Increased bone mineral density in the non-resurfaced patella after total knee arthroplasty: a clinical and densitometric study.

We report the results of a longitudinal study of 40 patients with osteoarthritis who had primary prosthetic replacement without patellar resurfacing, and were followed at 6 months postoperatively with a densitometric study and clinically at a minimum follow-up of 2 years. Densitometric analysis showed a mean preoperative density at the affected knee of 0.69 g/cm(2) (CI: 0.62-0.76), compared to 0.86 g/cm(2) (CI: 0.79-0.93) for the opposite knee (p = 0.002). In our study population, the return to load and motion to the retained patella led to a significant increase in patellar bone density as measured by densitometry studies. This observation correlated with significant improvement in knee functional score.

Very-Low-Calorie Ketogenic Diets With Whey, Vegetable, or Animal Protein in Patients With Obesity: A Randomized Pilot Study.

CONTEXT: We compared the efficacy, safety, and effect of 45-day isocaloric very-low-calorie ketogenic diets (VLCKDs) incorporating whey, vegetable, or animal protein on the microbiota in patients with obesity and insulin resistance to test the hypothesis that protein source may modulate the response to VLCKD interventions. SUBJECTS AND METHODS: Forty-eight patients with obesity (19 males and 29 females, homeostatic model assessment (HOMA) index ≥ 2.5, aged 56.2 ± 6.1 years, body mass index [BMI] 35.9 ± 4.1 kg/m2) were randomly assigned to three 45-day isocaloric VLCKD regimens (≤800 kcal/day) containing whey, plant, or animal protein. Anthropometric indexes; blood and urine chemistry, including parameters of kidney, liver, glucose, and lipid metabolism; body composition; muscle strength; and taxonomic composition of the gut microbiome were assessed. Adverse events were also recorded. RESULTS: Body weight, BMI, blood pressure, waist circumference, HOMA index, insulin, and total and low-density lipoprotein cholesterol decreased in all patients. Patients who consumed whey protein had a more pronounced improvement in muscle strength. The markers of renal function worsened slightly in the animal protein group. A decrease in the relative abundance of Firmicutes and an increase in Bacteroidetes were observed after the consumption of VLCKDs. This pattern was less pronounced in patients consuming animal protein. CONCLUSIONS: VLCKDs led to significant weight loss and a striking improvement in metabolic parameters over a 45-day period. VLCKDs based on whey or vegetable protein have a safer profile and result in a healthier microbiota composition than those containing animal proteins. VLCKDs incorporating whey protein are more effective in maintaining muscle performance.

Relationships of acylated and des-acyl ghrelin levels to bone mineralization in obese children and adolescents.

AIMS: Bodyweight is a significant predictor of bone mass. Hormonal factors are thought to play a role in the mechanisms controlling the association of body weight and fat mass with bone mass. Very recently, the orexigenic hormone ghrelin has also been implicated in bone metabolism. In this study we examined the associations of circulating acylated and des-acyl ghrelin concentrations with measures of bone in a group of obese children and adolescents as well as in a group of healthy control children. We also determined whether the associations were independent of body composition, chronological age, gender, Tanner stage, and leptin, glucose, insulin and insulin-like growth factor (IGF)-1 levels. METHODS: We performed a prospective cross-sectional study of 100 obese children [age, 8.9 (8.3 to 9.4); BMI-Standard Deviation Score (SDS), 2.2 (2.0 to 2.3)], and 100 age-matched lean healthy subjects. Fasting insulin, leptin, IGF-1, acylated and total ghrelin were measured by radioimmunoassay. Des-acyl ghrelin values were calculated as total ghrelin minus acylated ghrelin. Whole body (WB) and lumbar spine (LS) BMD, and BMC as well as body composition were assessed by DXA (Hologic QDR-4500W). LS volumetric BMD (BMAD) was estimated using the formula of Katzman (BMC/area(1.5)), while WB BMC data were expressed as BMC/height. RESULTS: Backward linear regression analysis was performed for individual groups, with age, gender, Tanner stage, weight, height, body composition (lean and fat mass), acylated ghrelin, des-acyl ghrelin, leptin, glucose, insulin, and IGF-1, entered into the model. In healthy children, acylated ghrelin was a significant and independent negative predictor of WB BMD, and WB BMC/height, while lean mass was positively associated significantly with these bone measures. In contrast, in obese children, a positive significant association was observed between des-acyl ghrelin and WB BMD as well as WB BMC/height, along with lean mass, and to a lesser degree, with fat mass. Acylated as well as des-acyl ghrelin were not significant predictors of LS BMD and LS BMAD in obese as well as control children. CONCLUSIONS: The results of this investigation indicate that the influence of the two distinct isoforms of ghrelin on BMD is mediated by specific body composition parameters in obese and control healthy children.

