Journal articles on the topic 'Long-leg X-ray'
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1
Khan, Ghulam Mustafa Kaim, Syed Mujahid Humail, and Kamran Hafeez. "PRIMARY DIAPHYSEAL TUBERCULOUS OSTEOMYELITIS OF TIBIA." Professional Medical Journal 21, no. 06 (December 10, 2014): 1282–84. http://dx.doi.org/10.29309/tpmj/2014.21.06.2729.
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Diaphyseal tubercular osteomyelitis of long bone is extremely rare and few cases have been reported in literature. We are presenting a case of 17 years old girl presented with pain and swelling over lower half of leg for 7 months. There was often low grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays and MRI of involved leg were suggestive of osteomyelitis. Curettage and biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries, for an osteolytic lesion in bone, tuberculous osteomyelitis should be considered in differential diagnosis.
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Stojiljkovic, Predrag, Milan Jovanovic, Ivan Golubovic, Zoran Radovanovic, Goran Stevanovic, Ivana Golubovic, Dusan Djordjevic, Aleksandar Mitic, Svetlana Milijic, and Zoran Golubovic. "Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report." Vojnosanitetski pregled 75, no. 4 (2018): 422–27. http://dx.doi.org/10.2298/vsp160613343s.
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Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.
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Seo, Hyunsoo, Wooyoung Kim, Bongju Han, Huimin Jang, Myeong Seong Yoon, and Youngjin Lee. "Usefulness of an Additional Filter Created Using 3D Printing for Whole-Body X-ray Imaging with a Long-Length Detector." Sensors 22, no. 11 (June 6, 2022): 4299. http://dx.doi.org/10.3390/s22114299.
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We recently developed a long-length detector that combines three detectors and successfully acquires whole-body X-ray images. Although the developed detector system can efficiently acquire whole-body images in a short time, it may show problems with diagnostic performance in some areas owing to the use of high-energy X-rays during whole-spine and long-length examinations. In particular, during examinations of relatively thin bones, such as ankles, with a long-length detector, the image quality deteriorates because of an increase in X-ray transmission. An additional filter is primarily used to address this limitation, but this approach imposes a higher load on the X-ray tube to compensate for reductions in the radiation dose and the problem of high manufacturing costs. Thus, in this study, a newly designed additional filter was fabricated using 3D printing technology to improve the applicability of the long-length detector. Whole-spine anterior–posterior (AP), lateral, and long-leg AP X-ray examinations were performed using 3D-printed additional filters composed of 14 mm thick aluminum (Al) or 14 mm thick Al + 1 mm thick copper (Cu) composite material. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiation dose for the acquired X-ray images were evaluated to demonstrate the usefulness of the filters. Under all X-ray inspection conditions, the most effective data were obtained when the composite additional filter based on a 14 mm thick Al + 1 mm thick Cu material was used. We confirmed that an SNR improvement of up to 46%, CNR improvement of 37%, and radiation dose reduction of 90% could be achieved in the X-ray images obtained using the composite additional filter in comparison to the images obtained with no filter. The results proved that the additional filter made with a 3D printer was effective in improving image quality and reducing the radiation dose for X-ray images obtained using a long-length detector.
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Shrestha, Amin Kumar, Suman Raja Shrestha, Gopesh Kumar Thakur, and Arjun Prasad Dumre. "Tubercular Osteomyelitis of Tibia: A Case Report." Nepal Medical Journal 2, no. 1 (August 1, 2019): 92–94. http://dx.doi.org/10.37080/nmj.27.
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Tubercular osteomyelitis of long bone is extremely rare and very few cases have been reported in literature. We are presenting a case of 43 years gentlemen presented with pain and swelling over lower half of leg for 5 months. There was associated pus discharging sinus and often low-grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays of involved leg was suggestive of osteomyelitis. Curettage and Biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries like Nepal, for any osteolytic lesion in bone, tubercular osteomyelitis should always be considered in differential diagnosis.
Keywords: extrapulmonary tuberculosis; osteolytic lesion in bone; tubercular osteomyelitis.
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Puspita Arum, Purwa, and Panji Wibowo Nurcahyo. "PERANAN PROYEKSI STITCH VIEW LONG LEG PADA PEMERIKSAAN KNEE JOINT DENGAN INDIKASI OSTEOARTHRITIS." JRI (Jurnal Radiografer Indonesia) 4, no. 2 (November 29, 2021): 70–73. http://dx.doi.org/10.55451/jri.v4i2.90.
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ABSTRACT
Introduction: Long Leg View is an x-ray examination of all parts of the lower extremity using a long vertical cassette which aims to measure the angle between the mechanical axis of the femur and tibia. Knee Joint examination with indications of osteoarthritis at the Radiology Installation of RSUP Dr. Sardjito Yogyakarta uses supine AP projection, Lateral recumbent, Skyline, and Stitch View Long Leg.
Methods: This research is a qualitative research with a case study approach. Collecting data by means of observation, documentation, and in-depth interviews with patients, sending doctors, radiologists, and radiographers. Data collection was carried out in March 2018 at the Radiology Installation of Dr. RSUP. Sardjito Yogyakarta. The data obtained were analyzed using an interactive model.
