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1.
Instr Course Lect ; 69: 661-670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017759

RESUMO

Orthobiologics continue to be one of the most discussed and trending topics in orthopaedic surgery today. Pathology of tendons, ligaments, bone, cartilage, and meniscal tissue are all theoretically treatable with biologics. Ultimately, the hope for biologics is to provide symptom relief and improve tissue healing with the potential to treat some conditions without the need for surgery. It is important to review the current state of biologic therapies available for musculoskeletal disease, discuss government regulations and barriers to use, and, finally, examine current research in biologics and what the future may hold.


Assuntos
Produtos Biológicos , Ortopedia , Medicina Esportiva , Humanos , Ligamentos , Tendões
2.
J Zoo Wildl Med ; 50(4): 997-999, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926535

RESUMO

A single incision laparoscopic system (SILS) was used to remove the falciform ligament of an adult male cheetah (Acinonyx jubatus) during routine diagnostic liver biopsy. Adipose tissue isolated from the falciform ligament was used to establish a mesenchymal stem cell culture. The use of a SILS port for liver biopsy and falciform ligament collection allowed for a large amount of fat to be collected from a small surgical incision and rapid postoperative recovery. This case expands the use of the single incision laparoscopy surgical technique beyond reproductive sterilization procedures in large cats.


Assuntos
Acinonyx/cirurgia , Laparoscopia/veterinária , Ligamentos/cirurgia , Tecido Adiposo/citologia , Animais , Biópsia/instrumentação , Biópsia/métodos , Biópsia/veterinária , Fígado/patologia , Masculino , Células-Tronco Mesenquimais
3.
Urology ; 136: 190-195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31730940

RESUMO

OBJECTIVE: To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS: Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS: The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION: Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.


Assuntos
Ligamentos/anatomia & histologia , Próstata/anatomia & histologia , Prostatectomia/métodos , Osso Púbico/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade
4.
J Orthop Res ; 38(1): 7-12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529731

RESUMO

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7-12, 2020.


Assuntos
Ligamentos/lesões , Traumatismos dos Tendões/terapia , Tendões/fisiologia , Cicatrização , Animais , Humanos , Ligamentos/anatomia & histologia , Ligamentos/fisiologia , Tendões/anatomia & histologia
5.
J Craniomaxillofac Surg ; 47(12): 1952-1962, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812306

RESUMO

PURPOSE: This study investigated the outcome of lower eyelid ectropion (LEE) treatment in patients with another primary periorbital or mid-facial pathology. MATERIALS AND METHODS: This 18-year monocentric retrospective cohort study included patients admitted for various leading mid-facial pathologies and presenting with a LEE. The primary diagnosis, surgical pretreatment, ectropion type, ectropion severity score (ESS), and surgical techniques were recorded. The primary endpoint was the postoperative ESS score. RESULTS: Overall, 40 patients (female n = 16, male n = 24, average age 70.8 years), primarily with periorbital skin cancer (n = 21, 52.5%), facial palsy (n = 7, 17%), trauma (n = 6, 15%), or other pathologies (n = 6, 15%), were included. Surgical procedures mostly addressed a correction of anterior and posterior lamellae (n = 22, 55%), with isolated anterior lamellae in only a few cases (n = 10, 25%). The ESS score significantly decreased from 4.8 ± 1.8 to 1.3 ± 1.3 (paired t-test, p < 0.001) after a mean follow-up of 23.8 months. CONCLUSION: LEE constitutes a relevant problem. Due to preexisting canthal ligament laxity in patients undergoing oncologic or traumatic midface surgery, the risk of ectropion has so far been underestimated. Bilamellar approaches in elderly patients are likely to be obligatory in any case.


