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Although pyogenic spondylitis is an infrequent infection, its incidence is increasing because of the growing number of elderly people and immunocompromised patients. Diagnosis is often difficult and appropriate imaging, blood cultures and/or biopsy are essential in making an early diagnosis. Most of the cases can be treated non-operatively. Surgical treatment is indicated in patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients who have failed conservative treatment. Early and accurate diagnosis of pyogenic spondylitis is important for timely and effective management, in order to reduce the occurrence of spinal deformity and dysfunction.
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Espondilite/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Espondilite/epidemiologia , Espondilite/terapiaRESUMO
Ossification of the posterior longitudinal ligament (OPLL), a spinal ligament, reduces the range of motion in limbs. No treatment is currently available for OPLL, which is why therapies are urgently needed. OPLL occurs in obesity, is more common in men, and has an onset after 40 years of age. The mechanisms underlying OPLL remain unclear. In this study, we performed a serum proteomic analysis in both OPLL patients and healthy subjects to identify factors potentially involved in the development of OPLL, and found reduced levels of a protein that might underlie the pathology of OPLL. We isolated the protein, determined its amino acid sequence, and identified it as chemokine (C-X-C motif) ligand 7 (CXCL7). Based on these proteomics findings, we generated a CXCL7 knockout mouse model to study the molecular mechanisms underlying OPLL. CXCL7-null mice presented with a phenotype of OPLL, showing motor impairment, heterotopic ossification in the posterior ligament tissue, and osteoporosis in vertebrate tissue. To identify the mechanisms of CXCL7 deficiency in OPLL, we searched for single nucleotide polymorphisms and altered DNA exons, but no abnormalities were found. Although miR-340 levels were found to be high in an miRNA array, they were insufficient to reduce CXCL7 levels. Ubiquitin C-terminal hydrolase1 (UCHL1) was found to be overexpressed in CXCL7-null mice and in the sera of patients with OPLL, and was correlated with OPLL severity. Post-translational modifications of proteins with ubiquitin and ubiquitin-like modifiers, orchestrated by a cascade of specialized ubiquitin activating enzyme (E1), ubiquitin conjugating enzyme (E2), and ubiquitin ligase (E3) enzymes, are thought to control a wide range of cellular processes, and alterations in the ubiquitin-proteasome system have been associated with several degenerative disorders. In addition, the OPLL tissue of CXCL7-null mouse and its primary cells expressed the antibody to ubiquitin (linkage-specific K48). Our data clearly show decreased CXCL7 levels in patients with OPLL, and that OPLL developed in mice lacking CXCL7. Tumor necrosis factor receptor-associated factor (TRAF)6 expression was decreased in CXCL7-null mouse primary cells. Furthermore, K48 polyubiquitination was found in posterior longitudinal ligament ossified tissue and primary cells from CXCL7-null mice. We performed a phosphoproteomics analysis in CXCL7-deficient mice and identified increased phosphorylation of mitogen-activated protein kinase kinase (ME3K)15, ubiquitin protein ligase E3C (UBE3C) and protein kinase C (PKC) alpha, suggesting that ubiquitin-dependent degradation is involved in CXCL7 deficiency. Future studies in the CXCL7-null mouse model are, therefore, warranted to investigate the role of ubiquitination in the onset of OPLL. In conclusion, CXCL7 levels may be useful as a serum marker for the progression of OPLL. This study also suggests that increasing CXCL7 levels in patients can serve as an effective therapeutic strategy for the treatment of OPLL.
