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1.
BMC Med Genet ; 21(1): 21, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005172

RESUMO

BACKGROUND: More than 95% of individuals with RTT have mutations in methyl-CpG-binding protein 2 (MECP2), whose protein product modulates gene transcription. The disorder is caused by mutations in a single gene and the disease severity in affected individuals can be quite variable. Specific MECP2 mutations may lead phenotypic variability and different degrees of disease severity. It is known that low bone mass is a frequent and early complication of subjects with Rett syndrome. As a consequence of the low bone mass Rett girls are at an increased risk of fragility fractures. This study aimed to investigate if specific MECP2 mutations may affects the degree of involvement of the bone status in Rett subjects. METHODS: In 232 women with Rett syndrome (mean age 13.8 ± 8.3 yrs) we measured bone mineral density at whole body and at femur (BMD-FN and BMD-TH) by using a DXA machine (Hologic QDR 4500). QUS parameters were assessed at phalanxes by Bone Profiler-IGEA (amplitude dependent speed of sound: AD-SoS and bone transmission time: BTT). Moreover, ambulation capacity (independent or assisted), fracture history and presence of scoliosis were assessed. We divided the subjects with the most common point mutations in two group based on genotype-phenotype severity; in particular, there has been consensus in recognising that the mutations R106T, R168X, R255X, R270X are considered more severe. RESULTS: As aspect, BMD-WB, BMD-FN and BMD-TH were lower in subjects with Rett syndrome that present the most severe mutations with respect to subjects with Rett syndrome with less severe mutations, but the difference was statistically significant only for BMD-FN and BMD-TH (p < 0.05). Also both AD-SoS and BTT values were lower in subjects that present the most severe mutations with respect to less severe mutations but the difference was not statistically significant. Moreover, subjects with Rett syndrome with more severe mutations present a higher prevalence of scoliosis (p < 0.05) and of inability to walk (p < 0.05). CONCLUSION: This study confirms that MECP2 mutation type is a strong predictor of disease severity in subjects with Rett syndrome. In particular, the subjects with more severe mutation present a greater deterioration of bone status, and a higher prevalence of scoliosis and inability to walk.


Assuntos
Doenças Ósseas/genética , Proteína 2 de Ligação a Metil-CpG/genética , Osteoporose/genética , Síndrome de Rett/genética , Adolescente , Adulto , Densidade Óssea/genética , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Mutação , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Síndrome de Rett/diagnóstico por imagem , Síndrome de Rett/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/genética , Escoliose/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
2.
J Surg Res ; 246: 182-189, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31593862

RESUMO

BACKGROUND: Trauma patients with pelvic fractures have a high rate of venous thromboembolism (VTEs). The reason for this high rate is unknown. We hypothesize that fibrinolysis shutdown (SD) predicts VTE in patients with severe pelvic fracture. METHODS: Retrospective chart review of trauma patients who presented with pelvic fracture from 2007 to 2017 was performed. Inclusion criteria were injury severity score > 15, abdomen/pelvis abbreviated injury scale >/= 3, blunt mechanism, admission citrated rapid thrombelastography (TEG). Fibrinolytic phenotypes were defined by fibrinolysis on citrated rapid TEG as hyperfibrinolysis, physiologic lysis, and SD. Univariate analysis of TEG measurements and clinical outcomes, followed by multivariable logistic regression (MV) with stepwise selection, was performed. RESULTS: Overall, 210 patients were included. Most patients (59%) presented in fibrinolytic shutdown. VTE incidence was 11%. There were no significant differences in fibrinolytic phenotypes or other TEG measurements between those who developed VTE and those who did not. There was a higher rate of VTE in patients who underwent pelvic external fixation or resuscitative thoracotomy. On MV, pelvic fixation and resuscitative thoracotomy were independent predictors of VTE. CONCLUSIONS: In severely injured patients with pelvic fractures, there was a high rate of VTE and the majority presented in SD. However, we were unable to correlate initial SD with VTE. Ultimately, the high rate of VTE in this patient population supports the concept of implementing VTE chemoprophylaxis measures as soon as hemostasis is achieved.