Assuntos
Ectrópio/cirurgia , Pálpebras/cirurgia , Paralisia Facial/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Zhongguo Gu Shang ; 32(11): 1008-1013, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870048

RESUMO

OBJECTIVE: To compare clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO) and open reduction and internal fixation under arthroscopy for the treatment of low energy tibial plateau fracture with ligament injury. METHODS: From March 2016 to March 2017, 60 tibial plateau fracture patients with ligament injury were divided into A and B groups according to random number table. In group A, there were 30 patients including 14 males and 16 females aged from 30 to 63 years old with an average of (47.25±5.36) years old; 8 patients were classified type I, 12 patients were typeII and 10 patients type III; treated by MIPPO under arthroscopy. In group B, there were 30 patients including 16 males and 14 females aged from 32 to 60 years old with an average of (43.39±4.62) years old; 10 patients were classified to type I, 11 patients were type I and 9 patients type III; treated by open reduction and internal fixation. Imaging data, length of incision, postoperative volume of drainage, intraoperative blood loss, complications, postoperative activity time and hospital stays were observed and compared. Postoperative HSS score at 18 months was used to compare recovery of knee joint function. RESULTS: Sixty patients were followed up for 12 to 24 months with average of 18 months. There were no statistical differences in tilt angle of the tibial plateau (TPA), posterior angle of tibial plateau (PA) and femoro tibial angle (FTA) between two groups at 3 days and 12 months after operation. There was no significance in width of internal joint apace before operation, while group B(6.59±0.71) mm was bigger than group A (4.25±0.65) mm after operation at 12 months. Two patients in group A occurred complications and 6 patients in group B occurred complications, and had differences between two groups(P<0.05). Length of incision, hospital stays, postoperative volume of drainage, intraoperative blood loss and postoperative activity time in group A were(5.17±1.89) cm, (2.14±0.65) weeks, (30.02±3.15) ml, (62.63±9.58) ml, (3.16±1.87)d, respectively; while in group B were(16.25±3.47) cm, (4.57±1.09) weeks, (63.75±9.84) ml, (145.89±12.61) ml, (7.86±2.14) d, respectively; and had statistical differences between two groups(P<0.05). HSS score in group A (87.68±7.39) was higher than that of in group B(69.42±5.13) at 18 months after operation (P<0.05). CONCLUSIONS: Both of MIPPO and open reduction and internal fixation under arthroscopy for low energy tibial plateau fracture with ligament injury could provide stable fixation. Open reduction and internal fixation has advantages of simple operation, but had seriously-injured, MIPPO has advantages of less trauma, good recovery of joint function, less complications and could deal with ligament and meniscus injury.


Assuntos
Artroscopia , Fraturas da Tíbia , Adulto , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
7.
Invest Ophthalmol Vis Sci ; 60(14): 4564-4573, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675425

RESUMO

Purpose: The aim was to clarify the topographical anatomy of the common tendinous ring for the four rectus muscles in both adults and fetuses. Methods: We histologically examined the annular ligament for a common origin of the extraocular rectus muscles using 10 specimens from elderly individuals and 31 embryonic and fetal specimens. Results: At 6 to 8 weeks, each rectus carried an independent long tendon, individually originating from the sphenoid. Notably, we found additional origins from the optic or oculomotor nerve sheath. At 12 to 15 weeks, the lateral, inferior, and medial recti muscles were united to provide a C-shaped musculofibrous mass that was separated from the superior rectus originating from the edge of the optic canal opening. Morphologic features at 31 to 38 weeks were almost the same as those at 12 to 15 weeks, but the long and thick common tendon of the three recti reached the sphenoid body in the parasellar area. In adults, a ring-like arrangement of the rectus muscles ended at a site 8.1 to 12.0 mm anterior to the optic canal opening and independent of the superior rectus origin, the lateral, inferior, and medial recti formed a C-shaped muscle mass. The united origins of the three recti changed to a fibrous band extending along the superomedial wall of the orbital fissure. Conclusions: Consequently, none of the specimens we examined exhibited an annular tendon representing a common origin of the four recti, suggesting that the common tendinous ring includes only medial, lateral, and inferior rectus muscles with the superior rectus taking its origin independently.