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Biomarcadores/metabolismo , Quimiocinas CXC/fisiologia , Ossificação do Ligamento Longitudinal Posterior/patologia , Ubiquitina-Proteína Ligases/metabolismo , beta-Tromboglobulina/metabolismo , Idoso , Animais , Feminino , Humanos , Masculino , Camundongos , Camundongos Knockout , MicroRNAs/genética , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/genética , Ossificação do Ligamento Longitudinal Posterior/metabolismo , Fenótipo , Proteólise , Proteômica , Ubiquitinas/metabolismo , beta-Tromboglobulina/genéticaRESUMO
BACKGROUND CONTEXT: Patients with infective spondylodiscitis who failed conservative treatment are generally indicated for open surgery. However, some patients are poor candidates for standard surgery, hence the need to evaluate less invasive approaches. Good outcomes were previously reported for percutaneous suction aspiration and drainage (PSAD) in the treatment of infective spondylodiscitis resistant to conservative therapy. We recently extended the surgical approach of PSAD to allow drainage of paravertebral or epidural abscesses in patients with progressive infective spondylodiscitis. PURPOSE: To evaluate the clinical outcomes of PSAD for infective spondylodiscitis with paravertebral or epidural abscess. DESIGN: Retrospective case series. PATIENT SAMPLE: Patients with infective spondylodiscitis and associated epidural or paravertebral abscess treated using PSAD at our institution, between 1998 and 2014. OUTCOME MEASURES: Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and imaging data obtained via plain radiography, computed tomography, and magnetic resonance imaging were analyzed. Serum measurements were taken preoperatively and at several time points postoperatively. Clinical outcomes were evaluated using the modified MacNab criteria for overall functional mobility. METHODS: Data were obtained from the patients' case notes, radiological images, and medical records. Student t test was used to assess the relevance of changes in serum levels of CRP and ESR at each evaluated time point, as well as the change in sagittal Cobb angle between the preoperative state and the state at final follow-up. RESULTS: Fifty-two patients (31 men and 21 women; average age, 70.6 years) were included in our analysis. The median (range) CRP levels and ESR values at the time of diagnosis were 6.86 (0.04-20.15) mg/dL and 78.8 (26-120) mm/h, respectively. At 1 year postoperatively, these values had decreased to 0.18 (0.0-1.2) mg/dL and 13.8 (4-28) mm/h for CRP and ESR, respectively. At final follow-up, bone union was observed in 80.8% (42 of 52) of patients, with instability identified in five patients. Regarding functional mobility, excellent outcomes were obtained in 26.9% (14 of 52) of patients, whereas good, fair, and poor outcomes were noted in 42.3% (22 of 52), 3.9% (2 of 52), and 26.9% (14 of 52) of patients, respectively. Overall, treatment was considered effective in 69.2% (36 of 52) of patients. CONCLUSIONS: Percutaneous suction aspiration and drainage can serve as an effective alternative to open surgery for the treatment of patients with progressive infective spondylodiscitis and associated paravertebral or epidural abscess.
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Discite/cirurgia , Drenagem/efeitos adversos , Abscesso Epidural/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sucção/efeitos adversos , Adulto , Idoso , Drenagem/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Sucção/métodos , Tomografia Computadorizada por Raios XRESUMO
Patients who undergo surgical extirpation of a primary liver carcinoma followed by radiotherapy and chemotherapy leading to complete remission are nevertheless known to develop cancerous metastases 3-10 years later. We retrospectively examined the blood sera collected over 8 years from 30 patients who developed bone metastases after the complete remission of liver cancer to identify serum proteins showing differential expression compared to patients without remission. We detected a novel RGD (Arg-Gly-Asp)-containing peptide derived from the C-terminal portion of fibrinogen in the sera of metastatic patients that appeared to control the EMT (epithelial-mesenchymal transition) of cancer cells, in a process associated with miR-199a-3p. The RGD peptide enhanced new blood vessel growth and increased vascular endothelial growth factor levels when introduced into fertilized chicken eggs. The purpose of this study was to enable early detection of metastatic cancer cells using the novel RGD peptide as a biomarker, and thereby develop new drugs for the treatment of metastatic cancer.