Results: On the Stitch View Long Leg examination at the Radiology Installation, Dr. Sardjito Yogyakarta uses a collimation area from the pelvis to the ankle joint. According to the resident doctor of orthopedic surgery and traumatology, Dr. Sardjito Yogyakarta, Stitch View Long Leg is able to see the shape of the foot formation, namely the O formation or X formation. In addition, according to radiology specialists, looking at the alignment deviation of the lower extremities can be used to assess the grade of osteoarthritis. Under normal conditions, the anatomical axis of the femur and tibia forms an angle of 6º ± 2º, while the mechanical axis line under normal conditions is 8 mm ± 7 mm medial to the center of the knee joint line. The alignment of varus and valgus has been associated with the development of medial or lateral osteoarthritis.
Conclusion: Stitch View Long Leg aims to assess the grade of osteoarthritis through assessment of lower extremity alignment deviations, see the overall mechanical and anatomical alignment of the lower extremities, help determine the calculation of the angle of bone cutting during Total Knee Replacement surgery, and see the right and left symmetrical balance of genu.
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Savin, Liliana, Olivera Lupescu, A. Patrascu, D. Mihailescu, V. Grigorescu, T. Zlate, Dana Nicoleta Mihai, Carmen Grierosu, and P. Botez. "Implantarea componentelor protetice axata pe planningul radiologic in diformitatile genunchiului in valgus." Materiale Plastice 54, no. 1 (March 30, 2017): 79–82. http://dx.doi.org/10.37358/mp.17.1.4790.
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The present study evaluates the radiologic particularities of deformities in valgus that are necessary for a correct positioning in frontal and rotational plane of the prosthetic components and for a long term life of the polyethylene and the prosthetic implant. Long leg X-ray performed in orthostatism can evaluate the type and degree of the deformity in frontal plane, it can establish the osteotomy cuts and the necessity of ligament release. The anterior-posterior radiologic incidence of the knee in flexion of 900 evaluates the individual rotational profile by calculating the torsion of the distal femoral. Although the frequency of deformity in valgus is more reduced, it presents important clinical and radiologic particularities for the surgical technique.
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Ahmad, Javed, Mohit Kumar Singh, Brij Mohan Patel, Vivek Shrivastava, Amit Kumar Rajan, and Satyajeet Verma. "Long standing Brodie’s abscess of the diaphysis of the upper tibia in a young male." IP International Journal of Orthopaedic Rheumatology 8, no. 2 (January 15, 2023): 93–96. http://dx.doi.org/10.18231/j.ijor.2022.019.
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Brodie’s abscess is a long standing localized form of osteomyelitis seen in cases where either the virulence of the infecting organism is low or the immunity of the host is good. Brodie’s abscess is relatively uncommon type of osteomyelitis that is a diagnostic challenge due to its indolent onset and limited systemic response. We here present a case of Brodie’s abscess in a young male with long standing pain and swelling over the right upper leg from 8 years. The diagnosis was made on X-Ray showed a large osteolytic lesion in the upper tibia with surrounding sclerosis and supported by the CT scan and confirmed by the open biopsy and curettage. On bone drilling frank pus came out and culture showed Staphylococcus aureus. Post-operatively the patient was managed by prolonged course of antibiotics. In this case patient showed complete resolution of symptoms with no signs of recurrence.
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McWilliams, Anthony B., Anastasios Lampropoulos, and Martin H. Stone. "Revision surgery for leg length inequality after primary hip replacement." HIP International 28, no. 5 (June 5, 2018): 554–58. http://dx.doi.org/10.1177/1120700017752568.
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Background: We discuss the surgical results of revision surgery for patients with refractory symptomatic leg length inequality (LLI) after primary hip replacement. Methods: This is a retrospective review of 21 patients who underwent revision for LLI after primary total hip replacement. All of them were referred to a tertiary clinic between 2006 and 2015. Leg length was measured, to the nearest mm, using Woolson’s validated X-ray technique which references to centre of femoral rotation, the acetabular teardrop and the midpoint of the lesser trochanter. The post-operative clinical assessment using a modified D’Aubigne and Postel scoring system investigated the pain, function, and satisfaction after surgery. Results: The mean pre-revision LLI was 16.2 mm (8–30 mm). The mean post revision operation leg length inequality was 2.0 mm (12 mm short to 9 mm long). The mean post-operative D’Aubigne and Postel scores, achieved at a mean 12 months (6–30 months), were; pain 5.2 (3–6), function 4.6 (3–6) and satisfaction 4.4 (3–5). Following revision surgery 20 out of 21 (95%) patients were satisfied with the improvement in LLI. Conclusion: Revision surgery for LLI, while it may not resolve all of the pain that the patient presents with, it is a successful treatment for patients who do not respond to conservative management of their LLI.
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Vukasinovic, Zoran, Dusko Spasovski, Igor Seslija, Ismet Gavrankapetanovic, Elvir Bazdar, and Zorica Zivkovic. "Congenital pseudarthrosis of lower leg treated by almost outdated method: Case report." Srpski arhiv za celokupno lekarstvo 142, no. 1-2 (2014): 89–93. http://dx.doi.org/10.2298/sarh1402089v.