Assuntos
Desenvolvimento Fetal/fisiologia , Ligamentos/embriologia , Músculos Oculomotores/embriologia , Órbita/embriologia , Tendões/embriologia , Idoso , Idoso de 80 Anos ou mais , Tecido Conjuntivo/embriologia , Feminino , Idade Gestacional , Humanos , Ligamentos/anatomia & histologia , Masculino , Desenvolvimento Muscular , Junção Neuromuscular , Músculos Oculomotores/anatomia & histologia , Órbita/anatomia & histologia , Tendões/anatomia & histologia
8.
Sports Med Arthrosc Rev ; 27(4): 169-170, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688537

RESUMO

Long experience and recent evidence suggest that trochleoplasty is needed in very few patella stabilization surgeries. As trochleoplasty adds risk, this author recommends it only in patients with high degrees of dysplasia, prominent supratrochlear spurs, ligamentous laxity, and more dramatic J signs.


Assuntos
Artroplastia , Instabilidade Articular/cirurgia , Patela , Luxação Patelar/cirurgia , Humanos , Ligamentos/fisiopatologia , Recidiva
9.
Curr Urol Rep ; 20(11): 70, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31612341

RESUMO

PURPOSE OF REVIEW: Due to recent concerns over the use of synthetic mesh in pelvic floor reconstructive surgery, there has been a renewed interest in the utilization of non-synthetic repairs for pelvic organ prolapse. The purpose of this review is to review the current literature regarding pelvic organ prolapse repairs performed without the utilization of synthetic mesh. RECENT FINDINGS: Native tissue repairs provide a durable surgical option for pelvic organ prolapse. Based on recent findings of recently performed randomized clinical trials with long-term follow-up, transvaginal native tissue repair continues to play a role in the management of pelvic organ prolapse without the added risk associated with synthetic mesh. In 2019, the FDA called for manufacturers of synthetic mesh for transvaginal mesh to stop selling and distributing their products in the USA. Native tissue and non-synthetic pelvic organ prolapse repairs provide an efficacious alternative without the added risk inherent to the utilization of transvaginal mesh. A recent, multicenter, randomized clinical trial demonstrated no clear advantage to the utilization of synthetic mesh. Furthermore, transvaginal native tissue repairs have demonstrated good long-term efficacy, particularly when anatomic success is not the sole metric used to define surgical success.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos , Ligamentos/cirurgia , Tratamentos com Preservação do Órgão , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Resultado do Tratamento
10.
J Craniofac Surg ; 30(8): 2632-2634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31592846

RESUMO

The aim of this study was to compare Hamra's and Mendelson's models of midface lift.The terms "Hamra ST" and "Mendelson BC" were used to search PubMed, yielding 35 and 48 papers, respectively. Of the 83 abstracts, 55 were excluded and 28 full papers discussing midface lift were reviewed. Among those 28 papers, 13 were excluded because they did not have sufficient content. Among the 15 full texts, 5 mined papers were added. Thereafter, 20 papers were analyzed.Hamra's description of his surgical technique changed twice. In 1990 (The Deep-Plane Rhytidectomy), he wrote that he performed Skoog-type subsuperficial muscular aponeurotic system (SMAS) dissection to the nasolabial fold. In 1992 (Composite Rhytidectomy), however, he cited a paper insisting that the SMAS does not exist in the cheek area. He wrote that his deep-plane rhytidectomy was not a sub-SMAS procedure, stating that he dissected the cheek fat that is attached to the zygomaticus major, then repositioned the skin. This was a substantially different explanation of the dissection plane. In 1997, he stated that instead of dividing the orbicularis oculi muscle from the zygomaticus major and minor, he elevated them together in a flap. Thus, his method returned to the sub-SMAS plane. Mendelson introduced the concepts of the prezygomatic space, orbicularis-retaining ligament, and zygomatic-retaining ligament, and proposed an anatomical model.If the authors explain Hamra's zygorbicular dissection using Mendelson's model, the dissection starts just beneath the roof of the prezygomatic space, traverses the floor, and then releases the zygomatic ligament (lower boundary of the space). The authors should consider the necessity and riskiness of this release.