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Gene and protein abnormalities of anaplastic lymphoma kinase (ALK) play an important role in the pathogenesis of various cancers and serve as important therapeutic targets. We investigated ALK protein expression, phosphorylation, and genetic aberrations using fluorescence in situ hybridization (FISH) in 81 soft tissue tumor samples: inflammatory myofibroblastic tumor, n=1; alveolar soft part sarcoma, n=2; leiomyosarcoma, n=10; well-differentiated liposarcoma, n=7; pleomorphic liposarcoma, n=2; extraskeletal osteosarcoma, n=1; epithelioid sarcoma, n=1; synovial sarcoma, n=4; malignant peripheral nerve sheath tumor, n=4; undifferentiated pleomorphic sarcoma, n=19; rhabdomyosarcoma, n=6; myxofibrosarcoma, n=8; myxoid liposarcoma, n=11; fibrosarcoma, n=4; and desmoid-type fibromatosis, n=1. ALK protein expression, gene signal gain (without translocation), and phosphorylation were observed in 33/81 (40.7%), 55/81 (67.9%), and 30/81 (37.0%) tumor samples, respectively. ALK protein expression was statistically associated with phosphorylation, but not with gene signal gain. ALK phosphorylation-positive cases showed a statistically worse metastasis-free survival compared with phosphorylation-negative cases (P=0.0215). Particularly, metastasis of myxoid liposarcoma was associated with ALK phosphorylation (P=0.0019), but not with ALK protein expression or gene signal gain. However, the prognosis had no association with ALK protein expression, gene signal gain, or phosphorylation. ALK protein expression and phosphorylation play an important role in tumor biology and provide potential therapeutic targets for soft tissue tumors. Future research should focus on the oncogenic role and the efficacy of potential inhibitors of ALK.
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Metástase Neoplásica/genética , Proteínas de Neoplasias/metabolismo , Processamento de Proteína Pós-Traducional , Receptores Proteína Tirosina Quinases/metabolismo , Neoplasias de Tecidos Moles/enzimologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quinase do Linfoma Anaplásico , Criança , Pré-Escolar , Feminino , Seguimentos , Regulação Enzimológica da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Técnicas Imunoenzimáticas , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Fosforilação , Prognóstico , Receptores Proteína Tirosina Quinases/genética , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/secundário , Adulto JovemRESUMO
UNLABELLED: This report presents a case of rapidly progressive collapse of the humeral head following arthroscopic rotator cuff repair. We performed humeral head replacement 8 months after the index surgery; histological examination of the collapsed area revealed necrosis, degeneration, fibrillation, and granulation in the cartilage and trabeculae. Osteonecrosis due to the use of metal anchors was considered the primary cause of the post-operative humeral head collapse. As the demand for arthroscopic cuff repair is expected to increase in the future, we recommend that surgeons become aware of the potential for complications, as seen in the present case. LEVEL OF EVIDENCE: IV.
Assuntos
Artroscopia/efeitos adversos , Cabeça do Úmero/patologia , Osteonecrose/etiologia , Osteonecrose/cirurgia , Manguito Rotador/cirurgia , Âncoras de Sutura/efeitos adversos , Idoso , Artroplastia de Substituição , Materiais Biocompatíveis , Feminino , Humanos , Cabeça do Úmero/irrigação sanguínea , Metais , Osteonecrose/diagnóstico , Osteonecrose/patologia , Lesões do Manguito RotadorRESUMO
Studies have demonstrated favorable outcomes of arthroscopic decompression for ganglion cyst in the supraspinous fossa; however, little attention has been paid to the difficulty in detecting these cysts during arthroscopy. In this report, we present 2 cases in which ganglion cysts in the supraspinous fossa were undetectable during arthroscopy. The ganglion cysts were not identified in these cases during surgery despite arthroscopic decompression being performed through the area in which the cyst was expected until the suprascapular nerve was entirely exposed. After surgery, magnetic resonance imaging (MRI) confirmed the disappearance of the ganglion cyst and external rotation strength was fully improved, without shoulder pain. We emphasize here that surgeons should be aware of this difficulty when performing arthroscopic decompression of ganglion cysts in the supraspinous fossa.
Assuntos
Artroscopia , Descompressão Cirúrgica/métodos , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/cirurgia , Articulação do Ombro/cirurgia , Adulto , Fenômenos Biomecânicos , Cistos Glanglionares/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Articulação do Ombro/fisiopatologia , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia , Dor de Ombro/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture. METHODS: We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification. RESULTS: The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296). CONCLUSIONS: The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.