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Introduction. Congenital pseudarthrosis of tibia is a rare congenital deformity with progressive evolution. Treatment is vague and difficult, and many methods have been used - from once mandatory early amputation to contemporary operative (Ilizarov method, free microvascular fibular graft) and adjuvant methods (electrostimulation, biphosphonates, bone morphogenetic protein). We present the usage of once popular method of homologous graft insertion and intramedullary fixation. Case Outline. This is a case report of male patient with pseudarthrosis involving both crural bones (Boyd type 5), diagnosed in neonatal age. Early conservative treatment was unsuccessful, so child never initiated gait. At the age of three and a half years, operative treatment was applied: resection of pseudarthrosis on both tibia and fibula, and osteoplasty of tibia using cylindric homologous graft and intramedullary fixation with transtarsal Steinman pin, followed by long leg cast immobilization. Pin was removed after ten months, and physical therapy was initiated 1.5 year after surgery, with initial to partial weight bearing and short leg cast throughout another year. Two and a half years after surgery complete union of graft was documented, and then full weight bearing was allowed. At final visit, five years and three months after surgery, shin axis was correct, leg lengths were equal, and child had normal walk with full range of motion. X-ray showed complete union of both tibia and fibula. Conclusion. Despite bad prognostic factors (young age, severe deformity), utilization of obsolete and almost forgotten treatment methods can provide excellent result.
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Maciunas, Robert J., and Burton M. Onofrio. "The long-term results of chymopapain chemonucleolysis for lumbar disc disease." Journal of Neurosurgery 65, no. 1 (July 1986): 1–8. http://dx.doi.org/10.3171/jns.1986.65.1.0001.
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✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.
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Marinkovic, Nadica, and Jasenka Vasic-Vilic. "Correlation between the lenghts of the long bones of the forearm and the fibula with body height in our population." Vojnosanitetski pregled 69, no. 5 (2012): 394–98. http://dx.doi.org/10.2298/vsp1205394m.
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Background/Aim. The task of a forensic examiner during exhumation of skeletal remains is to calculate antemortem height of a person whose skeletal remains were found. Anthropological investigations which provided formulae for calculating ante-mortem body height date back from XIX or from the first half of XX centuries. The most commonly used formulae are those of Trotter- Gleser, which were used to investigate skeletal remains from the World War II. Those investigations were conducted on skeletal remains of various ages and degrees of decay. Our experience with exhumation have shown that the present formulae do not deliver reliable values of antemortem height. The aim of this study was to investigate if there is a correlation of the length of long bones of leg and forearm with body height within our population and to establish the formulae for calculating ante-mortem body height within our population based on the obtained values. Methods. The lengths of ulna, radius, fibula and tibia were determined precisely by measuring bones on living individuals using a digital X-ray system. The height of individuals whose bones were measured was determined using an anthropometer. Results. The highest degree of correlation between bone length and body height was found for tibia in males (r = 0.859, p < 0.005) and ulna in females (r = 0.679, p < 0.05). We calculated the regression formulae for determination of ante-mortem body height that differ from the current body height formulae. Conclusion. In our population the length of long bones of the forearm and the leg are characterized by various degree of correlation with body height. The formulae that we set, make less distinction between the measured and the calculated body height as compared with the Trotter-Gleser formulae. We do hope that their implementation will facilitate identification of sceletal remains in our population.
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Sakti, Triharto Banjaran, Natan Kevin Partogu Siagian, Wongso Kesuma, and Andreas Marojahan Haratua Siagian. "Simultaneous Gradual Correction of Bilateral Late Onset Tibia Vara using High Tibial Osteotomy with a Mono-Axis Dynamic External Fixator: A Case Report." Hip and Knee Journal 3, no. 1 (February 25, 2022): 40–43. http://dx.doi.org/10.46355/hipknee.v3i1.115.
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Tibia vara is a disease characterized by an abrupt angulation of the tibia into varus in the proximal end. This condition is caused by developmental growth defect of the proximal tibia physis. Tibia Vara can be classified into groups according to the age of the patient and the mainstay treatment is either acute or gradual surgical correction.A 21 year-old man with chief complaint bowing of the legs with leg pain since 3 years ago. Physical examination showed bilateral genu varum. The anteroposterior long leg standing X-Ray found that the deformity was of osseous origin at the proximal part of the tibia in varus position. Medial osteotomy of the proximal tibia was performed and a dynamic external fixator was installed. Gradual correction was performed at a rate of 1 mm per day. After 3 months, radiological evaluation showed good union and target angle of correction with acceptable mechanical axis was achieved. Patient had no complaint of pain or instability post-surgery.Gradual correction using external fixator provides a more flexible angle correction with lower risk of neurovascular compromises; but with its own disadvantage such as loss of correction after removal of the external device. In this case, gradual correction of late onset tibia vara using dynamic external fixator provides satisfactory outcome and enable a more fine-tuned angle correction. It also potentially eliminate the need for a second surgery to remove the external device; thus reducing the length of hospitalization.
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Hjeltnes, N., A. K. Aksnes, K. I. Birkeland, J. Johansen, A. Lannem, and H. Wallberg-Henriksson. "Improved body composition after 8 wk of electrically stimulated leg cycling in tetraplegic patients." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 273, no. 3 (September 1, 1997): R1072—R1079. http://dx.doi.org/10.1152/ajpregu.1997.273.3.r1072.