Assuntos
Fibrinólise/fisiologia , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Tromboembolia Venosa/epidemiologia , Ferimentos não Penetrantes/complicações , Escala Resumida de Ferimentos , Adulto , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/fisiopatologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboelastografia , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/fisiopatologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/fisiopatologia
3.
Maturitas ; 129: 50-56, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547913

RESUMO

OBJECTIVES: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. STUDY DESIGN: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. MAIN OUTCOME MEASURES: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. RESULTS: 452 patients (mean age 80 ±â€¯8 years; 70.8% women) were included. Baseline BI was 79.3 ±â€¯23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline. CONCLUSION: Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.


Assuntos
Acidentes por Quedas , Atividades Cotidianas , Nível de Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Fraturas Ósseas/fisiopatologia , Hospitalização , Humanos , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
4.
Eur J Radiol ; 118: 181-186, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439239

RESUMO

PURPOSE: To assess how many and which CT reformats of long bone non-unions should be analyzed to best approximate the analysis of a larger number of CT reformats obtained in the three orthogonal planes. METHOD: We used 29 CT examinations of tibial or femoral non-unions to obtain 87 stacks of 7 CT reformats each in the coronal (n = 29), sagittal (n = 29) or transverse (n = 29) planes. Two independent radiologists scored two fracture sites on each CT reformat by using a Tomographic Union Score (TUS) (1: no callus, 2: non-bridging callus; 3: bridging immature callus; 4: bridging remodeled callus). The reference standard was the mean of the three TUS calculated from the cortical scores obtained on all the sagittal, coronal and transverse CT reformats. We determined the agreement (intra-class correlation coefficient (ICC) between the reference standard and 33 models combining one to seven CT reformats from one to three planes. The three best models were compared following a resampling procedure by a Wilcoxon's signed rank test. RESULTS: Three models combining two (mid-coronal and mid-sagittal), three (mid-coronal, mid-sagittal and mid-transverse) or four (two paramedian coronal and sagittal) CT reformats had the highest ICC (ICC ≥ 0.89) for both observers. After resampling, the model combining the two paramedian sagittal and coronal CT reformats statistically outperformed the two other models. CONCLUSION: Semi-quantitative analysis of the two paramedian sagittal and coronal CT reformats is an acceptable alternative to the analysis of more numerous reformats.


Assuntos
Fêmur/diagnóstico por imagem , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Feminino , Fêmur/lesões , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/lesões , Adulto Jovem
5.
Trials ; 20(1): 510, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420055

RESUMO

BACKGROUND: Opioids and acetaminophen are both widely used to relieve pain after non-operative treatment of limb fractures, but evidence for the superiority of opioids versus acetaminophen is lacking. In this study, we aim to determine whether acetaminophen is non-inferior to the acetaminophen/oxycodone combination for pain relief after non-operative fixation of an extremity limb fracture. We hypothesize that acetaminophen is non-inferior to the acetaminophen/oxycodone combination. METHODS: A double-blind randomized controlled trial will be conducted. Power analysis determined that 1226 participants will be needed (P <0.05, power 90%). Patients with acute limb fracture who receive non-operative treatment will be recruited and randomly allocated into two groups: the intervention group will receive oral oxycodone (10 mg) and acetaminophen (650 mg), and the control group will receive acetaminophen (650 mg) only. All participants will be instructed to take one pill of study medication on an as-needed basis and no more frequently than once every 8 h. The primary outcome measure will be scores on the 11-point Numeric Rating Scale (NRS-11) over 14 days. Secondary outcome measures are scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), EuroQol five-dimension questionnaire (EQ-5D), self-rated satisfaction with the analgesia produced, self-reported nighttime sleep duration, number of intervention or control pills used, and total duration for taking intervention or control medication. Change of pain scores and the number of times that analgesic drugs were taken in the two groups will be statistically evaluated with Student t tests according to their fracture site. DISCUSSION: This study will be a randomized controlled trial that is adequately powered to test the hypothesis that acetaminophen is non-inferior to the combination of acetaminophen and oxycodone in relieving objectively measured pain after non-operative treatment of limb fractures in adults. It will hopefully provide a safe and effective analgesic plan for such patients. TRIAL REGISTRATION: ChiCTR registry: ChiCTR1800017015 . Registered on July 8, 2018.