Assuntos
Lesões do Manguito Rotador , Manguito Rotador/cirurgia , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Idoso , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Força Muscular/fisiologia , Dor/etiologia , Medição da Dor/métodos , Amplitude de Movimento Articular/fisiologia , Recidiva , Índice de Gravidade de Doença , Articulação do Ombro/fisiopatologia , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/diagnóstico , Resultado do TratamentoRESUMO
Our objective was to facilitate ligament tissue reconstruction by characterizing the mechanism of expression of ligament tissue. To accomplish this, we searched for proteins specific to the tissue and introduced them into mesenchymal stem cells. In the two-dimensional phosphorescent gel electrophoresis, the spots in common with the normal human ligament tissue were selected after removing the spots of the normal bone tissue from those of the ossified tissue in the spinal ligament. Proline/arginine-rich end leucine-rich repeat protein (PRELP) was identified in ligament-specific locations by liquid chromatography-tandem mass spectrometry. Transfection of PRELP into mouse mesenchymal stem cells yielded ligament-like connective tissue comprised of parallel fibers. Thus, expression of the PRELP protein could reconstruct the ligament tissue. Since zinc-related proteins were found with high incidence as a result of an array analysis of PRELP's ProtoArray, it was considered that there is a relationship to the zinc metabolism. Tissue induction was mediated by the tumor necrosis factor (TNF)-α via the zinc pathway. PRELP may be a useful gene in syndesmoplasty, provided zinc is present for tissue reconstruction. Chromosome division becomes active with the addition of zinc, and rapid tissue induction takes place in the presence of zinc and TNF-α. Currently, the reconstruction of a ruptured ligament tissue is difficult, but we expect that the PRELP protein expression may facilitate this process. This study describes the discovery of the gene responsible for the differentiation of stem cells into ligament tissue. This important finding may lead to treatments for gonarthrosis, cruciate ligament, and periodontal ligament ruptures, and ossification of the posterior longitudinal ligament.
Assuntos
Cloretos/farmacologia , Proteínas da Matriz Extracelular/genética , Glicoproteínas/genética , Ligamentos/metabolismo , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Ossificação do Ligamento Longitudinal Posterior/genética , Compostos de Zinco/farmacologia , Animais , Diferenciação Celular , Cloretos/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Expressão Gênica , Perfilação da Expressão Gênica , Glicoproteínas/metabolismo , Humanos , Ligamentos/patologia , Células-Tronco Mesenquimais/efeitos dos fármacos , Camundongos , Ossificação do Ligamento Longitudinal Posterior/patologia , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/terapia , Análise Serial de Proteínas , Regeneração/fisiologia , Transfecção , Fator de Necrose Tumoral alfa/farmacologia , Compostos de Zinco/metabolismoRESUMO
PURPOSE: The role of matrix metalloproteases (MMPs) in ruptured rotator cuff tendons remains unknown. This study aimed to investigate the gene expression of MMPs in ruptured rotator cuff tendons and to compare their expression levels between patients with and without postoperative tendon retear. METHODS: Twenty-four patients (a median age of 61 years: interquartile range, 55-66 years) with full-thickness rotator cuff tears were examined in this study. The marginal site of the ruptured tendon was harvested during surgery. The mRNA expression levels of collagen types I and III, MMP-1, MMP-3, MMP-7, MMP-9, MMP-13, tissue inhibitor of MMP (TIMP)-1, and TIMP-2 were analysed by real-time reverse transcription polymerase chain reaction. Postoperative retear was evaluated by magnetic resonance imaging at a minimum of 1 year following surgery. RESULTS: The mRNA expression levels of MMP-3 and TIMP-1 in ruptured rotator cuff tendons were significantly increased in patients with postoperative retear (n = 6), compared with patients without retear (n = 18) (P = 0.04). For collagens, MMP-1, MMP-7, MMP-9, MMP-13, and TIMP-2, there were no significant differences in the mRNA expression levels in ruptured tendons between patients with and without retear. CONCLUSIONS: These results suggest that, in addition to up-regulation of TIMP-1 gene expression, increased MMP-3 gene expression in ruptured rotator cuff tendons is associated with postoperative tendon retear. Thus, drug therapy specifically targeting MMP-3 after rotator cuff repair should be considered in the future.
