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1.
Anim Biosci ; 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35507843

RESUMO

Objective: The quantitative reverse transcription polymerase chain reaction (qPCR) is the most accurate and reliable technique for analysis of gene expression. Endogenous reference genes (RGs) have been used to normalize qPCR data, although their expression may vary in different tissues and experimental conditions. Therefore, verification of the stability of RGs in selected samples is a prerequisite for reliable results. Therefore, we attempted to identify the most stable RGs in the hypothalamic-pituitary-gonadal (HPG) axis in sows. Methods: The cycle threshold values of nine commonly used RGs (18S, HPRT1, GAPDH, RPL4, PPIA, B2M, YWHAZ, ACTB, and SDHA) from HPG axis-related tissues in the domestic sows in the different stages of estrus cycle were analyzed using two RG-finding programs, geNorm and Normfinder, to rank the stability of the pool of RGs. In addition, the effect of the most and least stable RGs was examined by normalization of the target gene, gonadotropin-releasing hormone (GnRH), in the hypothalamus. Results: PPIA, HPRT1, and YWHAZ were the most stable RGs in the HPG axis-related tissues in sows regardless of the stages of estrus cycle. In contrast, traditional RGs, including 18S and ACTB, were found to be the least stable under these experimental conditions. In particular, in the normalization of GnRH expression in the hypothalamus against several stable RGs, PPIA, HPRT1, and YWHAZ, could generate significant (P < 0.05) elevation of GnRH in the preovulatory phase compared to the luteal phase, but the traditional RGs with the least stability (18S and ACTB) did not show a significant difference between groups. Conclusion: s: These results indicate the importance of verifying RG stability prior to commencing research and may contribute to experimental design in the field of animal reproductive physiology as reference data.

2.
J Orthop Trauma ; 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-35551158

RESUMO

OBJECTIVES: OTA/AO 61C pelvic ring injuries are vertically unstable due to complete sacral fractures combined with anterior ring injury. The objective of this study was to compare the biomechanical characteristics of four transsacral screw constructs for posterior pelvic ring fixation, including one that utilizes a novel fixation method with a pair of locked washers with interdigitating cams. METHODS: Type C pelvic ring disruptions were created on 16 synthetic pelvis models. Each pelvis was fixated with an S2 screw in addition to being allocated to 1 of 4 transsacral constructs through S1: (1) 8.0-mm screw, (2) 8.0-mm bolt, (3) 8.0-mm screw locked with a nut, and (4) 8.00-mm screw locked with a nut with the addition of interdigitating washers between the screw head and ilium on the near cortex, and ilium and nut on the far cortex. The anterior ring fractures were not stabilized. Each pelvis underwent 100,000 cycles at 250 N and was then loaded to failure using a unilateral stance testing model. Both the anterior and posterior osteotomy sites were instrumented with pairs of Infrared (IR) light-emitting markers, and the relative displacement of the markers was monitored using a three-dimensional (3D) motion capture system. Displacement measurements at 25,000; 50,000; 75,000; and 100,000 cycles and failure force were recorded for each pelvis. RESULTS: The novel washer design construct performed better than the screw construct with less posterior ring motion at 75,000 (p = 0.029) and 100,000 cycles (p = 0.029). CONCLUSIONS: The novel interdigitating washer design may be superior to using a screw construct alone to achieve rigid, locked posterior ring fixation in a synthetic pelvis model with a Type C pelvic ring disruption.

3.
J Pediatr Orthop ; 42(5): e453-e458, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35250016

RESUMO

PURPOSE: While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions. METHODS: A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Radiographs were analyzed to identify the type of coalition (osseous or nonosseous), presence of any posterior facet involvement, and presence of a planovalgus foot deformity. Patients who underwent a subtalar joint steroid injection after failing other conservative treatments were identified and compared with those who did not receive an injection as part of their nonoperative management with regard to the need for ultimate surgical intervention and the time from presentation to surgery when applicable. RESULTS: A total of 83 patients (125 feet) met inclusion criteria, of whom 25 patients (34 feet) received a subtalar steroid injection. When compared with the 58 patients (91 feet) treated with standard nonoperative modalities, there were no differences with regard to sex, age at presentation (12.4 and 12.3 y, respectively), facet involvement, type of coalition, or the presence of a planovalgus deformity. In all, 12/34 (35%) feet in the injection group eventually elected surgical intervention compared with 36/91 (39%) feet that did not receive an injection (P=0.72). For those patients ultimately selecting surgical intervention, the average time from initial presentation to surgery was 878 days in the injection group versus 211 days in the noninjection group (P<0.001). CONCLUSIONS: While subtalar steroid injection can alleviate symptoms in some patients with a talocalcaneal coalition, this intervention does not appear to decrease the need for surgery when compared with traditional nonoperative therapies. In patients failing other forms of conservative treatment, subtalar steroid injections can delay surgical intervention by an average of nearly 2 years. LEVEL OF EVIDENCE: Level-III-therapeutic study.


