) patients. METHODS: Thirty-seven SSc patients were included. Twenty of them were recruited into the study group (SG) undergoing BETY group exercise sessions three times a week for three months and 17 were in the control group (CG) following a home exercise program. Assessments tools were the Modified Rodnan Skin Score (mRSS), Scleroderma Health Assessment Questionnaire (SHAQ), Modified Hand Mobility in Scleroderma (mHAMIS), Duruoz Hand Index (DHI), Six Minute Walk Test (6MWT), skeletal muscle strength measurements using an isokinetic dynamometer (Biodex System 3 Pro), Shear Wave Elastography (SWE), ELISA kits (for tumor necrosis factor-alpha, Interleukin-6, IL-10, serum irisin level), BETY-Biopsychosocial Questionnaire (BETY-BQ), Hospital Anxiety and Depression Scale (HADS), and Short Form-36 (SF-36). RESULTS: The SG demonstrated improvements in SHAQ, mHAMIS, 6MWT, BETY-BQ, HADS, and SF-36 values, excluding the DHI scores (p < 0.05). In contrast, CG showed worsening in SHAQ-general scleroderma symptoms and HADS scores compared to SG (p < 0.05). IL-10 and TNF-alpha increased in both groups, also various vascular parameters were significantly different changed in SG than CG (p < 0.05). Muscle strength values improved in the SG but decreased in the CG however this was statistically not significant (p > 0.05). CONCLUSIONS: BETY can be recommended as a nonpharmacologic approach to the disease management of SSc patients.

Evaluation of muscle and bone composition and function in aging women with polycystic ovary syndrome.

OBJECTIVE: The potential effects of polycystic ovary syndrome (PCOS) on the musculoskeletal system are not well established. We examined the musculoskeletal system in women with PCOS in their late reproductive years. STUDY-DESIGN: This cross-sectional study included 34 women with PCOS and 32 control women matched for age and body mass index (BMI). MAIN OUTCOME MEASURES: Dual-energy x-ray absorptiometry (DXA) was used for body composition analysis and cross-sectional areas and fat fraction of muscles were assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) of the abdomen and thigh. Muscle strength was measured using an isokinetic dynamometer. RESULTS: The mean age of the PCOS group was 43 ± 3.7 years and of the control group 42.2 ± 3.5 years. Testosterone, free androgen index, and fasting insulin were higher in PCOS patients than controls (p < 0.001, p = 0.001 and p = 0.032, respectively). Patients and controls had similar values for total abdominal muscle area (TAMA), paraspinal muscle area, thigh muscle area, vertebral MRI-PDFF, thigh and paraspinal muscle MRI-PDFF. There was no difference in DXA-derived muscle and bone composition between the two groups. Body composition parameters measured by MRI and DXA were correlated with BMI and fasting insulin levels, but not with androgen levels in both groups. Subgroup analyses showed that PCOS women with obesity had higher TAMA than controls with obesity (p = 0.012). Apart than higher 60°/sec knee extensor average power in nonobese PCOS (p = 0.049), no difference in muscle mechanical function was detected between PCOS patients and controls. CONCLUSION: Musculoskeletal composition and function are similar in PCOS patients and healthy women in late reproductive years. Body composition is linked with obesity and insulin resistance rather than hyperandrogenemia.

A pilot study: Nano-hydroxyapatite-PEG/PLA containing low dose rhBMP2 stimulates proliferation and osteogenic differentiation of human bone marrow derived mesenchymal stem cells.