Assuntos
Metaloproteinases da Matriz Secretadas/genética , RNA Mensageiro/metabolismo , Lesões do Manguito Rotador , Manguito Rotador/metabolismo , Idoso , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Colágeno Tipo III/genética , Colágeno Tipo III/metabolismo , Humanos , Imageamento por Ressonância Magnética , Metaloproteinases da Matriz Secretadas/metabolismo , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reação em Cadeia da Polimerase em Tempo Real , Recidiva , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Inibidor Tecidual de Metaloproteinase-2/genética , Inibidor Tecidual de Metaloproteinase-2/metabolismo , Regulação para CimaRESUMO
BACKGROUND: Ceramics are inorganic nonmetallic materials and are used as bioinert components in joint replacement surgeries. Ceramics are known to be low allergenic. We experienced a ceramic-induced psoriasis. OBJECTIVE: We report a first case of possible ceramic-induced psoriasis caused by a ceramic insert. METHODS: A 55-year-old female received an implanted ceramic-on-ceramic total hip replacement for osteoarthritis of the right hip joint. Following surgery, she developed psoriatic lesions, which continued for 10 years. We suspected that psoriasis was caused by a ceramic insert and removed it surgically. RESULTS: When the ceramic insert was replaced with a polyethylene-on-metal hip joint, the psoriatic lesions completely disappeared. CONCLUSION: The pathogenesis of psoriasis is still an enigma, although deregulation of nuclear factor κB signaling and resulting abnormal cytokine secretion are speculated to be involved. Ceramics may affect these signaling events and cause the onset of psoriasis.
Assuntos
Materiais Biocompatíveis/efeitos adversos , Cerâmica/efeitos adversos , Prótese de Quadril/efeitos adversos , Psoríase/induzido quimicamente , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , ReoperaçãoRESUMO
PURPOSE: To investigate the usefulness of the "inducer grafting" technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. METHODS: Twenty knees of 20 patients (mean age at the time of surgery, 23.1 years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients)."Inducer grafting" techniqueAfter harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15 months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. RESULTS: One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. CONCLUSION: These results suggest that the "inducer grafting" technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn't improve the deficits in knee flexion torque after ACL reconstruction.
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Flexor tendons of white Leghorn chickens (n = 25) were used for this study. One chicken was used as a normal control (no surgery), and the remaining 24 were used for experiments. After partial tendon-severing in both legs of 24 chickens, the right and the left leg were treated differently, thereby creating two groups: Group I, in which the tenosynovium was preserved, and Group II, in which the tenosynovium was removed. Hematoxylin-eosin staining was performed to observe adhesions; immunohistochemical analysis was used to localize HA. HA production was noted in granulation tissue invading between the tendon stumps in both groups; however, HA expression in the tenosynovium was observed only in Group I where adhesion formation was minimal. The HA-producing tenosynovium plays a crucial role in preventing adhesion formation in this model of flexor tendon injuries.
Assuntos
Ácido Hialurônico/metabolismo , Membrana Sinovial/metabolismo , Traumatismos dos Tendões/metabolismo , Animais , Galinhas , Modelos Animais de Doenças , Tecido de Granulação/metabolismo , Humanos , Receptores de Hialuronatos/metabolismo , Imuno-Histoquímica , Traumatismos dos Tendões/patologia , Traumatismos dos Tendões/cirurgia , Aderências Teciduais/prevenção & controle , CicatrizaçãoRESUMO
We report the case of a patient with rheumatoid arthritis (RA) who showed a reduction in disease severity (from class IV to class II) after multi-joint surgery. The patient was a 61-year-old man with a history of RA, type-2 diabetes, chronic obstructive pulmonary disease, and nephrotic syndrome. He had been undergoing treatment for RA for the past 10 years, but his condition could not be appropriately controlled. In addition to generalized edema, marked destruction of the left elbow joint and knees was observed, and he was unable to move in bed (Steinbrocker classification: stage IV, class IV). In March 2009, he developed suppurative arthritis of the left elbow (methicillin-sensitive Staphylococcus aureus [MSSA] infection) and was referred to our institution, where the infection subsided after cleaning of the wound and administration of antibiotics. In March 2010, he underwent artificial joint replacement arthroplasty of the left elbow, followed by replacement arthroplasty of the right knee in July that year and of the left knee in November. As of December 2011, the patient showed no signs of inflammatory reactions and was able to walk using crutches (Steinbrocker classification: stage IV, class II). Recent advancements in pharmacotherapy have made it possible to control the advancement of joint destruction in RA. However, in this patient, because of the advanced stage of joint destruction, surgical methods were required to aid the patient in recovering his ability to walk.