Assuntos
Acetaminofen/uso terapêutico , Extremidades/lesões , Fraturas Ósseas/terapia , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acetaminofen/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Biomed Res Int ; 2019: 1983131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467871

RESUMO

Nonunion with bone defects, a common complication after long bone fracture, is a major challenge for orthopaedic surgeons worldwide because of the high incidence rate and difficulties in achieving successful treatment. Bone defects are the main complications of nonunion. The conventional biological treatments for nonunion with bone defects involve the use of autologous bone grafts or bone graft substitutes and cell-based therapy. Traditional nonunion treatments have always been associated with safety issues and various other complications. Bone grafts have limited autologous cancellous bone and there is a risk of infection. Additionally, problems with bone graft substitutes, including rejection and stimulation of bone formation, have been noted, and the health of the stem cell niche is a major consideration in cell-based therapy. In recent years, researchers have found that exosomes can be used to deliver functional RNA and mediate cell-to-cell communication, suggesting that exosomes may repair bone defects by regulating cells and cytokines involved in bone metabolism. In this review, we highlight the possible relationships between risk factors for nonunion and exosomes. Additionally, we discuss the roles of exosomes in bone metabolism and bone regeneration.


Assuntos
Regeneração Óssea/genética , Exossomos/genética , Fraturas Ósseas/terapia , Fraturas não Consolidadas/terapia , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Terapia Baseada em Transplante de Células e Tecidos/tendências , Exossomos/transplante , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Fraturas não Consolidadas/fisiopatologia , Humanos , Osteogênese
7.
Wounds ; 31(8): 213-218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31298660

RESUMO

INTRODUCTION: Graft fixation is critical for the successful survival of a skin graft. Conventional mechanical fixation may induce inappropriate pressure and increase wound complications. Negative pressure wound therapy (NPWT) could be utilized to secure a skin graft and improve drainage. Limited quantitative data exist on the efficacy of NPWT for skin grafting. OBJECTIVE: This retrospective study compares the efficacy and complications between NPWT and conventional mechanical fixation in skin grafts. MATERIALS AND METHODS: Patients who underwent skin graft surgery from January 2015 to December 2016 at a large university hospital in southwest China were retrospectively analyzed. Characteristics, including wound pattern, skin graft type, surgical procedure, survival rate, and postoperative complication, were statistically analyzed by Pearson chi-square or Fisher's exact test. RESULTS: A total of 186 patients were included in the study; 72 received NPWT and 114 received conventional mechanical dressing fixation after skin grafting. Overall survival rate of full-thickness skin grafts was significantly higher in the NPWT group than the dressing group (P ⟨ .01). The NPWT group showed a higher survival rate than the dressing group for each anatomic site, but only patients who had skin grafts of the hand exhibited statistically significant results. CONCLUSIONS: This study reports a quantitative analysis of the efficacy of NPWT on skin graft fixation with NPWT providing consistent pressure and better drainage than conventional mechanical fixation. In addition, the use of NPWT also could increase graft take on the hand region.


Assuntos
Sobrevivência de Enxerto/fisiologia , Tratamento de Ferimentos com Pressão Negativa/métodos , Transplante de Pele/métodos , Cicatrização/fisiologia , Adulto , Traumatismos do Braço/fisiopatologia , Traumatismos do Braço/cirurgia , Cicatriz Hipertrófica/fisiopatologia , Cicatriz Hipertrófica/cirurgia , Contratura/fisiopatologia , Contratura/cirurgia , Fasciite Necrosante/fisiopatologia , Fasciite Necrosante/cirurgia , Feminino , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Fraturas Múltiplas/fisiopatologia , Fraturas Múltiplas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Injury ; 50(8): 1423-1428, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31256910

RESUMO

There has been very limited analysis of the relationship between obesity and fractures in the orthopaedic literature. It has been established for some years that underweight individuals are at greater risk of proximal femoral fractures but recently there has been interest in the susceptibility of obese post-menopausal females to fracture. We have undertaken an analysis of 4886 adult patients who presented with a fracture and had their BMI assessed. Analysis has confirmed the relationship between underweight individuals and proximal femoral fractures but there is also a negative association between obesity and clavicle fractures in males and females and with calcaneal fractures in females. There is a positive relationship between obesity and proximal humeral, finger phalangeal and ankle fractures in males and with humeral diaphyseal, carpal and ankle fractures in females. There was no relationship found between open or multiple fractures and obesity.