Impairment of diastolic function in adult patients affected by osteogenesis imperfecta clinically asymptomatic for cardiac disease: casuality or causality?

Osteogenesis imperfecta (OI) is a rare inherited connective disorder causing increased bone fragility and low bone mass. OI includes severe bone fragility, impaired dentinogenesis, with less common alterations in the joints, blood vessels, heart valves, skin. Interestingly, description of left ventricular rupture, aortic dissection and heart valves incompetence has been previously described. Death may occur in OI patients for cardiac disease in asyntomatic subjects. Aim of our study has been to evaluate the presence of potential subclinical cardiac disorders and to characterize cardiac functional parameters by echocardiography in adults with OI in absence of cardiac symptoms. Forty patients (21 females and 19 males) affected by type I, III, IV OI and 40 control subjects (20 females and 20 males) were evaluated in the study. Patients and controls underwent clinical examination, screening for endocrine and metabolic disorders, 12-lead electrocardiogram and echocardiogram. In particular, all subjects were evaluated by two-dimensional echocardiography with continuous- and pulse-wave Doppler. Patients and controls belonged to NYHA class I and no significant electrocardiographic alteration was documented in both groups. Thirty-eight patients (95%) showed valvular regurgitation compared to one control subject (2.5%; P<0.001). As regards the diastolic function parameters, in OI patients E wave velocity was reduced by 23% (95% CI: 9% to 29%; P<0.001), E/A ratio was reduced by 17% (95% CI: 15% to 26%; P<0.001) while isovolumetric relaxation time (IRT) was increased by 47% (95% CI: 26% to 53%; P<0.001) and E wave deceleration time (DT) was increased by 18% (95% CI: 13% to 26%; P<0.001) compared to controls. In conclusion, our data indicate that adult patients affected by OI have an altered diastolic function in absence of other metabolic alterations. These diastolic echocardiographic parameters might worsen over time, especially if other cardiovascular risk factors (e.g., smoking, hypertension, metabolic and endocrine alterations) are not carefully checked, monitored and treated. In the context of a multidisciplinary evaluation of OI patients, our data suggest that a careful cardiological evaluation of these patients is indicated beside skeletal evaluation and therapeutical skeletal options.

Value of echo-planar diffusion-weighted MRI in the detection of secondary and postoperative relapsing/residual cholesteatoma.

PURPOSE: To assess the utility of echo-planar diffusion-weighted magnetic resonance imaging (EPI-DWI) in the diagnosis of secondary cholesteatoma of the middle ear and in the differential diagnosis between residual/relapsing cholesteatoma and non-cholesteatomatous tissues (scar, granulation and inflammatory tissue) after conservative mastoidectomy. MATERIALS AND METHODS: Twenty-four patients, who had previously undergone clinical and CT investigation, were prospectively examined by standard and EPI-DWI magnetic resonance imaging (MRI) after conservative mastoidectomy. Secondary cholesteatoma was suspected in 5 patients and residual/relapsing cholesteatoma in 19 patients. Two radiologists, blinded to patient's identity, clinical data and CT findings, reached consensus on the presence of tissue consistent with cholesteatoma in conventional CT and areas of altered signal in EPI-DWI in the petrous bone. All patients underwent mastoidectomy, second time of tympanoplasty or review surgery within 15 days from MR investigation. Sensitivity, specificity and negative and positive predictive values were evaluated separately for standard and EPI-DWI MRI. RESULTS: In EPI-DWI sequences, 11/12 patients with cholesteatoma showed an area of hyperintense signal, whereas patients with non-cholesteatomatous tissue showed no pathologic signal in the petrous bone. In the single case of cholesteatoma undetected on EPI-DWI a cholesteatomatous pearl approx. 2 mm in diameter was visible in the surgical cavity. Sensitivity, specificity, positive and negative predictive values were 92%, 100%, 100%, 92% for EPI-DWI MRI and 92%, 25%, 55%,75% for standard MRI, respectively. CONCLUSIONS: EPI-DWI sequences are useful in the diagnosis of secondary cholesteatoma and in the differential diagnosis between residual/relapsing cholesteatoma and non-cholesteatomatous tissues after conservative mastoidectomy. However, the usefulness of EPI-DWI sequences as a screening test after conservative mastoidectomy requires further assessment.