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The practical aspects of utilizing electrically stimulated leg cycling (ESLC) to counteract alterations in body composition were investigated in five tetraplegic subjects with long-standing complete spinal cord injuries (C5-C7). After a 2-wk adaptation period, the subjects performed seven ESLC sessions per week for 8 wk. No adverse reactions were noted in response to the ESLC program. The ESLC sessions were accompanied by higher lactate concentrations compared with arm exercise. Heart rate and blood pressure response revealed clear, but not serious, signs of autonomic dysreflexia in the beginning of the ESLC sessions. Body temperature increased moderately during the ESLC sessions. Peak oxygen uptake (Vo2) during an ESLC session increased by 70% (P < 0.05) after 8 wk of training. Body composition, evaluated by dual-energy X-ray absorptiometry (DEXA), demonstrated an increase in lean body mass (LBM) from 66.2 +/- 2.6 to 68.2 +/- 2.1% (P < 0.05), with a concomitant decrease in whole body fat (BF) content from 29.7 +/- 2.6 to 27.8 +/- 2.1% (P < 0.05) after training. The cross-sectional area of quadriceps, hamstrings, gluteus maximus, and gluteus medius muscles, measured by computer tomographic scans, increased from 267 +/- 27 to 324 +/- 27 cm2 (P < 0.05) after the training. In conclusion, daily ESLC sessions during a 2-mo period resulted in increased LBM, decreased BF content, and increased muscular endurance in tetraplegic subjects without any noticeable adverse effects.
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Golubovic, Ivan, Zoran Bascarevic, Predrag Stojiljkovic, Zoran Radovanovic, Ivana Golubovic, Milan Radojkovic, Dusan Djordjevic, Aleksandar Mitic, Svetlana Milijic, and Zoran Golubovic. "Surgical treatment of secondary hip osteoarthritis using cementless total hip endoprosthesis with Fitmore® Hip Stem: A case report." Vojnosanitetski pregled 74, no. 8 (2017): 791–94. http://dx.doi.org/10.2298/vsp151223198g.
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Introduction. Hip dysplasia with subluxation represents insufficient coverage of the femur's head placed in the dysplastic acetabulum. This lack of coverage ranges from barely noticeable to condition where half of femur head is uncovered by acetabulum. The caput-collum-diaphyseal angle of the proximal femur and anteversion angle of collum are increased, Wiberg?s angle is less than 15? and M?nard-Shenton line is interrupted. Hip joint degeneration occurs very early. When radiological signs of hip joint degenerative changes are discovered in elderly they are associated with pain, limited movements and leg shortening. Case report. We present a 53-year old female treated conservatively in childhood because of hip diyplasia with subluxation. After pregnancy, right hip pain emerged. Clinical and radiological examinations revealed hip subluxation with the signs of degenerative osteoarthritis. Initial treatment was conservative and included drugs and balneophysical procedures. Since pain and movement impairment progressed and became constant, a hip replacement using cementless total endoprosthesis with Fitmore? Hip Stem was done. In the pre-operative preparation, anteroposterior x-ray of the hip(with third of the proximal femur) was made. This X-ray enabled precise planning of implantation endoprosthesis component. The early postoperative course was uneventful with very good therapeutic effect. Following successful physical rehabilitation, the patient returned to work and full life activity. Conclusion. Implantation of the cementless endoprosthesis with Fitmore? Hip Stem in the treatment of secondary hip osteoarthritis is a good choice in the treatment of young patients with good bone quality. Future clinical and radiological follow-up and comparative studies are needed to show the advantages of this type of stem compared to the classical cementless long stem.
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Ilich, Jasminka Z., Owen J. Kelly, and Julia E. Inglis. "Osteosarcopenic Obesity Syndrome: What Is It and How Can It Be Identified and Diagnosed?" Current Gerontology and Geriatrics Research 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/7325973.
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Conditions related to body composition and aging, such as osteopenic obesity, sarcopenia/sarcopenic obesity, and the newly termed osteosarcopenic obesity (triad of bone muscle and adipose tissue impairment), are beginning to gain recognition. However there is still alack of definitive diagnostic criteriafor these conditions. Little is known about the long-term impact of these combined conditions of osteoporosis, sarcopenia, and obesity in older adults. Many may go undiagnosed and progress untreated. Therefore, the objective of this research is to creatediagnostic criteriafor osteosarcopenic obesity in older women. The proposeddiagnostic criteriaare based ontwo types of assessments: physical,via body composition measurements, andfunctional,via physical performance measures. Body composition measurements such asT-scores for bone mineral density, appendicular lean mass for sarcopenia, and percent body fat could all be obtained via dual energy X-ray absorptiometry. Physical performance tests: handgrip strength, one-leg stance, walking speed, and sit-to-stand could be assessed with minimal equipment. A score could then be obtained to measure functional decline in the older adult. Fordiagnosing osteosarcopenic obesityand other conditions related to bone loss and muscle loss combined with obesity, a combination of measures may more adequately improve the assessment process.
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Westerhold, Thomas, Ursula Röhl, Thomas Frederichs, Claudia Agnini, Isabella Raffi, James C. Zachos, and Roy H. Wilkens. "Astronomical calibration of the Ypresian timescale: implications for seafloor spreading rates and the chaotic behavior of the solar system?" Climate of the Past 13, no. 9 (September 11, 2017): 1129–52. http://dx.doi.org/10.5194/cp-13-1129-2017.