Background: Bone morphogenetic protein 2 (BMP2) can enhance posterolateral spinal fusion (PLSF). The minimum effective dose that may stimulate mesenchymal stem cells however remains unknown. Nano-hydroxyapatite (nHAp) polyethylene glycol (PEG)/polylactic acid (PLA) was combined with recombinant human BMP2 (rhBMP2). We in vitro evaluated proliferation, differentiation, and osteogenic genes of human bone marrow mesenchymal stem cells with 0.5, 1.0, and 3.0 µg/mL rhBMP2 doses in this study. Methods: In vitro experimental study was designed to proliferation by a real-time quantitative cell analysis system and the osteogenic differentiation by alkaline phosphatase (ALP) activity and osteogenic marker (Runx2, OPN, and OCN) gene expressions of human derived bone marrow mesenchymal stem cells (hBMMSCs). nHAp was produced by wet chemical process and characterized by Fourier transform infrared spectrophotometer, scanning electron microscopy, and energy-dispersive x-ray spectroscopy. PEG/PLA polymer was produced at a 51:49 molar ratio. 0.5, 1.0, and 3.0 µg/mL rhBMP2 and nHAp was combined with the polymers. hBMMSCs were characterized by multipotency assays and surface markers were assessed by flow cytometer. The hBMMSC-rhBMP2 containing nHAp-PEG/PLA composite interaction was evaluated by transmission electron microscopy. Proliferative effect was evaluated by real-time proliferation analysis, and osteogenic capacity was evaluated by ALP activity assay and qPCR. Results: hBMMSC proliferation in the 0.5 µg/mL rhBMP2 + nHAp-PEG/PLA and the 1.0 µg/mL rhBMP2 + nHAp-PEG/PLA groups were higher compared to control. 1.0 µg/mL rhBMP2 + nHAp-PEG/PLA and 3.0 µg/mL rhBMP2 + nHAp-PEG/PLA containing composites induced ALP activity on days 3 and 10. 0.5 µg/mL rhBMP2 + nHAp-PEG/PLA application stimulated Runx2 and OPN gene expressions. Conclusion: rhBMP2 + nHAp-PEG/PLA composites stimulate hBMMSC proliferation and differentiation. The nHAp-PEG/PLA composite with low dose of rhBMP2 may enhance bone formation in future clinical PLSF applications.

Six years of experience with the nationwide newborn ultrasonographic hip screening program in Turkey: a considerable change in the type of surgical interventions in developmental dysplasia of the hip.

This study aims to assess whether the nationwide newborn ultrasonographic hip screening program has influenced the rate of different types of surgical interventions performed in developmental dysplasia of the hip (DDH) in children in Turkey. A retrospective analysis of the nationwide data obtained from the National Registry System between January 1, 2015, and December 31, 2020, was carried out. The rate of minor and major surgical interventions was calculated by dividing the total number of primary closed/open reductions with or without tenotomies and the total number of primary pelvic or periacetabular osteotomies with or without femoral osteotomies by the total number of live births in the country per year, respectively. The rates of primary minor surgical interventions were found to be 0.47/1000 in 2015, 0.71/1000 in 2016, 1.07/1000 in 2017, 1.00/1000 in 2018, 1.06/1000 in 2019, and 0.89/1000 in 2020. The rates of primary major surgical intervention were found to be 0.74/1000 in 2015, 0.40/1000 in 2016, 0.33/1000 in 2017, 0.31/1000 in 2018, 0.32/1000 in 2019, and 0.21/1000 in 2020. The introduction of the nationwide newborn hip screening program has significantly changed the surgical treatment modalities in children with DDH. A nearly twofold increase in the rate of primary closed/open reduction and hip spica casting and nearly a three-quarter decrease in the rate of primary bony procedures were observed within 6 years.

Operative treatment in non-emergency sports injuries: a sports medicine clinic experience.

PURPOSE: To elucidate referrals from sports medicine clinic (SMC) to orthopedics, consensus rates among physicians and surgeons on surgical need in these patients, and reasoning of the patients who refused to have surgery despite the recommendations by both groups in non-emergency sports injury patients. METHODS: We conducted a retrospective cohort analysis by using the administrative and referral records of a sports medicine clinic for the 15 months between October 2017 and January 2019. Gender, age, diagnosis, and type of sport were compared between two groups (patients referred to orthopedics vs patients treated in SMC). Agreement between orthopedics and SMC on surgical need in those patients who were referred to orthopedics was evaluated. We additionally screened the hospital archive for surgery reports of patients recommended surgery, and, if a patient did not have a surgery record, we investigated the reasons by telephone interview and categorized these reasons. RESULTS: Surgical evaluation needed for 4.7% (n = 155) of the patients. Patients referred to orthopedics were younger (median: 22.0 years), mostly male (n = 119, 76.8%), and involved in contact sports (n = 108, 69.7%) (p < 0.001 for all) compared to patients treated conservatively. Majority of the consultations were made owing to certain diagnoses such as cruciate/collateral ligament sprain (n = 70, 45.2%), meniscal tear (n = 21, 13.5%), and cartilage injuries (n = 15, 9.7%). Most of the patients diagnosed with Achilles tendon rupture (n = 2, 100%) and patellar instability (n = 13, 81.3%) were referred to surgery. Orthopedics agreed with the sports medicine physicians' opinions in most cases (n = 110, 71.0%). Thirty-four patients (30.9%) recommended surgery by the surgeon postponed/refused the treatment for various reasons or had surgery in another hospital. CONCLUSION: Most non-emergency sports injuries can be treated conservatively. Young and male patients participating in contact sports are more likely to need surgical treatment. Non-surgeon musculoskeletal health-care providers may consider referring patients to orthopedics considering the data demonstrated in this study. Nevertheless, patient's motivation to undergo an operation should be considered before referring to orthopedics.

Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF) for Knee Osteoarthritis.

Adipose tissue contains adult mesenchymal stem cells that may modulate the metabolism when applied to other tissues. Stromal vascular fraction (SVF) can be isolated from adipose tissue mechanically and/or enzymatically. SVF was recently used to decrease the pain and improve the function of knee osteoarthritis (OA) patients. Primary and/or secondary OA causes inflammation and degeneration in joints, and regenerative approaches that may modify the natural course of the disease are limited. SVF may modulate inflammation and initiate regeneration in joint tissues by initiating a paracrine effect. Chemokines released from SVF may slow down degeneration and stimulate regeneration in joints. In this review, we overviewed articular joint cartilage structures and functions, OA, and macro-, micro-, and nano-fat isolation techniques. Mechanic and enzymatic SVF processing techniques were summarized. Clinical outcomes of adipose tissue derived tissue SVF (AD-tSVF) were evaluated. Medical devices that can mechanically isolate AD-tSVF were listed, and publications referring to such devices were summarized. Recent review manuscripts were also systematically evaluated and included. Transferring adipose tissues and cells has its roots in plastic, reconstructive, and aesthetic surgery. Micro- and nano-fat is also transferred to other organs and tissues to stimulate regeneration as it contains regenerative cells. Minimal manipulation of the adipose tissue is recently preferred to isolate the regenerative cells without disrupting them from their natural environment. The number of patients in the follow-up studies are recently increasing. The duration of follow up is also increasing with favorable outcomes from the short- to mid-term. There are however variations for mean age and the severity of knee OA patients between studies. Positive outcomes are related to the higher number of cells in the AD-tSVF. Repetition of injections and concomitant treatments such as combining the AD-tSVF with platelet rich plasma or hyaluronan are not solidified. Good results were obtained when combined with arthroscopic debridement and micro- or nano-fracture techniques for small-sized cartilage defects. The optimum pressure applied to the tissues and cells during filtration and purification of the AD-tSVF is not specified yet. Quantitative monitoring of articular joint cartilage regeneration by ultrasound, MR, and synovial fluid analysis as well as with second-look arthroscopy could improve our current knowledge on AD-tSVF treatment in knee OA. AD-tSVF isolation techniques and technologies have the potential to improve knee OA treatment. The duration of centrifugation, filtration, washing, and purification should however be standardized. Using gravity-only for isolation and filtration could be a reasonable approach to avoid possible complications of other methodologies.

Vancomycin Containing PDLLA and PLGA/ß-TCP Inhibit Biofilm Formation but Do Not Stimulate Osteogenic Transformation of Human Mesenchymal Stem Cells.