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Artrite Reumatoide/classificação , Artrite Reumatoide/cirurgia , Artrite Reumatoide/terapia , Antibacterianos/uso terapêutico , Artroplastia de Substituição , Complicações do Diabetes/diagnóstico , Cotovelo/cirurgia , Marcha , Humanos , Inflamação , Masculino , Staphylococcus aureus Resistente à Meticilina/metabolismo , Pessoa de Meia-Idade , Síndrome Nefrótica/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Reumatologia/métodos , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/terapiaRESUMO
BACKGROUND: Various forms of resistance are used in rotator cuff training programs. However, the muscular activity of the infraspinatus during arm elevation has not been clarified in detail. We aimed to evaluate infraspinatus fatigue during resisted arm elevation in various positions. METHODS: The dominant (right) shoulders of 39 healthy subjects were examined. Average mean power frequency shifts of the infraspinatus and deltoid were evaluated electromyographically when the subjects performed isometric contractions equivalent to 30% of the maximal voluntary isometric contraction force for 60 s during 90° arm elevation in the sagittal and scapular planes, prone and side-lying external rotations, and repeated side-lying external rotation exercise. Further, the arm-elevation force was measured before and after the repeated external rotation exercise. Analysis of variance and paired t tests were used for statistical analyses; differences at P < .05 were considered significant. RESULTS: The infraspinatus was fatigued easily during resisted arm elevation in the sagittal plane compared with the scapular plane (P < .01). Comparisons of sagittal-plane elevation with side-lying and prone external rotations revealed no significant differences in the fatigue levels. The arm-elevation force after the repeated external rotations was significantly decreased in the sagittal plane compared with the scapular plane (P < .01). CONCLUSION: In clinical settings, this data may be helpful in knowing how to helpful to protect the infraspinatus after surgical repair. Therefore, therapeutic exercise regimes with resisted arm elevation should avoid infraspinatus overfatigue in the sagittal plane in the early postoperative period.
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Teste de Esforço/métodos , Contração Isométrica/fisiologia , Fadiga Muscular , Treinamento Resistido , Articulação do Ombro/fisiologia , Adulto , Análise de Variância , Músculo Deltoide/fisiologia , Eletromiografia/métodos , Humanos , Masculino , Valores de Referência , Fatores de Risco , Estudos de Amostragem , Extremidade Superior/fisiologia , Adulto JovemRESUMO
For successful total knee arthroplasty (TKA), it is very important to gain an accurate grasp of the mechanical axis of the lower limb and establish a suitable ligament balance. Recently, TKA using navigation systems has been developed to accomplish more accurate component placement and to achieve a better understanding of the mechanical axis. The purpose of this study was to compare the radiological results of computer-navigated TKA with those of conventional TKA. We prospectively evaluated 75 primary TKAs (75 subjects) that were performed using a cruciate-retaining prosthesis of the same model at our institution. The subjects were allocated alternately to a navigation group (37 knees) and a conventional group (38 knees). Postoperative radiographs were taken in the standing position at 12 weeks after surgery, and were evaluated in accordance with the report of Bäthis et al. [1]. No significant difference in preoperative profiles was observed between the two groups. At the postoperative radiographic evaluation, significantly better results were obtained in the navigation group with regard to the mechanical axis and the component, but the results were less conclusive in the lateral femoral component position. Our findings suggest that computer-navigated TKA is useful for obtaining more accurate results. However, the present study was limited by the small number of subjects and short follow-up period, and therefore further study involving more subjects and a longer-term follow-up will be needed.