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Abstract. To fully understand the global climate dynamics of the warm early Eocene with its reoccurring hyperthermal events, an accurate high-fidelity age model is required. The Ypresian stage (56–47.8 Ma) covers a key interval within the Eocene as it ranges from the warmest marine temperatures in the early Eocene to the long-term cooling trends in the middle Eocene. Despite the recent development of detailed marine isotope records spanning portions of the Ypresian stage, key records to establish a complete astronomically calibrated age model for the Ypresian are still missing. Here we present new high-resolution X-ray fluorescence (XRF) core scanning iron intensity, bulk stable isotope, calcareous nannofossil, and magnetostratigraphic data generated on core material from ODP Sites 1258 (Leg 207, Demerara Rise), 1262, 1263, 1265, and 1267 (Leg 208, Walvis Ridge) recovered in the equatorial and South Atlantic Ocean. By combining new data with published records, a 405 kyr eccentricity cyclostratigraphic framework was established, revealing a 300–400 kyr long condensed interval for magnetochron C22n in the Leg 208 succession. Because the amplitudes are dominated by eccentricity, the XRF data help to identify the most suitable orbital solution for astronomical tuning of the Ypresian. Our new records fit best with the La2010b numerical solution for eccentricity, which was used as a target curve for compiling the Ypresian astronomical timescale (YATS). The consistent positions of the very long eccentricity minima in the geological data and the La2010b solution suggest that the macroscopic feature displaying the chaotic diffusion of the planetary orbits, the transition from libration to circulation in the combination of angles in the precession motion of the orbits of Earth and Mars, occurred ∼ 52 Ma. This adds to the geological evidence for the chaotic behavior of the solar system. Additionally, the new astrochronology and revised magnetostratigraphy provide robust ages and durations for Chrons C21n to C24n (47–54 Ma), revealing a major change in spreading rates in the interval from 51.0 to 52.5 Ma. This major change in spreading rates is synchronous with a global reorganization of the plate–mantle system and the chaotic diffusion of the planetary orbits. The newly provided YATS also includes new absolute ages for biostratigraphic events, magnetic polarity reversals, and early Eocene hyperthermal events. Our new bio- and magnetostratigraphically calibrated stable isotope compilation may act as a reference for further paleoclimate studies of the Ypresian, which is of special interest because of the outgoing warming and increasingly cooling phase. Finally, our approach of integrating the complex comprehensive data sets unearths some challenges and uncertainties but also validates the high potential of chemostratigraphy, magnetostratigraphy, and biostratigraphy in unprecedented detail being most significant for an accurate chronostratigraphy.
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Park, Byeong-Seop, Seungbum Koo, Won-keun Park, Ki-bum Kwon, and Kyoung Min Lee. "A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0033. http://dx.doi.org/10.1177/2473011419s00331.
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Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.
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Mitchell, Ulrike H., Bruce Bailey, and Patrick J. Owen. "Examining Bone, Muscle and Fat in Middle-Aged Long-Term Endurance Runners: A Cross-Sectional Study." Journal of Clinical Medicine 9, no. 2 (February 14, 2020): 522. http://dx.doi.org/10.3390/jcm9020522.
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Aerobic exercise training has many known cardiovascular benefits that may promote healthy aging. It is not known if long-term aerobic exercise training is also associated with structural benefits (e.g., lower fat mass, higher areal bone mineral density (BMD) and greater muscle mass). We evaluated these parameters in middle-aged long-term endurance runners compared to sex-, age-, height-, and weight-matched non-running controls. Total and regional lean and fat mass and areal BMD were assessed by dual-energy X-ray absorptiometry. Sagittal magnetic resonance images captured the cross-sectional area and thickness of the lumbar multifidus. Runners (n = 10; all male) had a mean (standard deviation; SD) age of 49 (4) years, height of 178.9 (4.9) cm, weight of 67.8 (5.8) kg, body mass index (BMI) of 21.4 (1.4) kg/m2 and had been running 82.6 (27.9) km/week for 23 (13) years. Controls (n = 9) had a mean (SD) age of 51 (5) years, height of 176.0 (5.1) cm, weight of 72.8 (7.1) kg, and BMI of 23.7 (2.1) kg/m2. BMI was greater in controls (p = 0.010). When compared to controls on average, runners had a 10 percentage-point greater total body lean mass than controls (p = 0.001) and 14% greater trunk lean mass (p = 0.010), as well as less total body (8.6 kg; p < 0.001), arm (58%; p = 0.002), leg (52%; p < 0.001), trunk (73%; p < 0.001), android (91%; p < 0.001), and gynoid fat mass (64%; p < 0.001). No differences were observed between groups for BMD outcomes or multifidus size. These results underscore the benefits of endurance running to body composition that carry over to middle-age.
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Nyström, Bo, Birgitta Gregebo, Adam Taube, Stig-Olof Almgren, Birgitta Schillberg, and Yingyan Zhu. "Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain." Scandinavian Journal of Pain 17, no. 1 (October 1, 2017): 22–29. http://dx.doi.org/10.1016/j.sjpain.2017.06.005.