Assuntos
Densidade Óssea/fisiologia , Fraturas Ósseas/epidemiologia , Obesidade/epidemiologia , Fraturas por Osteoporose/epidemiologia , Magreza/epidemiologia , Adulto , Índice de Massa Corporal , Calcâneo/lesões , Clavícula/lesões , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Úmero/lesões , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Prevalência , Escócia/epidemiologia , Fatores Sexuais , Ossos do Tarso/lesões , Magreza/complicações , Magreza/fisiopatologia
9.
Injury ; 50(8): 1470-1477, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31288938

RESUMO

PURPOSE: Open reduction and internal fixation (ORIF) of Bennett fractures is increasingly preferred over closed reduction and percutaneous fixation (CRIF) in an attempt to prevent the development of post-traumatic arthrosis. The aim of this systematic review was to determine whether the preference for ORIF is justified based on the available literature regarding functional outcome and complications after surgery. METHODS: A systematic review was performed in Medline, Embase, Cochrane CENTRAL, Web of science, and Google scholar. Duplicates were removed and title and abstract were screened after which full text articles were analysed. The reference lists of selected articles were screened for additional relevant studies. Study characteristics were recorded and methodological qualities were assessed after which data was extracted from the included articles. The Eaton-Littler score for post-traumatic arthrosis (primary outcome) on follow-up X-rays was used as primary outcome. Secondary outcomes were Grip strength, Pinch strength, persistent pain, fixation failure, functional impairment, infection and surgery time. RESULTS: Ten studies were included; three retrospective comparative studies and seven retrospective case series. Of the 215 patients in these studies, 138 had been treated using an open technique and 77 by a closed percutaneous technique. The pooled rate of post-traumatic arthrosis was 57.5% (26.6-85.5) in the ORIF group versus 26.1% (3.9-59.0) in the CRIF group. Mean surgical operation time was 71.9 min for ORIF and 30.2 min for percutaneous patients. Fixation failure was significantly more often seen in the ORIF patients, 8.2% (0.7-22.8) vs. 2.9% (0.8-9.1), Risk Ratio 1.132 (0.01-176.745); p = 0.048. Infection was only seen in 5 CRIF patients. Persistent pain was seen in 32.9% (0.6-83.1) in ORIF patients versus 22.3% (8.1-41.1) in the CRIF patients. The pooled means Grip strength was 48.3 kg (95% CI; 39.7-56.9) versus 43.4 kg (95% CI; 22.9-63.8) for ORIF and CRPF, respectively. Functional impairment was similar between the two groups, 1.4% (0.1-4.4) vs 1.8% (0.1-5.7) respectively. CONCLUSION: The analysed data do not confirm ORIF to prevent post-traumatic arthrosis, secondly more fixation failure and pain was seen in the ORIF group. The pooled data show percutaneous fixation to be preferable over ORIF in the surgical treatment of Bennett fractures.


Assuntos
Redução Fechada , Fratura-Luxação/cirurgia , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Ossos Metacarpais/cirurgia , Redução Aberta , Fenômenos Biomecânicos , Fratura-Luxação/fisiopatologia , Fraturas Ósseas/fisiopatologia , Humanos , Ossos Metacarpais/lesões , Ossos Metacarpais/fisiopatologia , Resultado do Tratamento
11.
J Shoulder Elbow Surg ; 28(10): 1877-1885, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272891

RESUMO

BACKGROUND: The purpose of this study was to measure the distance of the clavicle in 3 dimensions (3D) and each direction (anterior to posterior, medial to lateral, and superior to inferior) and to analyze the correlation of the angular orientation of the scapula according to each directional distance of the clavicle. METHODS: Sixty-seven patients with Robinson 2B1 and 2B2 clavicle midshaft fracture (46.0 ± 17.4 years, men = 50, women = 17) were selected as final subjects. Patients' computed tomography was reconstructed using an image processing program (3D Slicer 4.3 software). Anteroposterior (AP) distance, medial-to-lateral distance, superior-to-inferior distance, and 3D distance of both clavicles were measured. The plane connecting the 3 points (superior pole, inferior pole, and center of glenoid) of the scapula was used to calculate differences in the angular orientation between both scapulae. RESULTS: Among each directional distance of the clavicle, only the AP distance showed negative correlation with scapular angular orientation with anterior tilting, internal rotation, and upward rotation of the scapula (Pearson's correlation coefficient: -0.68, -0.24, and -0.28; P < .001, P = .048, and P = .021). CONCLUSION: The shortening of the AP distance of the clavicle was related to the angular orientation of the scapula in acute clavicle fracture. AP shortening should be considered when determining the treatment of clavicle fracture.