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Artroplastia do Joelho/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Computadores , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: The purpose was to evaluate the correlation between messenger RNA (mRNA) expression of collagen at the edge of the ruptured rotator cuff tendon and postoperative cuff integrity. METHODS: The edge of the ruptured tendon was sampled during open rotator cuff surgery in 12 patients with full-thickness rotator cuff tears (mean age, 58.2 years). The mean period from symptom onset was 9.3 months (range, 1 to 36 months), and the mean tear size was 4.1 cm. As controls, rotator cuff tendons with no gross rupture were taken from 5 fresh cadavers. Production of type I and type III collagen was examined by real-time reverse transcription polymerase chain reaction. By use of magnetic resonance imaging, postoperative cuff integrity was evaluated based on the classification of Sugaya et al. and then scored, ranging from 5 points for type I to 1 point for type V. RESULTS: Looking at the mRNA of type I and type III collagen in tendons, we found that the expression of mRNA for both collagen types in ruptured tendons was significantly greater than in control tendons (P = .0462 for type I collagen and P = .0306 for type III collagen). Correlating the mRNA of type I and type III collagen with repaired cuff integrity on postoperative magnetic resonance imaging, we found a close relation between expression of mRNA for both collagen types and postoperative rotator cuff integrity (r = 0.63 [P = .038] for type I collagen and r = 0.626 [P = .03] for type III collagen). Furthermore, expression of type I collagen mRNA showed a significant inverse correlation with the period from symptom onset (r = -0.845, P < .0005). CONCLUSIONS: This study showed that expression of mRNA for type I and type III collagen at the edge of the ruptured rotator cuff tendon was significantly correlated with postoperative cuff integrity and that mRNA expression for type I collagen was significantly associated with the period from symptom onset. These results may suggest that conservative treatment should not be prolonged if patients do not respond within a certain period. LEVEL OF EVIDENCE: Level III, prognostic case-control study.
Assuntos
Colágeno Tipo III/biossíntese , Colágeno Tipo I/biossíntese , RNA Mensageiro/biossíntese , Manguito Rotador/metabolismo , Western Blotting , Estudos de Casos e Controles , Colágeno Tipo I/genética , Colágeno Tipo III/genética , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador , Ruptura/metabolismo , Ruptura/patologia , Ruptura/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
"Hybrid exercise" utilizing combined electrical stimulation and voluntary muscle contraction has been developed as a muscle exercise method. Although our previous studies have confirmed the effectiveness of the procedure, the mechanisms of its efficacy still remain unclear. In the present study, we identified genes that are specifically expressed in disused muscles, using the semitendinosus muscle from patients who underwent anterior cruciate ligament (ACL) reconstruction. Preoperative exercise was performed by four ACL-injured patients, who were subjected either to hybrid exercise (n=2), electrical stimulation (n=1), or no electrical stimulation (n=1), in addition to standard weight training for 4 weeks. Cross-sectional area (CSA) of the semitendinosus muscle was measured before and after the exercise by magnetic resonance imaging (MRI). A piece of the semitendinosus muscle was isolated during the surgery, and comprehensive analysis of the gene expression in this sample was performed using DNA microarray analysis. CSA increased in size by 4.2 and 14.7%, respectively, after hybrid exercise, and by 1.4% after electrical stimulation. However it shrunk by 7.7% without electrical stimulation. DNA microarray analysis revealed that hybrid exercise was more effective at stimulating the expression of signal transduction-, transcription- and cytoskeleton-related genes in semitendinosus muscles than electrical stimulation alone. In particular, gene ontology analysis revealed that hybrid exercise induced significantly higher expression of eukaryotic translation initiation factor 5A (EIFSA), peroxisomal biogenesis factor 6 (PEX6) and histone cluster 1 H4 (HIST1H4), compared with electrical stimulation alone. The expression of signal transduction-, transcription- and cytoskeleton-related genes may play an important role in muscle bulk increasing mechanisms in hybrid exercise.