Assuntos
Articulação Talocalcânea , Coalizão Tarsal , Criança , Humanos , Radiografia , Estudos Retrospectivos , Esteroides , Articulação Talocalcânea/diagnóstico por imagem , Articulação Talocalcânea/cirurgia
4.
Clin Orthop Relat Res ; 480(3): 587-599, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34652293

RESUMO

BACKGROUND: Perthes disease most commonly affects children 5 to 7 years old, and nonoperative management, such as weightbearing and activity restrictions, is generally recommended. In earlier research in children aged 8 to 14 years who had Perthes disease, we found that the restrictions were associated with worse mobility, but mental health or social health measures were not linked. However, Perthes disease most commonly affects children 5 to 7 years old who are more emotionally and cognitively immature. Children in this age group are beginning school and organized sports experiences while developing meaningful social relationships for the first time. Because of such different life experiences, it is important to understand the psychosocial consequences of weightbearing and activity restrictions on this specific age group, as they may help guide choices about weightbearing restrictions and mental health support. QUESTIONS/PURPOSES: In patients aged 5 to 7 years with Perthes disease, we asked: (1) Are weightbearing and activity restrictions associated with worse mental health, evaluated with the Patient-reported Outcome Measurement Information System (PROMIS) depressive symptoms, anxiety, and anger questionnaires? (2) Are weightbearing and activity restrictions associated with worse social health (PROMIS peer relationships measure)? (3) Are weightbearing and activity restrictions associated with worse physical health measures (PROMIS mobility, pain interference, and fatigue measures)? (4) What other factors are associated with mental, social, and physical health measures in these patients? METHODS: Data were collected from 97 patients with a diagnosis of Perthes disease. Inclusion criteria were age 5 to 7 years at the time the PROMIS was completed, English-speaking patients and parents, in the active stage of Perthes disease (Waldenstrom Stages I, II, or III) who were recommended weightbearing and activity restrictions because of worsening hip pain, poor hip ROM, femoral head deformity, as a postoperative regimen, or if there was substantial femoral head involvement on MRI [23]. Based on their weightbearing and activity restriction regimen, patients were categorized into one of four activity restriction groups (no, mild, moderate, and severe restriction). The following pediatric parent-proxy PROMIS measures were obtained: depressive symptoms, anxiety, anger, peer relationships, mobility, pain interference, and fatigue. We excluded five patients who did not meet the inclusion criteria. Of the remaining 92 patients, 21 were in the no restriction group, 21 were in the mild restriction group, 28 were in the moderate restriction group, and 22 were in the severe restriction group at the time of PROMIS administration. ANOVA was used to compare differences between the mean PROMIS T-scores of these four groups. T-scores are computed from PROMIS survey responses, and a T-score of 50 represents the age-appropriate mean of the US population with an SD of 10. A higher T-score means more of that measure is being experienced and a lower score means less of that measure is being experienced. To address the possibility of confounding variables such as Waldenstrom stage, gender, age at diagnosis, and history of major surgery, we performed a multivariable analysis to compare the association of different weightbearing regimens and the seven PROMIS measures. This allowed us to answer the question of whether weightbearing and activity restrictions are associated with worse physical, mental, and social health measures in Perthes patients aged 5 to 7 years, while minimizing the possible confounding of the variables listed above. RESULTS: After controlling for confounding variables such as Waldenstrom stage, gender, age at diagnosis, and history of major surgery, we found that moderate activity restriction was associated with worse depressive symptoms (ß regression coefficient = 6 [95% CI 0.3 to 12]; p = 0.04) and anxiety (ß = 8 [95% CI 1 to 15]; p = 0.02) T-scores than no restrictions. The mild (ß = -7 [95% CI -12 to -1]; p = 0.02), moderate (ß = -15 [95% CI -20 to -10]; p < 0.001), and severe (ß = -23 [95% CI -28 to -18]; p < 0.001), restriction groups had worse mobility T-scores than the no restriction group. Weightbearing and activity restrictions were not associated with anger, peer relationships, pain interference, and fatigue measures. Waldenstrom Stage II disease was associated with worse pain interference than Waldenstrom Stage III (ß = 7 [95% CI 0.4 to 13]; p = 0.04). A history of major surgery was associated with worse anger scores (ß = 18 [95% CI 3 to 33]; p = 0.02). The child's gender and age at diagnosis had no association with any of the seven PROMIS measures. CONCLUSION: Moderate weightbearing and activity restrictions are associated with worse depressive symptoms and anxiety in patients with Perthes disease aged 5 to 7 years, after controlling for Waldenstrom stage, gender, age at the time of diagnosis, and history of surgery. Considering the discoveries in this study and in our previous study, for patients 5 to 7 years old, we recommend that providers discuss the potential for mental health changes with moderate weightbearing restrictions with patients and their families. Furthermore, providers should monitor for worsening mental health symptoms at each follow-up visit and refer patients to a clinical child psychologist for support when appropriate. Future studies are needed to assess the effects of these restrictions on mental health over time and after patients are allowed to return to normal activities. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Doença de Legg-Calve-Perthes/psicologia , Doença de Legg-Calve-Perthes/terapia , Suporte de Carga , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos
5.
Dev Med Child Neurol ; 64(4): 476-480, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34664714

RESUMO

AIM: To identify all patients with arthrogryposis multiplex congenita presenting to a specialized pediatric orthopedic institution over a 28-year period; classify them into three groups (general arthrogryposis not otherwise specified [NOS], amyoplasia, or distal arthrogryposis); report the frequency of various musculoskeletal features; and determine the rate of operative treatment. METHOD: Patients with arthrogryposis under the age of 18 years who presented between 1990 and 2017 were included. Patients were placed into one of three groups based on clinical features and family history when available. Age of presentation, joint involvement, and utilization of surgical treatment were recorded. RESULTS: There were 417 patients in total (184 females, 233 males); 235 patients (56.4%) had general arthrogryposis NOS, 107 (25.7%) had amyoplasia, and 75 (18.0%) had distal arthrogryposis. Patients with amyoplasia presented at a younger age (median 4mo) than those with general arthrogryposis NOS (median 1y 3mo, p=0.005), and had a lower rate of spine involvement than patients with general arthrogryposis NOS (p=0.004) and distal arthrogryposis (p=0.023). The average number of surgeries across all patients was 1.9 (SD 2.2). INTERPRETATION: Pediatric patients with amyoplasia present to orthopedic care earlier and are less likely to have spine involvement than other forms of arthrogryposis. Multiple surgeries are common among all patients with arthrogryposis.