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AbstractBackgroundIt has been reported that in 13-32% of patients with chronic low back pain, the pain may originate in the sacroiliac (SI) joints. When treatment of these patients with analgesics and physiotherapy has failed, a surgical solution may be discussed. Results of such surgery are often based on small series, retrospective analyses or studies using a minimal invasive technique, frequently sponsored by manufacturers.PurposeTo report the clinical outcome concerning pain, function and quality of life following anterior arthrodesis in patients presumed to have SI joint pain using validated questionnaires pre- and post-operatively. An additional aim was to describe the symptoms of the patients included and the preoperative investigations performed.Material and methodsOver a 6 year period we treated 55 patients, all women, with a mean age of 45 years (range 28-65) and a mean pelvic pain duration of 9.1 years (range 2-30). The pain started in connection with minor trauma in seven patients, pregnancy in 20 and unspecified in 28. All patients had undergone long periods of treatment including physiotherapy, manipulation, needling, pelvic belt, massage and chiropractic without success, and 15 had been operated for various spinal diagnoses without improvement. The patients underwent thorough neurological investigation, plain X-ray and MRI of the spine and plain X-ray of the pelvis. They were investigated by seven clinical tests aimed at indicating pain from the SI joints. In addition, all patients underwent a percutaneous mechanical provocation test and extra-articular local anaesthetic blocks against the posterior part of the SI joints. Before surgery all patients answered the generic Short-Form-36 (SF-36) questionnaire, the disease specific Balanced Inventory for Spinal Disorders (BIS) questionnaire and rated their level of pelvic and leg pain (VAS, 0-100). At follow-up at a mean of 2 years 49 patients completed the same questionnaires (89%).ResultsAt follow-up 26 patients reported a lower level of pelvic pain than before surgery, 16 the same level and six a higher level. Applying Svensson’s method RPpelvic pain = 0.3976, with 95% CI (0.2211, 0.5740) revealed a statistically significant systematic improvement in pelvic pain. At follow-up 28 patients reported a higher quality of life and 26 reported sleeping better than pre-operatively. In most patients the character of the pelvic pain was dull and aching, often accompanied by a stabbing component in connection with sudden movements. Referred pain down the leg/s even to the feet and toes was noted by half of the patients and 29 experienced frequency of micturition.ConclusionsIt is apparent that in some patients the SI joints may cause long-term pain that can be treated by arthrodesis. We speculate that continued pain despite a healed arthrodesis may be due to persistent pain from adjacent ligaments. The next step should be a prospective randomized study comparing posterior fusion and ligament resection with non-surgical treatment.ImplicationsAnterior arthrodesis can apparently relieve pain in some patients with presumed SI joint pain. The problem is how to identify these patients within the low back pain group.
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Oktaviono, Yudi Her. "Hybrid Procedure in Aortoiliac Bifurcation and Femoral Lesion." Folia Medica Indonesiana 58, no. 4 (December 5, 2022): 348–54. http://dx.doi.org/10.20473/fmi.v58i4.16270.
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Highlights: A patient had a long segment of total occlusion to the proximal right common iliac and anterior tibial artery. The treatment is a combination of percutaneous transluminal angioplasty (PTA) using vascular stent and the Fogarty thrombectomy. Hybrid procedure can treat multilevel artery occlusive diseases, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy. Abstract: Critical limb ischemia is a condition that threatens the viability of lower extremities and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method for critical limb ischemia. Revascularization using a hybrid of endovascular and open surgery is a minimally invasive procedure that performs well as the treatment for medically high-risk patients. A hybrid procedure should be considered for patients with high surgical risk. However, there are factors that could compromise its long-term patency, such as critical limb ischemia and diabetes. This study reported a case of a 53-year-old Asian male with history of insulin-dependent diabetes mellitus and long-standing tobacco use, presented with pain in the right leg at rest approximately 30 days prior to admission. Physical examination revealed a low temperature and remarkable non-palpable pulses in the right femoral, posterior tibial, and dorsalis pedis segments. Arteriography with run-offs revealed a long segment of total occlusion from the proximal right common iliac and anterior tibial artery. There was non-significant stenosis in the right popliteal artery. The patient was treated using a combination of percutaneous transluminal angioplasty (PTA) of the right common iliac artery using vascular stent and the Fogarty thrombectomy of the common femoral artery, equipped with an X-ray system and a moveable radiolucent surgical table. The anticoagulant used on the patient during the procedure was heparin. There was no residual stenosis after the procedure on the occlusion along the right common iliac artery to the common femoral artery. In conclusion, multilevel artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization.
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Örlygsson, Gissur, Elín H. Laxdal, Sigurbergur Kárason, Atli Dagbjartsson, Eggert Gunnarsson, Chuen-How Ng, Jón M. Einarsson, Jóhannes Gíslason, and Halldór Jónsson. "Mineralization in a Critical Size Bone-Gap in Sheep Tibia Improved by a Chitosan-Calcium Phosphate-Based Composite as Compared to Predicate Device." Materials 15, no. 3 (January 22, 2022): 838. http://dx.doi.org/10.3390/ma15030838.