Assuntos
Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Traumatismos do Joelho/cirurgia , Atrofia Muscular/patologia , ATPases Associadas a Diversas Atividades Celulares , Adenosina Trifosfatases/genética , Adolescente , Adulto , Ligamento Cruzado Anterior/patologia , Terapia por Estimulação Elétrica , Exercício Físico , Feminino , Histonas/genética , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Contração Muscular , Análise de Sequência com Séries de Oligonucleotídeos , Fatores de Iniciação de Peptídeos/genética , Proteínas de Ligação a RNA/genética , Adulto Jovem , Fator de Iniciação de Tradução Eucariótico 5ARESUMO
BACKGROUND: Physical inactivity is a risk factor for the development of non-alcoholic fatty liver disease (NAFLD). "Hybrid training", a training that involves both voluntary and electrical muscle contractions, causes beneficial alterations in muscles even after short durations of exercise. The aim of this study was to investigate the therapeutic efficacy of hybrid training in patients with NAFLD. METHODS: Thirty-five patients with NAFLD who were resistant to lifestyle counseling were assigned to a hybrid-training group (n = 12) or a control group (n = 23). In the hybrid-training group, quadriceps and hamstrings were contracted voluntarily or electrically for 19 min twice a week. In the control group, patients received lifestyle counseling. The therapeutic efficacy of the hybrid training was evaluated after 12 weeks of the intervention. RESULTS: Serum alanine aminotransferase (ALT) levels and hepatic steatosis grade were significantly decreased in the hybrid-training group compared to that of the control group (-14.1 ± 5.8 vs. 3.5 ± 5.4 IU/mL; P < 0.05, -0.67 ± 0.19 vs. 0.09 ± 0.06 grade; P < 0.01, respectively). No significant changes were seen between the two groups in skeletal muscle mass. The decreases in homeostasis model assessment of insulin resistance (HOMA-IR) value and in serum IL-6 levels were significantly greater in the hybrid-training group than in the control group (-6.2 ± 3.2 vs. 0.4 ± 0.6; P < 0.05, -3.1 ± 1.1 vs. 1.1 ± 0.5 pg/mL; P < 0.01, respectively). CONCLUSION: Hybrid training of voluntary and electrical muscle contractions improved hepatic steatosis and reduced insulin resistance and serum IL-6 levels in NAFLD patients who are resistant to lifestyle counseling.
Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Fígado Gorduroso/terapia , Interleucina-6/metabolismo , Alanina Transaminase/sangue , Aconselhamento Diretivo/métodos , Fígado Gorduroso/patologia , Feminino , Humanos , Resistência à Insulina , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Fatores de RiscoRESUMO
PURPOSE: Since the development of the anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, many studies have focused on excursion and/or tension of each graft. However, no studies to date have adequately investigated thickness of the graft in anatomic double-bundle ACL reconstruction. To obtain basic knowledge from which an ideal graft thickness can be inferred, thicknesses of the anteromedial bundle (AMB) and posterolateral bundle (PLB) was measured in the normal ACL. METHODS: The right knees of 50 cadavers donated for anatomy instruction were studied. Each ACL was separated into the AMB and PLB, and circumferences at the mid-substance and cross-sectional area at the femoral and tibial footprints were measured in each. RESULTS: Cross-sectional areas of the AMB and PLB were 36 ± 10 and 32.1 ± 10.2 mm² at the femoral footprint, and 60.9 ± 21.8 and 52.2 ± 17.3 mm² at the tibial footprint, respectively. Circumferences at the mid-substance were 14.3 ± 3.3 mm for the ALB and 10.8 ± 3.1 mm for the PLB. A positive correlation was seen between AMB and PLB at each of the three sites. CONCLUSION: The AMB is thicker than the PLB, showing a constant correlation in the normal ACL. This suggests that the anteromedial graft must be thicker than the posterolateral graft at least in actual operations.