Assuntos
Artrogripose , Adolescente , Artrogripose/diagnóstico , Artrogripose/epidemiologia , Artrogripose/cirurgia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
6.
Spine Deform ; 10(2): 411-418, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34561841

RESUMO

PURPOSE: Intraoperative neuromonitoring (IONM) has historically been difficult to obtain in patients with Charcot-Marie-Tooth (CMT) disease. Transcranial motor-evoked potentials (TcMEPs) have been found to be safe and effective for other spinal deformity patients. Our objective was to determine the effectiveness of TcMEP monitoring in patients with CMT. METHODS: An IRB-approved, retrospective review of CMT patients undergoing spinal deformity surgery assessing TcMEP, somatosensory-evoked potential (SSEP), and neurogenic motor evoked potential (NMEP) IONM was performed. A 2:1 matched cohort control group of idiopathic spinal deformity patients was used. A waveform grading system was applied to review baseline TcMEP reliability and quality, which was validated via intraclass correlation coefficient amongst five raters. RESULTS: Twenty-three CMT patients (26 surgical cases) were identified. The use of TcMEP improved the ability to obtain baseline IONM when compared to SSEP (83% vs. 20%; p < 0.001) and NMEP (83% vs. 18%; p = 0.003). Baseline monitoring was obtained less often for CMT patients using SSEP (20% vs. 100%; p < 0.001) and TcMEP (83% vs. 100%; p = 0.111) compared to idiopathic patients. Sweep length (time from stimulation waveform evaluation) and maximum stimulation voltage were higher in the CMT group (289 ms vs. 111 ms p = 0.007 and 740 V vs. 345 V p = 0.089, respectively). CONCLUSION: TcMEP monitoring significantly improves the ability to provide IONM for CMT patients undergoing spinal deformity surgery. Utilizing longer sweep lengths enhances the ability to attain baseline TcMEP readings, allowing surgeons to more safely proceed with surgery for these complex patients. LEVEL OF EVIDENCE: Therapeutic-Level III.


Assuntos
Potencial Evocado Motor , Potenciais Somatossensoriais Evocados , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Humanos , Procedimentos Neurocirúrgicos , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
J Pediatr Orthop ; 42(3): e266-e270, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34967806

RESUMO

BACKGROUND: The efficacy of preliminary traction to increase the likelihood of closed reduction and/or decrease the incidence of avascular necrosis in the management of developmental dysplasia of the hip (DDH) is controversial. We sought to document compliance with and effectiveness of Bryant's outpatient traction in patients with idiopathic DDH. METHODS: Patients presenting between 6 and 24 months of age with idiopathic irreducible DDH were prospectively enrolled in the study. Prereduction outpatient traction was prescribed at participating surgeons' preference and parents' expressed willingness to comply with a traction protocol of at least 14 hours/day for 4 weeks. Traction hours were documented using a validated monitor; parents also reported average daily usage. Rate of successful closed reduction and evidence of capital epiphyseal growth disturbance 1 year' and 2 years' postreduction were documented. RESULTS: Ninety-six patients with 115 affected hips were enrolled. Reliable recorded traction hours were obtained in 31 patients with 36 affected hips. Defining compliance as 14 hours/day average use, 14 of 31 patients (45.2%) were compliant, 2 (6.5%) admitted noncompliance, while 15 (48.2%) claimed to be compliant, but were not. Overall, 68/115 hips (59.0%) were closed reduced. Age at treatment was the only demographic characteristic associated with an increased incidence of closed reduction (11.7 vs. 14.6 mo, P<0.01). Successful closed reduction was achieved in 10/16 hips (62.5%) of compliant patients, 12/20 (60.0%) of noncompliant patients, and 43/72 (59.7%) of no-traction patients. Irregular ossific nucleus development was noted 1-year postindex reduction in 5/16 (31.3%) of complaint-patient hips and 25/92 (27.2%) of noncomplaint and no-traction hips. Distorted proximal femoral epiphysis was noted at 2 years postreduction in 2/15 hips (13.3%) of compliant patients and 15/52 hips (28.8%) in noncompliant and no-traction patients. None of these differences was statistically significant. CONCLUSIONS: Parent-reported use of outpatient traction is unreliable. Four weeks of outpatient overhead Bryant's traction did not affect the rate of closed reduction or avascular necrosis in late-presenting DDH in this cohort. LEVEL OF EVIDENCE: Level II-prospective cohort.


Assuntos
Luxação Congênita de Quadril , Osteonecrose , Humanos , Pacientes Ambulatoriais , Estudos Prospectivos , Estudos Retrospectivos , Tração , Resultado do Tratamento
8.
Biomed Res Int ; 2021: 4604856, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527737