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Deacetylated chitin derivatives have been widely studied for tissue engineering purposes. This study aimed to compare the efficacy of an injectable product containing a 50% deacetylated chitin derivative (BoneReg-Inject™) and an existing product (chronOS Inject®) serving as a predicate device. A sheep model with a critical size drill hole in the tibial plateau was used. Holes of 8 mm diameter and 30 mm length were drilled bilaterally into the proximal area of the tibia and BoneReg-Inject™ or chronOS Inject® were injected into the right leg holes. Comparison of resorption and bone formation in vivo was made by X-ray micro-CT and histological evaluation after a live phase of 12 weeks. Long-term effects of BoneReg-Inject™ were studied using a 13-month live period. Significant differences were observed in (1) amount of new bone within implant (p < 0.001), higher in BoneReg-InjectTM, (2) signs of cartilage tissue (p = 0.003), more pronounced in BoneReg-InjectTM, and (3) signs of fibrous tissue (p < 0.001), less pronounced in BoneReg-InjectTM. Mineral content at 13 months postoperative was significantly higher than at 12 weeks (p < 0.001 and p < 0.05, for implant core and rim, respectively). The data demonstrate the potential of deacetylated chitin derivatives to stimulate bone formation.
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Dusak, I. Wayan Suryanto, and I. Dewa Gede Bracika Damma Prasada. "Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0005. http://dx.doi.org/10.1177/2325967120s00056.
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The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters. Case Presentation: A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release. Discussion: Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal. Conclusion: Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen
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Polat, Gökhan, Koray Şahin, Ufuk Arzu, and Mehmet Aşık. "The prevalance of femoroacetabular impingement findings on radiological survey of the emergeny service patients with trauma." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0006. http://dx.doi.org/10.1177/2325967117s00066.
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Femoroacetabular impingemet (FAI) is a disease causing hip pain in young-adult population and can be diagnosed frequently on asymptomatic stage. The European studies on this subject show that 20-25% of the population actually has asymptomatic FAI. Actually, there is no study in Turkey on this topic. The purpose of our study is to determine the prevalance of FAI on the X-rays of the patients who applied to the emergency service with trauma. Materials-Methods: Patients applied between September 2015 and January 2016 aged 18-65 and who has pelvis AP and frog leg X-rays were included. Pelvic graphs on which both iliac crests and proximal femurs are seen, the X-ray tube is centralised to the symphysis pubis and the obturator foramens are symmetrical were included. The graphs with fractures or ligamentous injuries affecting the pelvic ring, fractures on long bones of the lower limbs, arthrosis on coxofemoral joint and findings of previous pelvic and hip surgery were excluded. Totally 3487 patients were evaluated and 528 of them were included. Alpha, lateral central edge (LCE), Tönnis and collodiaphyseal angle were measured. The morphological anomalies (FAI, dysplasia) were noted. The measured alpha angle value above 55° graphs were accepted as CAM type; Tönnis angle below 4° angle or LCE angle above 39° were accepted as Pincer type impingement. The graphs with LCE angle below 25° or with Tönnis angle above 10° were considered as dysplasia. Results: The average age of the 528 included patients was 43,38. 323 were female and 205 were male. We determined 15,5% CAM, 11,1% Pincer and 4,7% combined type FAI in these 528 patients.The ratios were noted in female group, 4,6% CAM, 13,3% Pincer and 1,5% combined type; in male group 32,7% CAM, 7,8% Pincer 9,8% combined type. Average alpha angle on pelvis AP graphs was 48,9° on right and 47,8° on left side. Average alpha angle on pelvis frog leg graphs was 51,7° on right, 49,8° on left side. Average LCE angle was 32,9° on right and 34,7° on left side. Average Tönnis angle was 6,7° for right and 5,8° for left side. SPSS.21 were used to analyse the data. Discussion: FAI can be seen in population asymptomatically with a seriously high rates. In our study, we evaluated the asypmtomatic patients with trauma applying to the emergency service and we found radiological FAI findings rate 19,5% in females and 50,2% in males.
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Farsijani, Samaneh, Lingshu Xue, Robert Boudreau, Adam Santanasto, Stephen Kritchevsky, and Anne Newman. "Body Composition by CT vs. DXA: Long-Term Prediction of Mortality in the Health Health ABC Cohort." Innovation in Aging 4, Supplement_1 (December 1, 2020): 239. http://dx.doi.org/10.1093/geroni/igaa057.770.
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Abstract Background: Early work in the Health ABC cohort found that strength, but not muscle size predicted mortality. Recent literature suggests that body composition by computerized tomography (CT) and magnetic resonance imaging (MRI) predicts adverse health outcomes in diverse populations, but has not been directly compared to dual-energy X-ray absorptiometry (DXA) for predicting mortality. Objective: With long term follow-up, we reexamined body composition and mortality in Health ABC, comparing DXA and CT measures of muscle and fat. Methods: The Health ABC study assessed body composition in 2911 older adults (age 73.6±2.9 years) in 1996-97. Mid-thigh CTs were read for muscle area, inter-muscular, subcutaneous-fat areas and muscle density (HU). DXAs were read for whole body fat mass and appendicular lean mass (ALM). Mortality was assessed every 6-months through 2014 (maximum 17.4 years). Cox proportional hazards models, adjusting for age, sex, race, height, weight, physical activity, smoking and comorbidities were used to assess mortality risk. Results: Strong correlations were observed between mid-thigh muscle and subcutaneous fat areas by CT and leg lean and fat mass by DXA (P<0.05). Lower mortality rates, per SD, were associated with higher CT muscle area (HR-men=0.76 [95%CI: 0.68-0.86]; HR-women=0.84 [0.75-0.94]), muscle density (HR-men=0.86 [0.79-0.93]; HR-women=0.89 [0.81-0.97]) and higher subcutaneous-fat (HR-men=0.90 [0.81-0.99]; HR-women=0.87 [0.77-0.98]), adjusting for covariates. Similarly for DXA, greater ALM (HR-men=0.56 [0.44-0.71]; HR-women=0.77 [0.59-1.01]) and higher total fat mass (HR-men=0.53 [0.40-0.72]; HR-women=0.58 [0.37-0.90]) were associated with lower risk of death. Conclusion: With long term follow-up, both CT and DXA assessments of body composition predicted all-cause mortality risk.