Aims: Chronic osteomyelitis, including implant-related prosthetic joint infection, is extremely difficult to cure. We develop vancomycin containing release systems from poly(d,l-lactide) (PDLLA) and poly(d,l-lactide-co-glycolide) (PLGA) composites with beta-tricalcium phosphate (ß-TCP) to treat methicillin-resistant Staphylococcus aureus osteomyelitis. We ask whether vancomycin containing PDLLA/ß-TCP and PLGA/ß-TCP composites will prevent early biofilm formation, allow cell proliferation and osteogenic differentiation, and stimulate osteogenic signaling molecules in the absence of an osteogenic medium. Methods: Composites were produced and characterized with scanning electron microscopy. In vitro vancomycin release was assessed for 6 weeks. Biofilm prevention was calculated by crystal violet staining. Human bone marrow-derived mesenchymal stem cells (hBM-MSCs) and osteosarcoma cell (SaOS-2) proliferation and differentiation were assessed with water soluble tetrazolium salt and alkaline phosphatase (ALP) staining. Real-time quantitative polymerase chain reaction defined osteogenic signaling molecules for hBM-MSCs. Results: Totally, 3.1 ± 0.2 mg and 3.4 ± 0.4 mg vancomycin released from PDLLA/ß-TCP and the PLGA/ß-TCP composites, respectively, and inhibited early biofilm formation. hBM-MSCs and SaOS-2 cells proliferated on the composites and stimulated ALP activity of cells. Runt-related transcription factor 2 (RUNX2) and SRY-Box transcription Factor 9 (SOX9) expressions were, however, lower with composites when compared with control. Conclusion: Vancomycin containing PDLLA/ß-TCP and PLGA/ß-TCP composites inhibited early biofilm formation and proliferated and differentiated hBM-MSCs and SaOS-2 cells, but osteogenesis-related RUNX2 and SOX9 transcription factors were not strongly expressed in the absence of an osteogenic medium for 14 days.

Block slope is the main determinant of block phase performance in swimming / A inclinação do bloco é o principal determinante do desempenho da fase de bloco em natação / La inclinación del bloque es el principal determinante del desempeño de la fase de bloque en natación

ABSTRACT Introduction Swimming starts are an important component for decreasing the total race time, especially in short events. In this phase of swimming, the aim is to increase performance using many different techniques and starting platforms. Objectives The effects of height and slope of the starting block on kick-start performance were assessed in this study. Methods Six male competitive swimmers performed 24 kick-starts using four block settings: 65 cm & 75 cm flat and 65 cm & 75 cm sloped. Two-dimensional kinetic and three-dimensional kinematic data were analyzed, including average and maximum horizontal/vertical forces and impulses; reaction times; movement and block times; and take-off vertical/horizontal velocities. Two-way within-subject design ANOVAs were implemented to test the effects of block height and slope on the kinetic and kinematic variables. Results Block slope was the main factor affecting most of the dependent variables. Shorter block and movement times, greater average and maximum vertical forces, vertical impulse, and maximum horizontal force were found for the sloped settings. An inverse relationship was found between block height and 0-5 m times. Conclusion Based on the results, blocks with height of 75 cm and slope of 10° provided better results in swimmers' performance in the block phase. Level of evidence II, Therapeutic Studies -Investigating the Results of Treatment

RESUMO Introdução As largadas de natação são um componente importante para reduzir o tempo total de competição, especialmente em eventos curtos. Nessa fase da natação, o objetivo é aumentar o desempenho usando várias técnicas e plataformas de largada distintas. Objetivos Neste estudo, foram avaliados os efeitos da altura e da inclinação da plataforma sobre desempenho da saída kick-start. Métodos Seis nadadores de competição do sexo masculino realizaram 24 largadas, usando quatro tipos de bloco de partida (65 cm e 75 cm de altura planos e 65 cm e 75 cm com inclinação). Foram analisados dados cinéticos bidimensionais e cinemáticos tridimensionais, incluindo forças e impulsos horizontais/verticais médios e máximos; tempos de reação, movimento e de bloco; e velocidades vertical/horizontal da decolagem. Empregou-se o método ANOVA bidirecional intraindivíduo para analisar os efeitos da altura e da inclinação do bloco sobre as variáveis cinéticas e cinemáticas. Resultados A inclinação do bloco foi o principal fator que afetou a maioria das variáveis dependentes. Nas plataformas de largada inclinadas, verificou-se que os tempos de bloco e movimento eram mais curtos e as forças verticais médias e máximas, o impulso vertical e a força horizontal máxima foram maiores nas configurações inclinadas. Foi encontrada uma relação inversa entre a altura do bloco e os tempos para as distâncias de 0 a 5 metros. Conclusões Com base nos resultados, os blocos com 75 cm de altura e 10 graus de inclinação forneceram melhores resultados de desempenho dos nadadores na fase de bloco. Nível de Evidência II - Investigação dos resultados do tratamento.