RESUMO

IFN-γ licensing to mesenchymal stem cells (MSCs) is applied to enhance the therapeutic potential of MSCs. However, although the features of MSCs are affected by several stimuli, little information is available on changes to the therapeutic potential of IFN-γ-licensed differentiated MSCs during xenogeneic applications. Therefore, the present study is aimed at clarifying the effects of adipogenic/osteogenic differentiation and IFN-γ licensing on the in vitro immunomodulatory and migratory properties of porcine bone marrow-derived MSCs in xenogeneic applications using human peripheral blood mononuclear cells (PBMCs). IFN-γ licensing in differentiated MSCs lowered lineage-specific gene expression but did not affect MSC-specific cell surface molecules. Although indoleamine 2,3 deoxygenase (IDO) activity and expression were increased after IFN-γ licensing in undifferentiated MSCs, they were reduced after differentiation. IFN-γ licensing to differentiated MSCs elevated the reduced IDO expression in differentiated MSCs; however, the increase was not sufficient to reach to the level achieved by undifferentiated MSCs. During a mixed lymphocyte reaction with quantification of TNF-α concentration, proliferation and activation of xenogeneic PBMCs were suppressed by undifferentiated MSCs but inhibited to a lesser extent by differentiated MSCs. IFN-γ licensing increasingly suppressed proliferation of PBMCs in undifferentiated MSCs but it was incapable of elevating the reduced immunosuppressive ability of differentiated MSCs. Migratory ability through a scratch assay and gene expression study was reduced in differentiated MSCs than their undifferentiated counterparts; IFN-γ licensing was unable to enhance the reduced migratory ability in differentiated MSCs. Similar results were found in a Transwell system with differentiated MSCs in the upper chamber toward xenogeneic PBMCs in the lower chamber, despite IFN-γ licensing increased the migratory ability of undifferentiated MSCs. Overall, IFN-γ licensing did not enhance the reduced immunomodulatory and migratory properties of differentiated MSCs in a xenogeneic application. This study provides a better understanding of the ways in which MSC therapy can be applied.


Assuntos
Interferon gama/metabolismo , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Animais , Medula Óssea/metabolismo , Células da Medula Óssea/metabolismo , Diferenciação Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Técnicas de Cocultura , Citocinas/metabolismo , Xenoenxertos/metabolismo , Humanos , Imunomodulação/efeitos dos fármacos , Interferon gama/fisiologia , Células-Tronco Mesenquimais/fisiologia , Osteogênese/efeitos dos fármacos , Suínos , Fator de Necrose Tumoral alfa/metabolismo
9.
Biomed Res Int ; 2021: 5540877, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34337022

RESUMO

Mesenchymal stem cells (MSCs) are valuable candidates in tissue engineering and stem cell-based therapy. Traditionally, MSCs derived from various tissues have been successfully expanded in vitro using adherent culture plates commonly called as monolayer two-dimensional (2D) cultures. Recently, many studies demonstrated that stemness and multilineage differentiation potential could be enhanced to greater extent when MSCs are cultured as suspended aggregates by means of three-dimensional (3D) culturing techniques. However, there are limited reports on changed mitochondrial metabolism on 3D spheroid formation of MSCs. Therefore, the present study was aimed at investigating the stemness, differentiation potential, and mitochondrial metabolism capacity of 3D dental pulp-derived MSC (DPSC) spheroids in comparison to monolayer cultured DPSCs. We isolated dental pulp-derived MSCs (DPSCs) and successfully developed a 3D culture system which facilitated the formation of MSC spheroids. The cell aggregation was observed after 2 hours, and spheroids were formed after 24 hours and remained in shape for 72 hours. After spheroid formation, the levels of pluripotent markers increased along with enhancement in adipogenic and osteogenic potential compared to 2D cultured control cells. However, decreased proliferative capacity, cell cycle arrest, and elevated apoptosis rate were observed with the time course of the 3D culture except for the initial 24-hour aggregation. Furthermore, oxygen consumption rates of living cells decreased with the time course of the aggregation except for the initial 24 hours. Overall, our study indicated that the short-term 3D culture of MSCs could be a suitable alternative to culture the cells.


Assuntos
Diferenciação Celular , Polpa Dentária/citologia , Células-Tronco Mesenquimais/citologia , Mitocôndrias/metabolismo , Células-Tronco Pluripotentes/citologia , Esferoides Celulares/citologia , Adipogenia , Apoptose , Biomarcadores/metabolismo , Técnicas de Cultura de Células , Ciclo Celular , Proliferação de Células , Células Cultivadas , Humanos , Células-Tronco Mesenquimais/metabolismo , Osteogênese , Consumo de Oxigênio , Células-Tronco Pluripotentes/metabolismo , Esferoides Celulares/metabolismo
10.
J Bone Joint Surg Am ; 103(18): 1713-1717, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34166322

RESUMO

BACKGROUND: Several methods are available to estimate leg lengths at maturity to facilitate the determination of timing of epiphysiodesis. We compared the Paley multiplier, Sanders multiplier, and White-Menelaus methods in an epiphysiodesis-aged cohort. We assessed intra- and interrater reliability for Sanders skeletal stages and Greulich and Pyle atlas skeletal age. METHODS: Actual growth was recorded in healthy, unoperated femoral and tibial segments from an epiphysiodesis database. The predicted and actual lengths were compared with use of the Paley multiplier and White-Menelaus methods, Greulich and Pyle skeletal age, and the Sanders multiplier using Sanders stages. Intra- and interrater reliability were assessed in a separate group of 76 skeletal age films. RESULTS: The cohort included 148 femora and 195 tibiae in 197 patients. Femoral length at maturity was slightly underestimated by the Sanders multiplier and staging, was overestimated by the Paley multiplier and skeletal age, and was most accurately predicted with use of the White-Menelaus formula and skeletal age. All methods overestimated tibial length at maturity. The whole-leg prediction accuracy of the Sanders multiplier and White-Menelaus formula were comparable and were more accurate than that of the Paley multiplier. For Sanders skeletal staging, the interrater reliability varied from 0.86 to 0.88 and the intrarater reliability varied from 0.87 to 0.96. For Greulich and Pyle skeletal age, the interrater reliability varied from 0.87 to 0.89 and the intrarater reliability varied from 0.91 to 0.95. CONCLUSIONS: Use of the Sanders multiplier and skeletal stages was more accurate than the Paley multiplier and skeletal age in this cohort. Use of the White-Menelaus formula and skeletal age was slightly more accurate in predicting femoral length and slightly less accurate in predicting tibial length compared with the Sanders multiplier. Intra- and interrater reliability were similar between Sanders skeletal stages and Greulich and Pyle atlas skeletal age. The White-Menelaus formula and skeletal age was the recommended method for predicting lower-extremity segment lengths at maturity and epiphysiodesis effect. Although easier to recall without referencing an atlas and not sex-specific, Sanders skeletal staging does not correspond directly to years of growth remaining, and thus cannot be used with the White-Menelaus formula. CLINICAL RELEVANCE: The Greulich and Pyle atlas to determine skeletal age and the White-Menelaus formula to determine growth remaining are reliable predictors of epiphysiodesis effect in the lower extremities.