Assuntos
Bochecha/cirurgia , Músculos Faciais/cirurgia , Aponeurose/cirurgia , Dissecação , Pálpebras/cirurgia , Humanos , Ligamentos/cirurgia , Sulco Nasogeniano/cirurgia , Ritidoplastia/métodos , Retalhos Cirúrgicos/cirurgia
11.
Medicine (Baltimore) ; 98(41): e17344, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593083

RESUMO

RATIONALE: The meningovertebral ligaments are a group of tissues that connect the dura and the vertebral bone. Abnormal fibrous ligaments in the canal space, which are essentially different from these ligaments, have been identified and their presence very rarely results in spinal disorder. PATIENT CONCERNS: A 20-year-old Mongolian woman had developed persistent headache at 15 years of age. She then became unable to run fast when she was 19 years old and had progressively declining ability to move. She complained of back pain and unstable gait 6 months prior to presentation. Physical examination revealed exaggerated deep tendon reflexes in the lower extremities and decreased proximal leg muscle strength bilaterally. DIAGNOSES: Magnetic resonance imaging (MRI) revealed abnormal bands compressing the spinal cord at the T10/11 level, with large epidural lipomatosis dorsal to the dural tube. INTERVENTION: To decompress the cord, posterior laminectomy for T3-L3 and removal of the heterotopic ligaments were performed with T8-L1 posterior fusion. OUTCOMES: Sufficient decompression of the cord was noted on postoperative MRI at the affected segments. The patient could subsequently walk without a cane and headache resolved immediately after the operation. LESSONS: The presence of an aberrant epidural band is a rare pathologic state that often coexists with a surrounding lipomatosis and can lead to spinal cord compression. Removal of the band is a promising treatment for myelopathy caused by the compressive lesion.


Assuntos
Coristoma/cirurgia , Ligamentos , Doenças da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia , Coristoma/complicações , Espaço Epidural/cirurgia , Feminino , Humanos , Doenças da Medula Espinal/etiologia , Doenças da Coluna Vertebral/complicações , Vértebras Torácicas/cirurgia , Adulto Jovem
12.
Nat Commun ; 10(1): 4825, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645555

RESUMO

Natural creatures, from fish and cephalopods to snakes and birds, combine neural control, sensory feedback and compliant mechanics to effectively operate across dynamic, uncertain environments. In order to facilitate the understanding of the biophysical mechanisms at play and to streamline their potential use in engineering applications, we present here a versatile numerical approach to the simulation of musculoskeletal architectures. It relies on the assembly of heterogenous, active and passive Cosserat rods into dynamic structures that model bones, tendons, ligaments, fibers and muscle connectivity. We demonstrate its utility in a range of problems involving biological and soft robotic scenarios across scales and environments: from the engineering of millimeter-long bio-hybrid robots to the synthesis and reconstruction of complex musculoskeletal systems. The versatility of this methodology offers a framework to aid forward and inverse bioengineering designs as well as fundamental discovery in the functioning of living organisms.


Assuntos
Bioengenharia , Simulação por Computador , Articulação do Cotovelo/fisiologia , Plumas/fisiologia , Fenômenos Fisiológicos Musculoesqueléticos , Asas de Animais/fisiologia , Animais , Osso e Ossos/fisiologia , Humanos , Ligamentos/fisiologia , Músculo Esquelético/fisiologia , Sistema Musculoesquelético , Amplitude de Movimento Articular/fisiologia , Robótica , Tendões/fisiologia
13.
Int J Sports Med ; 40(14): 903-908, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31614383