RESUMEN Introducción Las largadas de natación son un componente importante para reducir el tiempo total de competición, especialmente en eventos cortos. En esta fase de natación, el objetivo es aumentar el desempeño usando varias técnicas y plataformas de largada distintas. Objetivos En este estudio, fueron evaluados los efectos de la altura y de la inclinación de la plataforma sobre desempeño de la salida kick-start. Métodos Seis nadadores de competición del sexo masculino realizaron 24 largadas, usando cuatro tipos de bloque de partida (65 cm y 75 cm de altura planos y 65 cm y 75 cm con inclinación). Fueron analizados datos cinéticos bidimensionales y cinemáticos tridimensionales, incluyendo fuerzas e impulsos horizontales/verticales promedios y máximos; tiempo de reacción, movimiento y de bloque; y velocidades vertical/horizontal del despegue. Se empleó el método ANOVA bidireccional intraindividuo para analizar los efectos de la altura y de la inclinación del bloque sobre las variables cinéticas y cinemáticas. Resultados La inclinación del bloque fue el principal factor que afectó a la mayoría de las variables dependientes. En las plataformas de largada inclinadas, se verificó que los tiempos de bloque y movimiento eran más cortos y las fuerzas verticales promedio y máximas, el impulso vertical y la fuerza horizontal máxima fueron mayores en las configuraciones inclinadas. Fue encontrada una relación inversa entre la altura del bloque y los tiempos para las distancias de 0 a 5 metros. Conclusiones Con base en los resultados, los bloques con 75 cm de altura y 10 grados de inclinación proporcionaron mejores resultados de desempeño de los nadadores en la fase de bloque. Nivel de Evidencia II; Investigación de los resultados del tratamiento

Mean femoral cartilage thickness is higher in athletes as compared with sedentary individuals.

PURPOSE: It is unclear how high-intensity physical activity (HIPA) affects the knee joint, specifically the femoral cartilage (FC). Therefore, the aims of this study were to evaluate FC thickness via ultrasound among elite athletes involved in different types of HIPA, and to determine whether there is a correlation between serum cartilage oligomeric matrix protein (sCOMP) and rectus femoris (RF) thickness. METHOD: A total of 132 male individuals participated in this study and were assigned to two groups, the sedentary (n = 43, 23.9 ± 3.7) and athlete groups (n = 89, 22.7 ± 4.6), which did not significantly differ in age. The athletes were elite and performed HIPA during sports such as volleyball (n = 20), soccer (n = 21), basketball (n = 28), and weightlifting (n = 20). RF thickness and three (mid-point) measurements were obtained for each knee. The mean FC thickness for each knee was defined as the sum of the medial, lateral condyles, and intercondylar areas. Blood samples for sCOMP analyses were also obtained. RESULTS: All the measurements of the FC of both knees were significantly higher in the athletes than in the sedentary individuals (p < 0.001 and p = 0.001). The mean right and left FC values were also higher in the athletes (p < 0.001). Multiple linear regression analysis showed that participation in sporting activities was a significant predictor associated with the right and left mean FC thickness (p < 0.001 for both). No significant differences in the sCOMP levels were found between the two groups. CONCLUSION: It was found that the mean FC was higher among athletes than among sedentary individuals. As a result, it is suggested that sports' participation is an independent factor associated with the right and left mean FC thickness. LEVEL OF EVIDENCE: III.

Baicalein Nanofiber Scaffold Containing Hyaluronic Acid and Polyvinyl Alcohol: Preparation and Evaluation

Background/aim: Bone tumor is one of the major causes of tissue bone loss, particularly after performing surgical excision operation to bone lesion that needs to be replaced by biomaterials and ensure a complete filling of tissue-loss spaces. The purpose of our study was to produce a nanofiber-based bone graft scaffold to fill the gaps resulted from bone cancer treatment and also capable of carrying functional molecules that can play a major role in preventing further cancer growth at the targeted bone tissue. Materials and methods: Electrospinning method was used in order to produce nanofibers from different kinds of polymers; Hyaluronic acid (HA), Polyethylene oxide (PEO) and Polyvinyl alcohol (PVA) blended with different concentrations of herbal antibiotic and anti cancer flavonoid molecules called Baicalein (BE). The morphological and chemical structures of scaffold samples were studied using Scanning Electron Microscope (SEM), Fourier Transform Infrared-spectroscopy (FT-IR) and Surface-enhanced Raman spectroscopy (SERS) Analysis. Results: The results showed production of homogenous nanofibers-based scaffold (diameter between 80 nm and 470 nm) that contains the polymers used in the spinning process and the entrapped Baicalein molecules within the nanofiber structure. Conclusion: It was concluded that successful formation of bone tissue mimicking scaffold can be achieved by using Electrospinning method that produces nonwoven nanofibers and at the same time can hold functional anticancer agent such as Baicalein, which may allow using these types of scaffold in bone cancer treatment procedures.

