Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management.

Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. It may result in structural modifications, which may lead to early coxarthrosis. Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis. This review summarizes the currently practised strategies for the detection and treatment of DDH, focusing particularly on current practices for managing residual acetabular dysplasia (AD). AD may persist even after a successful hip reduction. Pelvic osteotomy is required in cases of persistent AD. It could also be undertaken simultaneously with an open hip reduction. Evaluation of the residual dysplasia (RD) of the hip and its management is still a highly active area of discussion. Recent research has opened the door to discussion on this issue and suggested treatment options for AD. But there is still room for more research to assist in managing AD.

Effect of fetuin-A on adenine-induced chronic kidney disease model in male rats.

Objectives: This study aimed to investigate the possible effects of fetuin-A on an adenine-induced chronic kidney disease (CKD) model in male rats. Materials and Methods: Rats were divided into three groups: group A included rats fed a normal diet; group B included rats fed a normal diet with 220 mg/kg adenine daily for 21 days; group C included rats fed a normal diet with 220 mg/kg adenine daily for 21 days and intraperitoneally administered with 5 mg\kg fetuin-A every other day for 2 weeks. Serum samples were assayed for serum creatinine, urea, sodium, potassium, calcium, phosphorus, tumor necrosis factor (TNF), interleukin-6 (IL-6), and estimated glomerular filtration rate (eGFR), and immunohistochemical staining was performed. Results: Group B showed a significant increase in serum creatinine, urea, phosphorus, potassium, TNF, and IL-6 and a significant decrease in serum sodium, calcium, and eGFR compared with group A. Regarding immunohistochemistry, group B showed increased apoptosis. In group C, fetuin-A reduced the urea, creatinine, and phosphorus levels, and in group C, fetuin-A decreased inflammation and apoptosis by reduction of caspase-3 staining. Conclusion: Fetuin-A improved kidney function in CKD due to its anti-inflammatory and anti-fibrotic role.

Missed post-traumatic radial head dislocation in a three-year-old child: A case report.

In children, traumatic radial head dislocation (RHD) is usually associated with ulnar fracture or deformation as reported in a Monteggia injury or its Monteggia variant. Isolated traumatic RHD is extremely rare and exceptional. Traumatic RHD is frequently missed on initial radiographs, particularly if it is isolated. The management of missed RHD is challenging and remains controversial. We report a Case of chronic post-traumatic RHD in a three-year-old child treated with open reduction and reconstruction of the annular ligament. The child's elbow was stable during the follow-up, without swelling or deformity, and the elbow function was normal. The injury of the reported case does not belong to any lesion described in the Monteggia-variant classification, which might explain the reason for missing the associated dislocation. The authors recommend urgent open reduction when a chronic RHD is diagnosed and annular ligament reconstruction, particularly when the open reduction is unstable.

OsbZIP47 Is an Integrator for Meristem Regulators During Rice Plant Growth and Development.

Stem cell homeostasis by the WUSCHEL-CLAVATA (WUS-CLV) feedback loop is generally conserved across species; however, its links with other meristem regulators can be species-specific, rice being an example. We characterized the role of rice OsbZIP47 in vegetative and reproductive development. The knockdown (KD) transgenics showed meristem size abnormality and defects in developmental progression. The size of the shoot apical meristem (SAM) in 25-day OsbZIP47KD plants was increased as compared to the wild-type (WT). Inflorescence of KD plants showed reduced rachis length, number of primary branches, and spikelets. Florets had defects in the second and third whorl organs and increased organ number. OsbZIP47KD SAM and panicles had abnormal expression for CLAVATA peptide-like signaling genes, such as FON2-LIKE CLE PROTEIN1 (FCP1), FLORAL ORGAN NUMBER 2 (FON2), and hormone pathway genes, such as cytokinin (CK) ISOPENTEYLTRANSFERASE1 (OsIPT1), ISOPENTEYLTRANSFERASE 8 (OsIPT8), auxin biosynthesis OsYUCCA6, OsYUCCA7 and gibberellic acid (GA) biosynthesis genes, such as GRAIN NUMBER PER PANICLE1 (GNP1/OsGA20OX1) and SHORTENED BASAL INTERNODE (SBI/OsGA2ox4). The effects on ABBERANT PANICLE ORGANIZATION1 (APO1), OsMADS16, and DROOPING LEAF (DL) relate to the second and third whorl floret phenotypes in OsbZIP47KD. Protein interaction assays showed OsbZIP47 partnerships with RICE HOMEOBOX1 (OSH1), RICE FLORICULA/LEAFY (RFL), and OsMADS1 transcription factors. The meta-analysis of KD panicle transcriptomes in OsbZIP47KD, OsMADS1KD, and RFLKD transgenics, combined with global OSH1 binding sites divulge potential targets coregulated by OsbZIP47, OsMADS1, OSH1, and RFL. Further, we demonstrate that OsbZIP47 redox status affects its DNA binding affinity to a cis element in FCP1, a target locus. Taken together, we provide insights on OsbZIP47 roles in SAM development, inflorescence branching, and floret development.

