Comparison of sonography and MRI in the evaluation of stability of capitellar osteochondritis dissecans.

PURPOSE: To compare the diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) with intraoperative capitellar osteochondritis dissecans (COCD) fragment stability findings. METHODS: Patients whose International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) classifications were I/II (stable) or III (unstable) were included. Patients underwent preoperative US and MRI. On US, lesions were evaluated as unstable when irregular contours of the chondral surface were observed. On MRI, lesions were evaluated as unstable when articular bone irregularity, a T2 high signal intensity interface, or a high signal intensity line through the articular cartilage was observed. Using the surgical assessment as the gold standard, accuracies of fragment stability diagnoses were calculated for US and MRI. RESULTS: Thirty-four patients with OCD classifications of I/II (stable) or III (unstable) were included. Twenty-four patients (stable: 12, unstable: 12) underwent preoperative US; 22 (stable: 11, unstable: 11) underwent preoperative MRI. Preoperative US and MRI stability assessments correctly matched intraoperative fragment findings in 23 of 24 patients and 16 of 22 patients, respectively. US criteria in this study achieved superior accuracy compared with MRI criteria (96% vs. 73%; P < .05). CONCLUSION: US was a useful tool for evaluating fragment instability in COCD.

Long-term survival after sporadic and delayed metastases of conventional osteosarcoma: A case report.

Histologically conventional osteosarcoma, once metastasized to the lung, generally causes a rapid and fatal outcome. Osteosarcoma metastasis to the gastrointestinal tract is extremely rare.We report herein a case of osteoblastic osteosarcoma with exceptionally unique features: sporadic lung metastases and delayed metastases to the stomach and the jejunum with long-term survival. She received multiple operations and chemotherapies, but consequently died of peritoneal dissemination. A review of the literature on osteosarcoma metastasis to the gastrointestinal tract is presented.This patient was very unusual in terms of a long-term survival and metastatic sites, suggesting the importance of vigilance and thorough follow-up for patients with conventional osteosarcoma.

Comparison of fibrin clots derived from peripheral blood and bone marrow.

BACKGROUND: Autologous fibrin clots derived from peripheral blood (pb-fibrin clot) and bone marrow (bm-fibrin clot) are thought to be effective for tissue regeneration. However, there is no report detailing the amount of growth factors in pb-/bm-fibrin clot. In this study we evaluated the amount of growth factors in human pb-/bm-fibrin clot, and prove the validity of fibrin clot for clinical use. METHODS: Human pb-/bm-fibrin clots were obtained during surgery. In the first experiment, enzyme-linked immunosorbent assay (ELISA) was performed for detecting the amount of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), fibroblast growth factor basic (bFGF), hepatocyte growth factor (HGF), transforming growth factor-beta (TGF-ß), platelet derived-growth factors-AB (PDGF-AB), and stromal cell-derived factor-1 (SDF-1). In the second experiment, the efficacy of fibrin clot on the osteogenic differentiation and fibroblast proliferation was evaluated. Pb-/bm-fibrin clots were incubated in human osteoblast derived from mesenchymal stromal cells (MSCs) or human skin fibroblast. Alizarin red staining and real-time PCR (COL1A1, RUNX2) were performed for the detection of osteogenic potential. Cell-growth assay (WST-8) and real-time PCR (COL1A1) were also performed for the detection of the potential of fibroblast proliferation. RESULTS: ELISA analysis revealed that the amount of VEGF, HGF, bFGF, IGF-1, and SDF-1 of bm-fibrin clot group is higher than that of pb-fibrin clot group with statistical differences. Besides, we confirmed that bm-fibrin clot has much potential for the osteogenic differentiation and fibroblast proliferation. CONCLUSION: The positive outcomes confirm the efficacy of pb-/bm-fibrin clot, and bm-fibrin clot was proved to have much potential for tissue regeneration compared with pb-fibrin clot. The current study showed the potential of a strategy for regenerative medicine using bm-fibrin clot.

Inhibition of microRNA-222 expression accelerates bone healing with enhancement of osteogenesis, chondrogenesis, and angiogenesis in a rat refractory fracture model.