The Effect of Boron-Containing Nano-Hydroxyapatite on Bone Cells.

Metabolic diseases or injuries damage bone structure and self-renewal capacity. Trace elements and hydroxyapatite crystals are important in the development of biomaterials to support the renewal of bone extracellular matrix. In this study, it was assumed that the boron-loaded nanometer-sized hydroxyapatite composite supports the construction of extracellular matrix by controlled boron release in order to prevent its toxic effect. In this context, boron release from nanometer-sized hydroxyapatite was calculated by ICP-MS as in large proportion within 1 h and continuing release was provided at a constant low dose. The effect of the boron-containing nanometer-sized hydroxyapatite composite on the proliferation of SaOS-2 osteoblasts and human bone marrow-derived mesenchymal stem cells was evaluated by WST-1 and compared with the effects of nano-hydroxyapatite and boric acid. Boron increased proliferation of mesenchymal stem cells at high doses and exhibited different effects on osteoblastic cell proliferation. Boron-containing nano-hydroxyapatite composites increased osteogenic differentiation of mesenchymal stem cells by increasing alkaline phosphatase activity, when compared to nano-hydroxyapatite composite and boric acid. The molecular mechanism of effective dose of boron-containing hydroxyapatite has been assessed by transcriptomic analysis and shown to affect genes involved in Wnt, TGF-ß, and response to stress signaling pathways when compared to nano-hydroxyapatite composite and boric acid. Finally, a safe osteoconductive dose range of boron-containing nano-hydroxyapatite composites for local repair of bone injuries and the molecular effect profile in the effective dose should be determined by further studies to validation of the regenerative therapeutic effect window.

In Vitro Assessment of Bioactive Glass Coatings on Alumina/Zirconia Composite Implants for Potential Use in Prosthetic Applications.

Achieving the stable osteointegration of prosthetic implants is one of the great challenges of modern orthopedic surgery. The fixation of ceramic acetabular cups of hip joint prostheses is usually achieved using a metal shell provided with screws or pegs that penetrate into the host pelvic bone. The deposition of bioactive coatings on the implant surface to be put in contact with bone could be a valuable strategy to promote a more "physiological" osteointegration. In this work, bioactive glass porous coatings were manufactured on the top of alumina/zirconia composite implants by two different methods, i.e., sponge replication and laser cladding. The coated samples underwent immersion studies in Kokubo's simulated body fluid (SBF) to assess in vitro bioactivity and were found to exhibit an excellent hydroxyapatite-forming ability, which is key to allow bonding to bone. Biological tests using mesenchymal stem and osteoblast-like cells revealed the good biocompatibility of both types of materials. Furthermore, a higher level of mineralization was induced by the sponge-replicated coatings at 10 days. Overall, these results are highly promising and encourage further research on these materials.

Advanced Injectable Alternatives for Osteoarthritis.

Osteoarthritis (OA) is a common form of arthritis, which is characterized by progressive degradation of joint cartilage resulting in pain, joint stiffness, deformity and disability that is also recently related to an increased incidence of mortality. Inhibition of the extracellular matrix (ECM) production by chondrocytes and accumulation of catabolic mediators associated with matrix degradation are the cause of OA. Nonsurgical treatments for OA can be characterised as symptom-modifying or disease-modifying approaches. It's estimated that 10% of the world population older than 60 years demonstrated symptoms of OA (Messier SP, Callahan LF, Beavers DP et al., BMC Musculoskelet Disord 18(1):91, 2017). A virtue of chondrocytes has a limited proliferation capability; nonsurgical OA therapies mostly include native cartilage extracellular component injections like hyaluronic acid, anti-inflammatory effected autologous cell implantations, platelet rich plasma injections and medicals like corticosteroids. Stem cells are searched to cure OA recently. Also nowadays we can develop injectable release systems, biocompatible hydrogels and micro/nano sized carriers to make these medicals more effective. In this review we cover injectable alternatives to modify the natural course of OA that gives a window for patients between conventional treatment methods and joint replacement surgery.