Assuntos
Clavícula/diagnóstico por imagem , Clavícula/lesões , Fraturas Ósseas/diagnóstico por imagem , Escápula/diagnóstico por imagem , Adulto , Diáfises/lesões , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Rotação , Escápula/fisiopatologia , Tomografia Computadorizada por Raios X
12.
Eklem Hastalik Cerrahisi ; 30(2): 130-6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291861

RESUMO

OBJECTIVES: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF). PATIENTS AND METHODS: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images. RESULTS: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up. CONCLUSION: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.


Assuntos
Articulações Carpometacarpais/cirurgia , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Adulto , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/fisiopatologia , Feminino , Seguimentos , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/fisiopatologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Nutrients ; 11(7)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31261978

RESUMO

Type 2 diabetes increases bone fracture risk in postmenopausal women. Usual treatment with anti-resorptive bisphosphonate drugs has some undesirable side effects, which justified our interest in the osteogenic potential of nutrition and exercise. Since meal eating reduces bone resorption, downhill locomotion increases mechanical stress, and brief osteogenic responsiveness to mechanical stress is followed by several hours of refractoriness, we designed a study where 40-min of mechanical stress was manipulated by treadmill walking uphill or downhill. Exercise preceded or followed two daily meals by one hour, and the meals and exercise bouts were 7 hours apart. Fifteen subjects each performed two of five trials: No exercise (SED), uphill exercise before (UBM) or after meals (UAM), and downhill exercise before (DBM) or after meals (DAM). Relative to SED trial, osteogenic response, defined as the ratio of osteogenic C-terminal propeptide of type I collagen (CICP) over bone-resorptive C-terminal telopeptide of type-I collagen (CTX) markers, increased in exercise-after-meal trials, but not in exercise-before-meal trials. CICP/CTX response rose significantly after the first exercise-after-meal bout in DAM, and after the second one in UAM, due to a greater CICP rise, and not a decline in CTX. Post-meal exercise, but not the pre-meal exercise, also significantly lowered serum insulin response and homeostatic model (HOMA-IR) assessment of insulin resistance.


Assuntos
Remodelação Óssea , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício , Fraturas Ósseas/prevenção & controle , Refeições , Osteogênese , Idoso , Biomarcadores/sangue , Colágeno Tipo I/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/sangue , Resistência à Insulina , Pessoa de Meia-Idade , Valor Nutritivo , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pós-Menopausa/sangue , Período Pós-Prandial , Pró-Colágeno/sangue , Fatores de Tempo , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 28(8): 1431-1440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327393

RESUMO

BACKGROUND: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. METHODS: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. RESULTS: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. CONCLUSIONS: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.


Assuntos
Adaptação Psicológica/fisiologia , Artralgia/psicologia , Articulação do Cotovelo/lesões , Fraturas Ósseas/psicologia , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Articulação do Cotovelo/fisiopatologia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
15.
Rev Assoc Med Bras (1992) ; 65(6): 902-908, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340323

RESUMO

OBJECTIVE: To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment. METHODS: Identification of publications on pathological skeletal fractures previously exposed to ionizing radiation. RESULTS: The incidence of fractures after irradiation varies from 1.2% to 25% with a consolidation rate of 33% to 75%, being more frequent in the ribs, pelvis, and femur. The time elapsed between irradiation and fracture occurs years after radiotherapy. Risk factors include age above 50 years, female gender, extensive periosteal detachment, circumferential irradiation, tumor size, and anterior thigh location. The etiology is still uncertain, but cellular disappearance, reduction of bone turnover and activity were observed hematopoietic as possible causes of failure of consolidation. CONCLUSION: There is no consensus in the literature on the factors related to the development of fractures, with radiation dose, previous tumor size and periosteal detachment being suggested as potential factors.


Assuntos
Fraturas Ósseas/etiologia , Lesões por Radiação/complicações , Radioterapia/efeitos adversos , Fraturas Ósseas/fisiopatologia , Humanos , Fatores de Risco
16.
Med Sci Monit ; 25: 5580-5588, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31350990