Assuntos
Fêmur/crescimento & desenvolvimento , Fêmur/cirurgia , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/cirurgia , Adolescente , Determinação da Idade pelo Esqueleto , Criança , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
11.
J Pediatr Orthop ; 41(5): 301-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33710127

RESUMO

BACKGROUND: Amniotic band syndrome (ABS) is a congenital disorder resulting in fibrous bands that can cause limb anomalies, amputations, and deformities. Clubfoot has been reported in up to 50% of patients with ABS. The purpose of this study is to compare treatment characteristics and outcomes of clubfoot patients with ABS to those with idiopathic clubfoot treated with the Ponseti method. METHODS: An Institution Review Board (IRB) approved retrospective review of prospectively gathered data was performed at a single pediatric hospital over a 20-year period. Patients with either idiopathic clubfeet or clubfeet associated with concomitant ABS who were <1 year of age and treated by the Ponseti method were included. Initial Dimeglio score, number of casts, need for heel cord tenotomy, recurrence, and need for further surgery were recorded. Outcomes were classified as "good" (plantigrade foot±heel cord tenotomy), "fair" (need for a limited procedure), or "poor" (need for a full posteromedial release). RESULTS: Forty-three clubfeet in 32 patients with ABS, and 320 idiopathic clubfeet in 215 patients were identified. Average age at last follow up was not different between ABS and idiopathic cohorts (7.4 vs. 5.2 y, P=0.233). Average Dimeglio score was lower in the ABS cohort (12.3 vs. 13.7, P=0.006). Recurrence rate was significantly higher in the ABS (62.8%) compared with idiopathic cohort (37.2%) (P=0.001). Clinical outcomes were significantly better in the idiopathic cohort (69.4% "good", 26.9% "fair", 3.8% "poor") compared with the ABS cohort (41.9% "good", 34.9% "fair", and 23.3% "poor") (P<0.001). Within the ABS cohort, no significant differences in clinical outcomes were found based upon location, severity, or presence of an ipsilateral lower extremity band. CONCLUSION: Clubfeet associated with ABS have higher rates of recurrence, a greater need for later surgery, and worse clinical outcomes than idiopathic clubfeet. This information may prove helpful in counseling parents of infants with ABS associated clubfeet. LEVEL OF EVIDENCE: Level III.


Assuntos
Síndrome de Bandas Amnióticas/complicações , Moldes Cirúrgicos , Pé Torto Equinovaro/etiologia , Pé Torto Equinovaro/terapia , Adolescente , Criança , Pré-Escolar , Pé Torto Equinovaro/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Tenotomia , Resultado do Tratamento
12.
J Pediatr Orthop ; 41(4): e304-e308, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560711

RESUMO

BACKGROUND: There is significant controversy in the literature over rates of late-developing dysplasia following normal screening ultrasound in breech babies, with reported rates varying from 7% to 29%. The purpose of this study is to investigate the rates of radiographic dysplasia in breech babies after a normal ultrasound with a minimum of 1 year of radiographic follow-up. METHODS: This study was an institutional review board-approved prospective study of all patients referred by their pediatrician for concern for developmental dysplasia of the hip between July 2008 and August 2014. We identified all subjects with breech presentation and excluded those with an abnormal initial examination/ultrasound or with <12 months of radiographic follow-up. Anterior-posterior pelvis films were obtained after >12 months and acetabular indices (AIs) were measured and compared with contemporary normative data. Dysplasia was diagnosed as >2 SDs above the mean. RESULTS: A total of 654 patients were referred with a history of a breech presentation, and 150 (22.9%) were found to have clinical instability or sonographic evidence of dysplasia on initial presentation and were observed with serial imaging or treated. Of the remaining 504 subjects with a normal clinical examination and screening ultrasound, 133 (26.4%; 74.4% females, 25.6% males) were followed until at least 12 months of age. Of those presenting at age 12 to 14 months, the mean AI was 0.42±0.83 SD above the mean with a skew towards elevated AIs. At the final follow-up (mean: 20.7±6.7 mo), the mean AI was 0.05±0.92 SD above the mean, and only 3/133 (2.2%) patients had a dysplastic hip. No patients underwent treatment other than an observation during the study period. CONCLUSIONS: One in 5 breech babies have dysplasia at presentation, but late dysplasia following normal screening ultrasound may be less common than previously reported and may be due to our prolonged follow-up period. We recommend surveillance of breech babies with follow-up visits after 12 months of age since earlier visits may offer limited benefits. LEVEL OF EVIDENCE: Level II-prospective prognostic study.