BACKGROUND: It is difficult to achieve bone union in case of non-union with non-invasive techniques. MicroRNAs (miRNAs) are short, non-coding RNAs that act as repressors of gene expression at the level of post-transcriptional regulation. This study focuses on microRNA (miR)-222 as it is known to be a negative modulator of angiogenesis, an essential component of fracture healing. The purpose of this study was to analyze the effects of miR-222 on osteogenic and chondrogenic differentiation in human mesenchymal stromal cell (MSC)s in vitro, and to determine whether local administration of miR-222 inhibitor into the fracture site could achieve bone union in vivo. METHOD: miR-222 expression in human bone marrow mesenchymal stem cells (hMSCs), and osteogenic differentiation in hMSCs, were investigated. The gain or loss of miR-222 function was examined, in order to assess the effects of miR-222 on osteogenic and chondrogenic differentiation in hMSCs. A femoral transverse fracture was completed in rats, and the periosteum at the fracture site was cauterized. Then, either an miR-222 inhibitor or an miR-222 mimics, mixed with atelocollagen, was administered into the fracture site. A non-functional inhibitor negative control was administered to the control group. At 2, 4, 6, and 8 weeks, radiographs of the fractured femurs were obtained. Immunohistochemistry was performed at 2 weeks to evaluate the capillary density. At 8 weeks, micro-computed tomography (µCT) imaging analysis and histological evaluations were performed. RESULTS: The expression of miR-222 significantly decreased as osteogenic differentiation of hMSCs proceeded. Inhibition of miR-222 promoted osteogenic differentiation, and over expression of miR-222 inhibited osteogenic differentiation in hMSCs, which was confirmed by measuring expression of Runx2, collagen type 1A1 (COL1A1), and osteocalcin. Inhibition of miR-222 promoted chondrogenic differentiation in hMSCs, which was confirmed by measuring expression of collagen type II (COL2A1), aggrican, and SOX9. Bone union at the fracture site was achieved in only the groups treated with the miR-222 inhibitor, confirmed by radiographic, µCT and histological evaluation at 8 weeks after administration. Immunohistochemistry showed that capillary density in the miR-222 inhibitor group was significantly higher than that in the control group and in the miR-222 mimics group. CONCLUSION: Local administration of miR-222 inhibitor can accelerate bone healing by enhancing osteogenesis, chondrogenesis, and angiogenesis in the rat refractory model.

Impact of Corticosteroid Injection Site on the Treatment Success Rate of Trigger Finger: A Prospective Study Comparing Ultrasound-Guided True Intra-Sheath and True Extra-Sheath Injections.

The aim of this study was to investigate whether differences in corticosteroid injection site influence the therapeutic effect on trigger finger and thickness of local structures such as the A1 pulley and flexor tendons. Previously untreated trigger fingers were randomly assigned to receive either a true intra-sheath (group I) or an extra-sheath (group E) injection under ultrasonographic guidance. Symptom remission and recurrence rates and recurrence timing did not significantly differ between the groups. Ultrasonography revealed mean (standard deviation) pre-injection A1 pulley thicknesses of 1.1 (0.3) and 1.1 (0.2) mm in groups I and E, respectively. One month after injection, these decreased to 0.7 (0.2) and 0.8 (0.2) mm, respectively (p < 0.05). Furthermore, mean (standard) pre-injection flexor digitorum tendon thickness was 4.1 (0.4) and 4.0 (0.5) mm in groups I and E, respectively, and, 1 mo after injection, decreased to 3.9 (0.3) and 3.8 (0.5) mm, respectively (p < 0.05). However, the difference at each time point between the two groups was not statistically significant. True intra-sheath injection offers no apparent advantage over extra-sheath injection for treating trigger fingers because both have the same effect on local structures.

MicroRNAs and Bone Regeneration.

Bone has multiple functions, both morphologically and physiologically, and it frequently features in the pathological condition, including fracture and osteoporosis. For bone regeneration therapy, the regulation of osteoblast differentiation is important. MicroRNA (miRNA)s are short noncoding RNA which regulate gene expression at the post-transcriptional level. MiRNAs play an important role not only in a variety of other cellular processes including differentiation, proliferation, and apoptosis but also in the pathogenesis of human diseases. Recently, miRNAs have been known to participate in osteoblast differentiation by regulating several signaling pathways including transcription factors. New insight into the mechanism during osteogenes is affected by miRNAs has been gained. Moreover, therapeutic trials for bone diseases including osteoporosis, fracture and bone defects targeting miRNAs have been examined in animal models. MiRNA therapy will enable development of a bone regeneration therapy.