RESUMO

BACKGROUND The factors associated with osteoporosis are poorly understood in the Chinese population. This study aimed to examine the factors associated with osteoporosis and with fractures in a Chinese elderly population. MATERIAL AND METHODS This was a cross-sectional study of elderly people living in Tianjin between 2012 and 2014. Bone mineral density was measured by dual X-ray absorptiometry. The subjects completed a questionnaire about lifestyle habits, personal and family medical history, calcium intake, and exercising. Data were gathered on occurrence of fracture at 5 years or August 2018, whichever occurred first. RESULTS There were 298 individuals with osteoporosis (18.5% male, median age 67 years) and 397 without (46.3% male, median age 62 years). Male sex (OR=0.051, 95% CI: 0.021-0.126), age (OR=1.049, 95% CI: 1.099-1.202), being divorced/widowed (OR=2.445, 95% CI: 1.219-4.904), digestive ulcer history (OR=3.805, 95% CI: 1.539-9.405), family history of hunchback (OR=2.659, 95% CI: 1.145-6.175), family history of osteoarthropathy (OR=4.222, 95% CI: 2.128-8.375), fracture history (OR=2.138, 95% CI: 1.307-3.496), drinking green tea (OR=0.352, 95% CI: 0.217-0.574), and exercising (OR=0.303, 95% CI: 0.193-0.475) were independently associated with osteoporosis. Digestive ulcer history (OR=3.183, 95% CI: 1.178-8.5992), exercising (OR=0.354, 95% CI: 0.139-0.903), and taking calcium supplements during follow-up (OR=0.262, 95% CI: 0.112-0.611) were independently associated with fractures in patients with osteoporosis. CONCLUSIONS Female sex, age, marital status, history of digestive ulcer and fracture, and family history of hunchback and osteoarthropathy are associated with osteoporosis among elderly subjects, while drinking green tea and exercising are inversely associated. Among the patients with osteoporosis, a history of digestive ulcer is associated with fractures, while exercising and taking calcium supplements are inversely associated.


Assuntos
Fraturas Ósseas/etiologia , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Densidade Óssea , Cálcio/metabolismo , China , Estudos Transversais , Suplementos Nutricionais , Exercício , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Fatores de Risco
17.
PLoS One ; 14(6): e0218404, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220118

RESUMO

In an ever-aging society the demand for bone-defect filling grafts continues to gain in importance. While autologous grafting still prevails as the gold standard, allografts and xenografts present viable alternatives with promising results. Physiochemical properties of a graft strongly depend on the processing method such as the decellularization protocol. In addition, the physiochemical characteristics are critical factors for a successful integration of the graft after the implantation and might influence mesenchymal stem cell function in therapeutic approaches combining grafts and autologous mesenchymal stem cells (MSCs). Several decellularization methods have been proposed, however it still remains unclear which method results in favorable physiochemical properties or might be preferred in stem cell applications. In the first part of this study we compared two decellularization approaches resulting in chemically processed allografts (CPAs) or sonication-based processed allografts (SPAs). Each decellularization approach was compared for its decellularization efficacy and its influence on the grafts' surface texture and composition. In the second part of this study biocompatibility of grafts was assessed by testing the effect of extraction medium on MSC viability and comparing them to commercially available allografts and xenografts. Additionally, grafts' performance in terms of MSC functionality was assessed by reseeding with MSCs pre-differentiated in osteogenic medium and determining cell adhesion, proliferation, as well as alkaline phosphatase (ALP) activity and the degree of mineralization. In summary, results indicate a more effective decellularization for the SPA approach in comparison to the CPA approach. Even though SPA extracts induced a decrease in MSC viability, MSC performance after reseeding was comparable to commercially available grafts based on DNA quantification, alkaline phosphatase activity and quantification of mineralization. Commercial Tutoplast allografts showed overall the best effects on MSC functionality as indicated by extraction biocompatibility testing as well as by comparing proliferation and osteogenic differentiation.


Assuntos
Aloenxertos/ultraestrutura , Transplante Ósseo , Fraturas Ósseas/terapia , Transplante de Células-Tronco Mesenquimais , Osteogênese/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aloenxertos/transplante , Animais , Materiais Biocompatíveis/uso terapêutico , Células da Medula Óssea/ultraestrutura , Bovinos , Destilação , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Células-Tronco Mesenquimais , Microscopia Confocal , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Minerais/uso terapêutico , Sonicação
18.
Arch Phys Med Rehabil ; 100(10): 1853-1862, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31229529