Assuntos
Apresentação Pélvica , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Exame Físico , Gravidez , Estudos Prospectivos , Radiografia , Ultrassonografia
13.
Biomed Res Int ; 2021: 8858412, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33553433

RESUMO

Previous studies have shown that mesenchymal stem cells (MSCs) derived from various tissue sources can be differentiated into smooth muscle-like cells (SMLCs) in vitro. In this paper, dental pulp-derived mesenchymal stem cells (DPSCs) were evaluated for their differentiation ability towards smooth muscle-like cells (SMLCs) under the effect of widely used cytokines (TGF-ß1 and PDGF-BB) with special focus on different culturing environments. For this purpose, both the commercially used culturing plates (Norm-c) and 0.1% gelatin-precoated (Gel-c) plates were used. Isolated cells displayed plastic adherence, pluripotency and cell surface marker profiling, and adipogenic and osteogenic differentiation potential with lineage specific marker expression. Differentiated cells induced under different culturing plates showed successful differentiation into SMLCs by positively expressing smooth muscle cell (SMC) specific markers both at the mRNA and protein levels. Gelatin coating could substantially enhance DPSC differentiation potential than Norm-c-induced cells. However, the absence of mature marker MHY-11 by immunostaining results from all treatment groups further indicated the development of immature and synthetic SMLCs. Finally, it was concluded that DPSC differentiation ability into SMLCs can be enhanced under cytokine treatment as well as by altering the cellular niche by precoating the culturing plates with suitable substrates. However, to get fully functional, contractile, and mature SMLCs, still many different cytokine cocktail combinations and more suitable coating substrates will be needed.


Assuntos
Técnicas de Cultura de Células/instrumentação , Diferenciação Celular/efeitos dos fármacos , Polpa Dentária/citologia , Células-Tronco Mesenquimais/citologia , Miócitos de Músculo Liso/citologia , Becaplermina/farmacologia , Biomarcadores/metabolismo , Técnicas de Cultura de Células/métodos , Diferenciação Celular/fisiologia , Linhagem da Célula , Células Cultivadas , Colágeno , Meios de Cultura/química , Meios de Cultura/farmacologia , Géis , Humanos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/fisiologia , Células-Tronco Pluripotentes/fisiologia , Fator de Crescimento Transformador beta1/farmacologia
15.
Clin Orthop Relat Res ; 479(6): 1360-1370, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394755

RESUMO

BACKGROUND: Weightbearing and activity restrictions are commonly prescribed during the active stages of Perthes disease. These restrictions, ranging from cast or brace treatment with nonweightbearing to full weightbearing with activity restrictions, may have a substantial influence on the physical, mental, and social health of a child. However, their impact on the patient's quality of life is not well-described. QUESTIONS/PURPOSES: After controlling for confounding variables, we asked (1) are restrictions on weightbearing and activity associated with physical health measures (as expressed by the Patient-Reported Outcome Measurement Information System [PROMIS] mobility, PROMIS pain interference, and PROMIS fatigue) of children in the active stages of Perthes disease? (2) Are these restrictions associated with poorer scores for mental health measures (PROMIS depressive symptoms and PROMIS anxiety)? (3) Are these restrictions associated with poorer scores for social health measures (PROMIS peer relationships)? METHODS: Between 2013 and 2020, 211 patients with Perthes disease at a single institution were assigned six PROMIS measures to assess physical, mental, and social health. Patients who met the following eligibility criteria were analyzed: age 8 to 14 years old, completion of six PROMIS measures, English-speaking, and active stage of Perthes disease (Waldenstrom Stage I, II, or III). Weightbearing and activity restrictions were clinically recommended to patients in the initial through early reossification stages of Perthes disease when patients had increasing pain, loss of hip motion, loss of hip containment, progression of femoral head deformity, increased hip synovitis, and femoral head involvement on MRI or as a postoperative regimen. Patients were categorized into four intervention groups based on weightbearing and activity regimen. We excluded 111 patients who did not meet the inclusion criteria. The following six pediatric self-report PROMIS measures were assessed: mobility, pain interference, fatigue, depressive symptoms, anxiety, and peer relationships. Of the 100 patients, 36 were categorized into the no-restriction regimen, 27 into the mild-restriction regimen, 25 into the moderate-restriction regimen, and 12 into the severe-restriction regimen at the time of PROMIS administration. The median (range) age at diagnosis was 8 years old (range 2 to 13 years). There were 85 boys and 15 girls. Eleven patients had hips in Waldenstrom Stage I, 10 were in Stage II, and 79 were in Stage III. Forty-four patients had hips classified as lateral pillar B and 47 patients as lateral pillar C. Nine patients had not reached the mid-fragmentation stage for appropriate lateral pillar classification by the time they took the PROMIS survey. ANOVA was used to compare differences between the mean PROMIS T-scores of these weightbearing/activity regimens. Results were assessed with a significance of p < 0.05 and adjusted for Waldenstrom stage, gender, age at diagnosis, and history of major surgery using multivariate regression analysis. RESULTS: After controlling for confounding variables, the mild- (ß regression coefficient -15 [95% CI -19 to -10]; p < 0.001), moderate- (ß -19 [95% CI -24 to -14]; p < 0.001), and severe- (ß -25 [95% CI -30 to -19]; p < 0.001) restriction groups were associated with worse mobility T-scores compared with the no-restriction group, but no association was detected for the pain interference or fatigue measures. Weightbearing and activity restrictions were not associated with mental health measures (depressive symptoms and anxiety). Weightbearing and activity restrictions were not associated with social health measures (peer relationships). Earlier Waldenstrom stage was associated with worse pain interference (ß 10 [95% CI 2 to 17]; p = 0.01) and peer relationships scores (ß -8 [95% CI -15 to -1]; p = 0.03); female gender was linked with worse depressive symptoms (ß 7 [95% CI 2 to 12]; p = 0.005) and peer relationships scores (ß -6 [95% CI -12 to 0]; p = 0.04); and earlier age at diagnosis was associated with worse peer relationships scores (ß 1 [95% CI 0 to 2]; p = 0.03). History of major surgery had no connection to any of the six PROMIS measures. CONCLUSION: We found that weightbearing and activity restriction treatments are associated with poorer patient-reported mobility in the active stages of Perthes disease after controlling for Waldenstrom stage, gender, age at diagnosis, and history of surgery. Weightbearing/activity restrictions, however, are not associated with pain interference, fatigue, depressive symptoms, anxiety, and peer relationships. Understanding how these treatments are associated with quality of life in patients with Perthes disease can aid in decision-making for providers, help set expectations for patients and their parents, and provide opportunities for better education and preparation. Because of the chronic nature of Perthes disease, future studies may focus on longitudinal trends in patient-reported outcomes to better understand the overall impact of this disease and its treatment. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Doença de Legg-Calve-Perthes/psicologia , Qualidade de Vida/psicologia , Restrição Física/psicologia , Suporte de Carga , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Doença de Legg-Calve-Perthes/terapia , Masculino , Medidas de Resultados Relatados pelo Paciente , Autorrelato
16.
J Bone Joint Surg Am ; 103(9): 803-811, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33439608