Humeral lateral condyle fractures in children: redefining the criteria for displacement.

The aim of this study is to define paediatric lateral humeral condyle fractures prone to later displacement. The authors reviewed 106 children who were treated surgically for this fracture. There were 74 boys and 32 girls with an age range of 3-10 years. The study included 27 minimally displaced and 79 displaced fractures. The average follow-up was 50 months. Binary logistic regression model indicated that 6-8-year-old children with minimally displaced fractures and who underwent immediate surgery have a better chance for satisfactory results. The authors concluded that routine use of 2 mm displacement for treatment decisions should be changed to avoid delayed surgery.

Osteomyelitis following Bacille Calmette-Guerin vaccination.

Secondary complications after Bacille Calmette-Guerin (BCG) vaccination are unusual. We describe 3 immunocompetent children who developed osteomyelitis after BCG vaccination. The course of the disease is not dramatic, but marked changes are frequently visible in plain radiograph and MRI. The real-time polymerase chain reaction has an essential role to confirm the diagnosis of BCG osteomyelitis. With proper surgical intervention and chemotherapy, the prognosis is usually good.

Effect of artificial saliva storage on microhardness and fracture toughness of a hydrothermal glass-ceramic.

PURPOSE: This study evaluated the effect of artificial saliva storage on the hardness, crack length, and fracture toughness of a glazed, polished, and bleached hydrothermal low-fusing glass-ceramic (Duceram LFC). MATERIALS AND METHODS: Forty ceramic discs were constructed. The discs were assigned to four groups (n = 10) according to their surface finish: Gp1 -- Autoglaze, Gp2 -- Autoglaze/ground/diamond-polished, Gp3 -- Overglaze, Gp4 -- Overglaze/ground/diamond-polished. Each group was further divided into two subgroups forming eight total subgroups (n = 5). Subgroup A was unbleached; Subgroup B was bleached. Testing was performed before and after 21 days of artificial saliva storage. Data were presented as means and standard deviation (SD). ANOVA was used, along with Duncan's post hoc test for pairwise comparison between the means when ANOVA test was found significant (p< or = 0.05). RESULTS: Surface treatments such as glazing, polishing, and bleaching, saliva storage, and the interaction between these variables had a statistically significant effect on mean values of microhardness, crack length, and fracture toughness of the specimens. There was a statistically significant increase in microhardness and fracture toughness mean values, while crack length values decreased after saliva storage. Polished specimens recorded the smallest crack lengths and fracture toughness, and highest hardness values before and after saliva storage. No difference in fracture toughness values was evident between glazed and polished specimens. Mean crack lengths decreased after saliva storage in all the tested specimens. Hardness values increased after saliva storage. The autoglazed group showed significantly higher fracture toughness, lower crack length, and microhardness than the overglazed group. CONCLUSIONS: Surface finishing procedures and artificial saliva storage had a statistically significant effect on mean values of microhardness, crack length, and fracture toughness. This in vitro study suggests that fracture toughness of ceramics may be affected by different surface treatments such as glazing, polishing, bleaching, or a combination; however, in this study Duceram LFC proved its self-healing property after 3-week storage in artificial saliva.

Chronic isolated distal tibiofibular syndesmotic disruption: diagnosis and management.

BACKGROUND: The current study outlines the pathology and treatment of persistent problems following isolated distal tibiofibular syndesmotic injuries. METHODS: A retrospective study was conducted to review patients with isolated chronic syndesmotic disruption who were managed in the authors' institute during 4 years, from January 2001 to January 2005. Patients with concomitant bony injuries or lateral ankle instability were excluded. RESULTS: The study included eleven patients with isolated syndesmotic disruption. All were males, with average duration of symptoms 4.7 years. Reconstruction of syndesmosis was achieved by semitendinosus tendon in all patients. The average hospital stay was 3.6 days, and the average follow up period was 3.1 years. According to West Point Ankle Score system, the average score after treatment was 95.4. CONCLUSION: Chronic isolated tibiofibular syndesmotic disruption appears amenable to accurate diagnosis and delayed stabilization. Arthroscopic management of the associated intraarticular pathology followed by reconstruction of torn syndesmosis can offer an excellent outcome.

The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children.

A total of 154 children admitted with septic arthritis (n=81) or transient synovitis (n=73) were studied retrospectively. Ultrasound findings for 127 patients were correlated with the final diagnosis. Sensitivity, specificity and positive predictive value of ultrasound for the diagnosis of pediatric septic hip were 86.4, 89.7 and 87.9%, respectively. Unsatisfactory outcome occurred more significantly in children, for whom treatment was initiated more than 4 days after the onset of symptoms and those who had a false-negative ultrasound study. Ultrasound cannot be used safely to distinguish between pediatric septic hip and transient synovitis. It may be a method of value to detect minimal hip effusion. A predictive algorithm using clinical, laboratory and ultrasound findings could be beneficial.