RESUMO

OBJECTIVE: To use Rasch analysis to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and existing short versions in individuals with traumatic brain injury and orthopedic injuries, with comparisons to a general population group. DESIGN: The Partial Credit Rasch model was applied to evaluate the WHOQOL-BREF as well as shortened versions using a cross-sectional study design. SETTING: Regional hospital, and national electoral sample in New Zealand. PARTICIPANTS: Individuals with traumatic brain injury (n=74), individuals with orthopedic injuries (n=114), general population (n=140). INTERVENTIONS: None. MAIN OUTCOME MEASURE: WHOQOL-BREF. RESULTS: The WHOQOL-BREF met expectations of the unidimensional Rasch model and demonstrated good reliability (person separation index [PSI] =0.82) when domain items were combined into physical-psychological, social, and environmental superitems. Analysis of shorter versions, the EUROHIS-QOL-8 and World Health Organization Quality of Life-5 (WHOQOL-5), indicated overall acceptable fit to the Rasch model and evidence of unidimensionality. The EUROHIS-QOL-8 showed good reliability (PSI=0.81); however, reliability of the WHOQOL-5 (PSI=0.68) was below acceptable standards for group comparisons, in addition to demonstrating poor person-item targeting. CONCLUSIONS: The WHOQOL-BREF and the 8-item EUROHIS-QOL-8 version are both reliable and valid in the assessment of quality of life in both injury and general populations. Ordinal-interval conversion tables published for these validated scales as well as for the WHOQOL-5 can be used to improve precision of assessment. The transformation of ordinal scale scores into an interval measure of health-related quality of life also permits the calculation of a single summary score for the WHOQOL-BREF, which will be useful in a wide range of clinical and research contexts. Further validation work of the WHOQOL-5 is needed to ascertain its psychometric properties.


Assuntos
Lesões Encefálicas Traumáticas , Fraturas Ósseas , Luxações Articulares , Qualidade de Vida , Entorses e Distensões , Inquéritos e Questionários , Adulto , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/psicologia , Feminino , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/psicologia , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Psicometria , Entorses e Distensões/fisiopatologia , Entorses e Distensões/psicologia
19.
Injury ; 50(8): 1483-1488, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31213306

RESUMO

AIMS: Fractures and dislocations of the midfoot are relatively uncommon but can be life changing injuries. Within the literature, there has been scant specific reference to the identification and management of medial ray injuries in midfoot trauma. Moreover, it is appreciated that these injuries are associated with poor outcomes. We aim to clearly define these injury characteristics and demonstrate fixation techniques. PATIENTS AND METHODS: A retrospective review of the case notes and imaging was conducted for operatively treated midfoot injuries between January 2013 and January 2018. RESULTS: 161 patients were identified, 31 of these with imaging and operative diagnosis suggestive of medial ray injury. Studying these 31 injuries revealed five patterns of injury. CONCLUSION: When treating midfoot trauma, it is important to fully understand the injury pattern as this dictates the principles and techniques of fixation. Identification and knowledge of these five injury patterns will aid surgeons in future management of these injuries and may improve treatment outcomes.


Assuntos
Traumatismos do Pé/classificação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/classificação , Luxações Articulares/classificação , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
PLoS One ; 14(5): e0217682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150482

RESUMO

OBJECTIVES: We hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the degree of pneumatization of the temporal bone with the severity of temporal bone fracture (TBF). METHODS: Charts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classification systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineural hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction. RESULTS: Patients with increased pneumatization of the temporal bone had significantly fewer and less severe SNHL. SNHL more strongly correlated with the degree of pneumatization in the mastoid (P = 0.005) than that in the petrous apex (P = 0.024). On the other hand, the degree of TBP correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule violations (P = 0.002). Fractures with otic-capsule violation were 4 times more likely to have vestibular dysfunction (P = 0.043) and 3 times more likely to have SNHL (P = 0.006). FNP was not associated with otic-capsule violating fractures but was 3.5 times more common in comminuted fractures (P = 0.025). CONCLUSIONS: The degree of temporal bone pneumatization was negatively correlated to the incidence of otic-capsule violation and the severity of hearing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of temporal bone pneumatization in TBFs.


Assuntos
Paralisia Facial/fisiopatologia , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva/fisiopatologia , Osso Temporal/fisiopatologia , Adulto , Idoso , Cóclea/fisiopatologia , Nervo Facial/diagnóstico por imagem , Nervo Facial/fisiopatologia , Paralisia Facial/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/etiologia , Humanos , Masculino , Processo Mastoide/fisiopatologia , Pessoa de Meia-Idade , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/fisiopatologia , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vertigem/diagnóstico por imagem , Vertigem/fisiopatologia
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