RESUMO

BACKGROUND: The Classification of Early-Onset Scoliosis (C-EOS) allows providers to differentiate patients, for clinical and research purposes, on the basis of the etiology of their disease as well as radiographic parameters. The Early Onset Scoliosis Questionnaire (EOSQ) is the first disease-specific, parent-reported HRQOL (health-related quality-of-life) outcome measure for this condition. We sought to determine the influence of the C-EOS etiology designation, radiographic parameters, and medical comorbidities on EOSQ scores to differentiate quality of life in this heterogeneous patient population. We hypothesized that baseline EOSQ scores for patients with EOS would be strongly affected by the C-EOS etiology designation. METHODS: The analysis included prospectively enrolled patients with EOSQ scores recorded in a multicenter EOS database prior to intervention for the EOS. EOSQ scores were compared across C-EOS etiologies, severity of disease based on radiographic measurements, and patient comorbidities prior to scoliosis intervention. RESULTS: Six hundred and ten patients with EOS were available for analysis; 119 had congenital, 201 had idiopathic, 156 had neuromuscular, and 134 had syndromic EOS. In multivariate analysis, neuromuscular and syndromic etiologies were associated with lower scores than congenital and idiopathic etiologies in many EOSQ domains including general health, transfer, daily living, fatigue/energy level, and emotion. Patients with neuromuscular EOS had the lowest EOSQ scores in general. Congenital and idiopathic EOS did not differ from each other in any EOSQ domain. Coronal Cobb and kyphosis angles had significant inverse but generally weak correlations with EOSQ domains. Individual medical comorbidities had a minor effect on certain domains while American Society of Anesthesiologists (ASA) class and total number of comorbidities had inverse correlations with most domains. CONCLUSIONS: The underlying etiology of EOS appears to have a significant influence on the parent-reported HRQOL outcomes of the disease. Specifically, syndromic and neuromuscular C-EOS diagnoses are associated with lower EOSQ scores before treatment compared with congenital and idiopathic diagnoses. Radiographic measurements of severity have a relatively small influence on EOSQ scores. These baseline differences in C-EOS-designated etiology should be accounted for in studies comparing outcomes of treatment for this heterogeneous patient population. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Pais , Qualidade de Vida , Escoliose , Inquéritos e Questionários , Adolescente , Idade de Início , Análise de Variância , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Humanos , Lactente , Cifose/complicações , Doenças Neuromusculares/complicações , Procurador , Escoliose/classificação , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Escoliose/psicologia , Índice de Gravidade de Doença , Síndrome
17.
J Pediatr Orthop ; 41(2): 93-98, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33229962

RESUMO

BACKGROUND: Deformity index (DI) and extrusion index (EI) are 2 radiographic methods currently used to quantify femoral head deformity in the active stages of Legg-Calvé-Perthes disease. This study aimed to quantify the interobserver reproducibility of the 2 methods using a large, international group of pediatric orthopaedic surgeons with diverse clinical experience. METHODS: Radiographs of patients (age 6 to 11 y at time of diagnosis) prospectively enrolled in an international multicenter-cohort study, were measured by members of our study group. For each radiograph, the raters independently assessed EI (n=33 cases) and DI (n=32 cases), along with the rater's subjective assessment of the extent of hip deformity (ie, none, mild, moderate, or severe). Reliability analysis was conducted using intraclass correlation coefficient (ICC) and κ techniques. RESULTS: The ICC for EI on the affected side was 0.68 (95% confidence interval: 0.57-0.79). The calculated DI ICC was 0.53 (95% confidence interval: 0.41-0.68). Subjectively, an average of 68±3.5% of surgeons agreed on the subjective description of each patient's femoral head deformity. CONCLUSIONS: EI is measured with a reasonably high rate of correlation among surgeons from disparate backgrounds. Agreement is lower among the same group of surgeons when the more complex DI is used. DI is most useful when utilized by a small number of experienced observers in a research setting, whereas EI may have better clinical applicability. LEVEL OF EVIDENCE: Level III-reliability study.