RESUMO

Football players frequently face the occurrence of non-contact injuries. Although there are likely multiple factors that contribute to increased risk of non-contact injury, it remains a challenge to correlate all these factors. However, it is not clear how much of individual training abilities may interfere in these events. As such, the primary aim of the present study was to determine whether the reduction of functional performance of the thigh in the isokinetic knee tests, anthropometric and morbid history can establish risk factors for lower-limb musculoskeletal injuries throughout the season. The incidence of injuries and odds ratios were calculated for suspected risk factors. Hamstring/Quadriceps conventional ratio outside of the safety range (55-64%) may be involved in the occurrence of non-contact muscle injuries and the risk for any musculoskeletal injuries in the lower extremities is 16 times higher when extensor peak of torque exceeds 10% and 12 times higher when flexor peak of torque difference was greater than 10%. This kind of evaluation can result in intervention programs that may decrease the risk of lower-limb musculoskeletal injuries. Based on these results we can establish a specific and individualized exercise program for each athlete and thus protect them during the season.


Assuntos
Extremidade Inferior/lesões , Medição de Risco/métodos , Futebol/lesões , Adolescente , Adulto , Antropometria , Teste de Esforço , Músculos Isquiotibiais/lesões , Músculos Isquiotibiais/fisiologia , Humanos , Joelho/fisiologia , Ligamentos/lesões , Estudos Longitudinais , Extremidade Inferior/fisiologia , Masculino , Condicionamento Físico Humano , Músculo Quadríceps/lesões , Músculo Quadríceps/fisiologia , Fatores de Risco , Futebol/fisiologia , Coxa da Perna/fisiologia , Lesões do Menisco Tibial/fisiopatologia , Adulto Jovem
14.
Zhongguo Gu Shang ; 32(9): 819-823, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615178

RESUMO

OBJECTIVE: To evaluate the effect of bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft on atlantoaxial dislocation caused by acute type I transverse ligament injury in school-age children. METHODS: From February 2006 to February 2019, 8 school-age children with atlantoaxial dislocation caused by acute type I transverse ligament injury were systematically reviewed, including 6 males and 2 females; aged 9 to 12 years old; 8 acute injuries included 4 high-level falls, 2 car accidents and 2 sports injuries; the atlantoaxial interval(ADI) was 5 to 8 mm. Eight cases presented with pain, stiffness, numbness and cervical spine dysfunction in different degrees. Two of them were accompanied by nerve compression and ASIA grade D. The preoperative C1,2 angle averaged 20.7° to 23.4°. All patients received cranial traction and surgical treatment after complete reduction or atlantoaxial reduction. The changes of Japanese Orthopaedic Association(JOA) score, space available for the cord(SAC), neck disability index(NDI), ADI, ASIA classification(ASIA) injury classification(1992) and C1,2 angle before and after treatment were observed. RESULTS: The average follow-up time was 8 to 156 months. Clinical and radiological follow-up showed that the atlantoaxial joint was completely relieved, the reduction was satisfactory and the arthrodesis was stable. Nerve and vascular injuries associated with this technique were not observed. JOA score, SAC, NDI, C1,2 angle of the last follow-up of the children were significantly improved. Two children of ASIA grade D recovered to grade E. CONCLUSIONS: Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft is simple, less bleeding, strong stability and high fusion rate. It is an ideal surgical procedure for acute type I transverse ligament injury with atlantoaxial dislocation in school-age children.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Fusão Vertebral , Articulação Atlantoaxial/cirurgia , Parafusos Ósseos , Criança , Feminino , Humanos , Ligamentos , Masculino , Resultado do Tratamento
15.
Invest Ophthalmol Vis Sci ; 60(13): 4416-4424, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31639828