Stem Cell and Advanced Nano Bioceramic Interactions.

Bioceramics are type of biomaterials generally used for orthopaedic applications due to their similar structure with bone. Especially regarding to their osteoinductivity and osteoconductivity, they are used as biodegradable scaffolds for bone regeneration along with mesenchymal stem cells. Since chemical properties of bioceramics are important for regeneration of tissue, physical properties are also important for cell proliferation. In this respect, several different manufacturing methods are used for manufacturing nano scale bioceramics. These nano scale bioceramics are used for regeneration of bone and cartilage both alone or with other types of biomaterials. They can also act as carrier for the delivery of drugs in musculoskeletal infections without causing any systemic toxicity.

Morphological and mechanical properties of plantar fascia and intrinsic foot muscles in individuals with and without flat foot.

PURPOSE: Many musculoskeletal disorders are associated with over-pronated foot and decreased medial longitudinal arch (MLA) height. Foot intrinsic muscles and plantar fascia (PF) are the primary structures that support MLA. An important reason for the over-pronated foot and the reduction in the MLA height may be the morphological characteristics of the foot intrinsic muscles and PF as well as changes in their mechanical properties. The aim of the present study is to investigate the morphologic structure and mechanical properties of PF, flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor hallucis (AbH) muscles in individuals with flat foot and to compare the results with those of healthy individuals. METHODS: The study included 80 participants, 40 with flat foot and 40 with normal foot posture. The foot posture of the participants was assessed using the Foot Posture Index. PF, FHB, FDB, and AbH thickness and stiffness were measured with an ultrasonography device using a linear ultrasonography probe. RESULTS: Individuals with flat foot had higher AbH thickness compared to individuals with normal foot posture ( p < 0.001), whereas both groups were similar in terms of PF ( p = 0.188), FHB ( p = 0.627), and FDB ( p = 0.212) thickness. Stiffness values of the assessed tissues were similar in both groups ( p > 0.05). CONCLUSION: AbH thickness was higher in individuals with flat foot; however, PF, FHB, and FDB thickness were similar in both groups. In addition, our results suggest that foot posture is not related to the stiffness of the assessed tissues.

Treatment of implant-related methicillin-resistant Staphylococcus aureus osteomyelitis with vancomycin-loaded VK100 silicone cement: An experimental study in rats.

INTRODUCTION: The purpose of this present study is to investigate the efficacy of vancomycin-loaded VK100 silicone cement drug delivery system in the treatment of implant-related methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis in rats. MATERIALS AND METHODS: Thirty-six adult (18-20 weeks old) female Sprague-Dawley rats were included in the study. All rats underwent experimental osteomyelitis surgery via injecting 100 µL bacterial suspension of MRSA into the medullary canal. After a 2-week duration for the formation of osteomyelitis model, rats were assigned randomly into four groups: control (C), systemic vancomycin (V), local vancomycin-loaded VK100 silicone cement (vVK100), and systemic vancomycin and local vancomycin-loaded VK100 silicone cement (V+vVK100). The following treatment protocols were administered to each group for 4 weeks. For group C, 0.9% saline solution equivalent to the volume of vancomycin dose (approximately 1 ml/kg) was administered intraperitoneally twice daily (12-h intervals). For group V, 15 mg/kg of vancomycin was administered intraperitoneally twice daily (12-h intervals). For group vVK100, vVK100 polymer was included so that the intramedullary canal of the rats are affected. For group V+vVK100, vVK100 polymer was included so that the intramedullary canal of the rats are affected and 15 mg/kg of vancomycin was administered intraperitoneally twice daily (12-h intervals). After 4 weeks of treatment, clinical, radiologic, microbiologic, and histopathologic evaluations were performed for all groups. RESULTS: Results of this study revealed that all scores of the evaluation criteria for the treatment groups (groups V, vVK100, and V+vVK100) decreased due to the treatment protocols when compared to group C. These results show the effectiveness of all treatment protocols for the implant-related chronic MRSA osteomyelitis. However, there were no statistical difference between these three protocols. CONCLUSIONS: vVK100 polymer, as a local antibiotic delivery system, seems to be an effective method for the treatment of implant-related chronic MRSA osteomyelitis.