Assuntos
Doença de Legg-Calve-Perthes/diagnóstico por imagem , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Prognóstico , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes
18.
Spine Deform ; 9(2): 471-480, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33118150

RESUMO

PURPOSE: Selective thoracic fusion (STF) for double curve patterns in idiopathic scoliosis is an attractive treatment option. However, short-term coronal decompensation and truncal imbalance are known findings. Previous studies with hook constructs showed that eventually balance is achieved via an increase in lumbar curve magnitude, as the lumbosacral obliquity did not change following surgery. Our aim is to investigate patients with idiopathic curves who underwent STF using all-pedicle screw constructs to determine if the uninstrumented lumbar curve and lumbosacral obliquity responded in the same manner as was previously reported with all-hook constructs. METHODS: 102 consecutive patients with Lenke 1B, 1C or 3C curves who underwent STF using all-screw constructs at a single institution were included in this study. Radiographic assessment was performed, and patient reported outcomes were obtained. Subgroup analyses were performed based on preoperative thoracic: lumbar curve ratio as well as lumbar curve magnitude. RESULTS: Overall, the patients showed statistically significant improvement in both trunk shift and L4-pelvis obliquity at final follow-up. The uninstrumented lumbar curves trended toward improvement over time, but did not reach statistical significance (p = 0.107). SRS-30 scores were statistically significantly improved in multiple domains. CONCLUSION: Selective thoracic fusion is an excellent treatment option in most double curve patterns. Balance in the coronal plane is predictably achieved at 2-year follow-up. The lumbosacral obliquity improves more with screw technology than was previously found with hook constructs; therefore, the improvement in balance over time does not depend upon an increase in the uninstrumented lumbar curve. LEVEL OF EVIDENCE: IV.


Assuntos
Parafusos Pediculares , Escoliose , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
19.
J Bone Joint Surg Am ; 103(3): 235-242, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33252590

RESUMO

BACKGROUND: Outcomes studies following successful closed reduction of late-detected developmental dysplasia of the hip (DDH) reveal high rates of secondary reconstructive surgery with limited comparative data demonstrating lower rates of residual dysplasia with open reduction. The purpose of this study was to compare long-term outcomes, with regard to radiographic evidence of residual dysplasia and secondary reconstructive procedures, between late closed and late open reduction for DDH in patients 6 to 24 months of age at reduction. METHODS: We identified all patients between 6 and 24 months of age who underwent closed or open reduction for DDH between 1980 and 2008 and were followed until at least 10 years of age. Outcomes included radiographic measurement of acetabular dysplasia after triradiate cartilage closure, development of osteonecrosis, and the need for secondary procedures for residual dysplasia. RESULTS: One hundred and four hips underwent index closed reduction and 54 hips underwent index open reduction. There was no significant difference in the age at reduction (p = 0.07). Among the 116 hips for which initial anteroposterior pelvic radiographs were available, most closed reductions (55%) were performed in International Hip Dysplasia Institute (IHDI) grade-III hips whereas most open reductions (71%) were performed in IHDI grade-IV hips. Analysis of the hips that did not undergo a secondary procedure showed that those with an index open reduction had a greater lateral center-edge angle (mean and standard deviation, 27.2° ± 10.0° versus 22.4° ± 6.8° in the closed reduction cohort; p = 0.02), lower femoral head extrusion index (22.2% ± 8.9% versus 26.0% ± 6.2%; p = 0.04), and lower Sharp angle (43.3° ± 6.0° versus 46.6° ± 3.1°; p = 0.002) at triradiate closure. There was no difference in the prevalence of osteonecrosis (Bucholz-Ogden grades II, III, and IV) between the closed and open reduction cohorts (22% versus 19%, respectively; p = 0.60). Secondary procedures were performed more frequently after closed reduction than after open reduction (47% versus 30%, respectively; p = 0.03). CONCLUSIONS: In patients with late reduction of DDH, closed reduction was associated with increased residual dysplasia and it was associated with a higher rate of secondary surgery in those >12 months old despite a decreased severity of displacement based on the IHDI classification. Additional, prospective studies with assessment of functional outcomes are needed to validate these findings. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Acetábulo/cirurgia , Displasia do Desenvolvimento do Quadril/cirurgia , Articulação do Quadril/cirurgia , Feminino , Humanos , Lactente , Masculino , Procedimentos Ortopédicos , Osteotomia/métodos , Reoperação , Resultado do Tratamento
20.
J Child Orthop ; 14(6): 529-536, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33343748

RESUMO

PURPOSE: The modified lateral pillar classification (mLPC) is used for prognostication in the fragmentation stage of Legg Calvé Perthes disease. Previous reliability assessments of mLPC range from fair to good agreement when evaluated by a small number of observers with pre-selected radiographs. The purpose of this study was to determine the inter-observer and intra-observer reliability of mLPC performed by a group of international paediatric orthopaedic surgeons. Surgeons self-selected the radiograph for mLPC assessment, as would be done clinically. METHODS: In total, 40 Perthes cases with serial radiographs were selected. For each case, 26 surgeons independently selected a radiograph and assigned mLPC and 21 raters re-evaluated the same 40 cases to establish intra-observer reliability. Rater performance was determined through surgeon consensus using the mode mLPC as 'gold standard'. Inter-observer and intra-observer reliability data were analysed using weighted kappa statistics. RESULTS: The weighted kappa for inter-observer correlation for mLPC was 0.64 (95% confidence interval: 0.55 to 0.74) and was 0.82 (range: 0.35 to 0.99) for intra-observer correlation. Individual surgeon's overall performance varied from 48% to 88% agreement. Surgeon mLPC performance was not influenced by years of experience (p = 0.51). Radiograph selection did not influence gold standard assignment of mLPC. There was greater agreement on cases of mild B hips and severe C hips. CONCLUSIONS: mLPC has low good inter-observer agreement when performed by a large number of surgeons with varied experience. Surgeons frequently chose different radiographs, with no impact on mLPC agreement. Further refinement is needed to help differentiate hips on the border of group B and C. LEVEL OF EVIDENCE: III.

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