RESUMO

Purpose: Lenses have an intracellular hydrostatic pressure gradient to drive fluid from central fiber cells to surface epithelial cells. Pressure is regulated by a feedback control system that relies on transient receptor potential vanilloid (TRPV)1 and TRPV4 channels. The ciliary muscle transmits tension to the lens through the zonules of Zinn. Here, we have examined if ciliary muscle tension influenced the lens intracellular hydrostatic pressure gradient. Methods: We measured the ciliary body position and intracellular hydrostatic pressures in mouse lenses while pharmacologically causing relaxation or contraction of the ciliary muscle. We also used inhibitors of TRPV1 and TRPV4, in addition to phosphoinositide 3-kinase (PI3K) p110α knockout mice and immunostaining of phosphorylated protein kinase B (Akt), to determine how changes in ciliary muscle tension resulted in altered hydrostatic pressure. Results: Ciliary muscle relaxation increased the distance between the ciliary body and the lens and caused a decrease in intracellular hydrostatic pressure that was dependent on intact zonules and could be blocked by inhibition of TRPV4. Ciliary contraction moved the ciliary body toward the lens and caused an increase in intracellular hydrostatic pressure and Akt phosphorylation that required intact zonules and was blocked by either inhibition of TRPV1 or genetic deletion of the p110α catalytic subunit of PI3K. Conclusions: These results show that the hydrostatic pressure gradient within the lens was influenced by the tension exerted on the lens by the ciliary muscle through the zonules of Zinn. Modulation of the gradient of intracellular hydrostatic pressure in the lens could alter the water content, and the gradient of refractive index.


Assuntos
Corpo Ciliar/metabolismo , Cristalino/metabolismo , Ligamentos/metabolismo , Músculo Liso/metabolismo , Canais de Cátion TRPV/metabolismo , Animais , Técnica Indireta de Fluorescência para Anticorpo , Pressão Hidrostática , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Contração Muscular/efeitos dos fármacos , Relaxamento Muscular/efeitos dos fármacos , Midriáticos/farmacologia , Fosfatidilinositol 3-Quinases/metabolismo , Pilocarpina/farmacologia , Canais de Cátion TRPV/antagonistas & inibidores , Tropicamida/farmacologia
16.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1469-1476, set.-out. 2019. graf
Artigo em Inglês | VETINDEX, LILACS | ID: biblio-1038657

RESUMO

This study aimed to histologically evaluate the quality of tissue repair in equine suspensory ligament treated with two cell therapy protocols. All four limbs of six animals were operated simultaneously to remove a fragment in each ligament using a skin biopsy punch. Two days later, intralesional injections were performed using bone marrow mononuclear fraction (BM group), cultivated cells derived from adipose tissue (AT group), saline (positive control group), or no treatment (negative control group), in such way that each horse received all treatments. After sixty days biopsies were performed for histological analysis (H & E, Masson's trichrome and picrosirius red) and immunohistochemistry analysis (collagen type III). Histological findings (H & E and Masson's trichrome), birefringence intensity (through picrosirius) and collagen type III expression (through immunohistochemistry) were analyzed. Samples from treated groups had better birefringence intensity (P=0.007) and fiber alignment scores were superior compared to controls, though not statistically significant (P=0.08). Presence of inflammatory cells and intense staining for collagen type III occurred in all groups demonstrating an active healing process. In conclusion, both protocols resulted in improvement of tissue repair indicating their potential to be used as an adjuvant treatment of equine suspensory ligament disorders.(AU)


Este estudo teve como objetivo a avaliação histológica e imunoistoquímica do reparo do ligamento suspensório equino tratado com dois protocolos de terapia celular. Os quatro membros dos seis animais do experimento foram submetidos a procedimento cirúrgico em que um fragmento de cada ligamento foi retirado, utilizando-se punch de biópsia. Dois dias após o procedimento, aplicações intralesionais foram realizadas, por meio de aspirado de medula óssea (bone marrow-BM), células mesenquimais derivadas de tecido adiposo (adipose tissue-AT), solução salina (positive control group-PC) ou controle (negative control-NC). Após 60 dias, biópsias foram retiradas da região de reparo dos ligamentos e foram submetidas à análise histológica (HE, tricrômio de Masson, picrosírius red) e imunoistoquímica (colágeno tipo III). Diferentes variáveis histológicas (HE e tricrômio de Masson), a intensidade de birrefringência das fibras colágenas (picrosírius red) e a expressão de colágeno tipo III foram avaliadas. Os grupos tratados apresentaram maior birrefringência (P=0,007) e alinhamento de fibras (P=0,08) comparados ao controle, para o qual o resultado não se mostrou estatisticamente significativo. Achados histológicos e imunoistoquímicos demonstraram um processo ativo de reparo tecidual em todos os grupos. Concluiu-se que os dois protocolos de terapia celular apresentaram melhora no reparo tecidual, demonstrando potencial terapêutico adjuvante no tratamento de afecções do ligamento suspensório equino.(AU)