Meloxicam and diclofenac do not change VEGF and PDGF-ABserum levels of platelet-rich plasma.

BACKGROUND/AIM: Platelet-rich plasma (PRP) application has gained widespread interest for musculoskeletal injuries. Nonsteroidal antiinflammatory drugs are frequently used in sports medicine before and/or after PRP application. Our study seeks to determine whether serum levels of platelet-derived growth factor-AB (PDGF-AB) and vascular endothelial growth factor (VEGF) levels of PRP would be affected by nonsteroidal antiinflammatory drugs. MATERIALS AND METHODS: Two different final concentrations of diclofenac (0.5 µg mL-1 and 2.5 µg mL-1), meloxicam (0.8 µg mL-1 and 2.0 µg mL-1), and acetylsalicylic acid (final concentration 450 µm) were obtained in separate tubes with PRPs prepared from 20 healthy male volunteers. Medicine-free PRP was the control group. Growth factors were measured using ELISA. RESULTS: PDGF-AB and VEGF serum levels did not change with diclofenac, meloxicam, or acetylsalicylic acid addition. PDGF-AB and VEGF serum levels correlated with each other. CONCLUSION: Diclofenac, meloxicam, and acetylsalicylic acid did not affect PDGF-AB and VEGF serum levels.

Hamstring Injury After Swimming in a Patient With Multiple Hereditary Osteochondromatosis.

Reported here is a 20-year-old male suffered a hamstring strain after a prolonged bout of swimming. After ultrasound imaging, the patient's injury was considered to be the result of nearby osteochondromas. Case reports have been previously published concerning anterior cruciate ligament injury, rotator cuff tears, subacromial impingement, or femoroacetabular impingement in multiple osteochondromatosis. However, to the best of our knowledge, this is the first reported case of a hamstring injury secondary to an osteochondroma.

Vancomycin containing PLLA/ß-TCP controls experimental osteomyelitis in vivo.

BACKGROUND: Implant-related osteomyelitis (IRO) is recently controlled with local antibiotic delivery systems to overcome conventional therapy disadvantages. In vivo evaluation of such systems is however too little. QUESTIONS/PURPOSES: We asked whether vancomycin (V)-containing poly-l-lactic acid/ß-tricalcium phosphate (PLLA/ß-TCP) composites control experimental IRO and promote bone healing in vivo. METHODS: Fifty-six rats were distributed to five groups in this longitudinal controlled study. Experimental IRO was established at tibiae by injecting methicillin-resistant Staphylococcus aureus (MRSA) suspensions with titanium particles in 32 rats. Vancomycin-free PLLA/ß-TCP composites were implanted into the normal and infected tibiae, whereas V-PLLA/ß-TCP composites and coated (C)-V-PLLA/ß-TCP composites were implanted into IRO sites. Sham-operated tibiae established the control group. Radiological and histological scores were quantified with microbiological findings on weeks 1 and 6. RESULTS: IRO is resolved in the CV- and the V-PLLA/ß-TCP groups but not in the PLLA/ß-TCP group. MRSA was not isolated in the CV- and the V-PLLA/ß-TCP groups at all times whereas the bacteria were present in the PLLA/ß-TCP group. Radiological signs secondary to infection are improved from 10.9 ± 0.9 to 3.0 ± 0.3 in the V-PLLA/ß-TCP group but remained constant in the PLLA/ß-TCP group. Histology scores are improved from 24.7 ± 6.5 to 17.6 ± 4.8 and from 27.6 ± 7.9 to 32.4 ± 8.9 in the CV-PLLA/ß-TCP and the V-PLLA/ß-TCP groups, respectively. New bone was formed in all the PLLA/ß-TCP group at weeks 1 and 6. CONCLUSIONS: CV- and V-PLLA/ß-TCP composites controlled experimental IRO and promoted bone healing. CLINICAL RELEVANCE: CV- and V-PLLA/ß-TCP composites have the potential of controlling experimental IRO and promoting bone healing.