Assuntos
Animais , Terapia Baseada em Transplante de Células e Tecidos/métodos , Terapia Baseada em Transplante de Células e Tecidos/veterinária , Cavalos/anatomia & histologia , Ligamentos/anatomia & histologia , Ligamentos/química , Imuno-Histoquímica/veterinária
19.
JAMA ; 322(11): 1054-1065, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529008

RESUMO

Importance: Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Transvaginal mesh hysteropexy is an alternative option. Objective: To compare the efficacy and adverse events of vaginal hysterectomy with suture apical suspension and transvaginal mesh hysteropexy. Design, Setting, Participants: At 9 clinical sites in the US Pelvic Floor Disorders Network, 183 postmenopausal women with symptomatic uterovaginal prolapse were enrolled in a randomized superiority clinical trial between April 2013 and February 2015. The study was designed for primary analysis when the last randomized participant reached 3 years of follow-up in February 2018. Interventions: Ninety-three women were randomized to undergo vaginal mesh hysteropexy and 90 were randomized to undergo vaginal hysterectomy with uterosacral ligament suspension. Main Outcomes and Measures: The primary treatment failure composite outcome (re-treatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival models. Secondary outcomes included operative outcomes and adverse events, and were evaluated with longitudinal models or contingency tables as appropriate. Results: A total of 183 participants (mean age, 66 years) were randomized, 175 were included in the trial, and 169 (97%) completed the 3-year follow-up. The primary outcome was not significantly different among women who underwent hysteropexy vs hysterectomy through 48 months (adjusted hazard ratio, 0.62 [95% CI, 0.38-1.02]; P = .06; 36-month adjusted failure incidence, 26% vs 38%). Mean (SD) operative time was lower in the hysteropexy group vs the hysterectomy group (111.5 [39.7] min vs 156.7 [43.9] min; difference, -45.2 [95% CI, -57.7 to -32.7]; P = <.001). Adverse events in the hysteropexy vs hysterectomy groups included mesh exposure (8% vs 0%), ureteral kinking managed intraoperatively (0% vs 7%), granulation tissue after 12 weeks (1% vs 11%), and suture exposure after 12 weeks (3% vs 21%). Conclusions and Relevance: Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery, vaginal mesh hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension did not result in a significantly lower rate of the composite prolapse outcome after 3 years. However, imprecision in study results precludes a definitive conclusion, and further research is needed to assess whether vaginal mesh hysteropexy is more effective than vaginal hysterectomy with uterosacral ligament suspension. Trial Registration: ClinicalTrials.gov Identifier: NCT01802281.


Assuntos
Histerectomia Vaginal/métodos , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Útero/cirurgia , Idoso , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerectomia Vaginal/efeitos adversos , Estimativa de Kaplan-Meier , Ligamentos/cirurgia , Pessoa de Meia-Idade , Pós-Menopausa , Complicações Pós-Operatórias , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Vagina/cirurgia
20.
BMJ ; 366: l5149, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506252

RESUMO

OBJECTIVE: To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. DESIGN: Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. SETTING: Four non-university teaching hospitals, the Netherlands. PARTICIPANTS: 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. MAIN OUTCOME MEASURES: Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. RESULTS: At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference-6.7%, 95% confidence interval -12.8% to-0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. CONCLUSIONS: At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. TRIAL REGISTRATION: trialregister.nl NTR1866.


Assuntos
Histerectomia Vaginal/efeitos adversos , Ligamentos/cirurgia , Qualidade de Vida , Prolapso Uterino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Países Baixos , Recidiva , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Técnicas de Sutura , Resultado do Tratamento , Prolapso Uterino/diagnóstico
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