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Fyfe, Jackson J., James R. Broatch, Adam J. Trewin, Erik D. Hanson, Christos K. Argus, Andrew P. Garnham, Shona L. Halson, Remco C. Polman, David J. Bishop, and Aaron C. Petersen. "Cold water immersion attenuates anabolic signaling and skeletal muscle fiber hypertrophy, but not strength gain, following whole-body resistance training." Journal of Applied Physiology 127, no. 5 (November 1, 2019): 1403–18. http://dx.doi.org/10.1152/japplphysiol.00127.2019.
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We determined the effects of cold water immersion (CWI) on long-term adaptations and post-exercise molecular responses in skeletal muscle before and after resistance training. Sixteen men (22.9 ± 4.6 y; 85.1 ± 17.9 kg; mean ± SD) performed resistance training (3 day/wk) for 7 wk, with each session followed by either CWI [15 min at 10°C, CWI (COLD) group, n = 8] or passive recovery (15 min at 23°C, control group, n = 8). Exercise performance [one-repetition maximum (1-RM) leg press and bench press, countermovement jump, squat jump, and ballistic push-up], body composition (dual X-ray absorptiometry), and post-exercise (i.e., +1 and +48 h) molecular responses were assessed before and after training. Improvements in 1-RM leg press were similar between groups [130 ± 69 kg, pooled effect size (ES): 1.53 ± 90% confidence interval (CI) 0.49], whereas increases in type II muscle fiber cross-sectional area were attenuated with CWI (−1,959 ± 1,675 µM2 ; ES: −1.37 ± 0.99). Post-exercise mechanistic target of rapamycin complex 1 signaling (rps6 phosphorylation) was blunted for COLD at post-training (POST) +1 h (−0.4-fold, ES: −0.69 ± 0.86) and POST +48 h (−0.2-fold, ES: −1.33 ± 0.82), whereas basal protein degradation markers (FOX-O1 protein content) were increased (1.3-fold, ES: 2.17 ± 2.22). Training-induced increases in heat shock protein (HSP) 27 protein content were attenuated for COLD (−0.8-fold, ES: −0.94 ± 0.82), which also reduced total HSP72 protein content (−0.7-fold, ES: −0.79 ± 0.57). CWI blunted resistance training-induced muscle fiber hypertrophy, but not maximal strength, potentially via reduced skeletal muscle protein anabolism and increased catabolism. Post-exercise CWI should therefore be avoided if muscle hypertrophy is desired. NEW & NOTEWORTHY This study adds to existing evidence that post-exercise cold water immersion attenuates muscle fiber growth with resistance training, which is potentially mediated by attenuated post-exercise increases in markers of skeletal muscle anabolism coupled with increased catabolism and suggests that blunted muscle fiber growth with cold water immersion does not necessarily translate to impaired strength development.
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Gabitov, S. Z., and P. I. Sakhovskiy. "Central nervous system involvement at the onset of systemic sclerosis." Kazan medical journal 94, no. 3 (June 15, 2013): 421–23. http://dx.doi.org/10.17816/kmj2199.
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A rare clinical case of a 23-year old patient with central nervous system damage at the onset of systemic sclerosis at the age of 14 is presented. The patient was born with cerebral damage which was taken as a reason of the neurological manifestations that developed long later (epileptic attacks at 14 years of age, autism at 17 years of age). At the clinical examination diffuse asymmetric scleroderma as face and hand teleangiectasias, chest hyper pigmentation and shin skin hyper pigmentation and hardening were present. A characteristic look with reduced mimics, significant jaw movement limitation, tongue mobility limitation (patient was not able to touch the palate with the tongue) were also present. Patient had swollen fingers with limited finger motions, reduced hand muscular strength due to sclerodactyly. A shadow in the right lung middle lobe on the chest X-ray was found. According to physical examination results and laboratory data the following diagnosis was set up: «Juvenile systemic sclerosis, chronic form with slow progression, spreading stage: leg induration, sclerodactyly, chest hyper pigmentation, face teleangiectasias, basal pneumosclerosis, myocarditis, myocardiosclerosis, glomerulonephritis, esophageal achalasia, hepatitis, autism, epileptic attacks, polyarthritis, left elbow periarticular calcinosis, complicated relapsing aspiration pneumonia». The characteristical features of this case are the atypical clinical course, appearance of the diagnostic markers after 8 years of the disease with multisystemic involvement of internal organs, skin and joints. Because of the late start of the corticosteroid treatment, relapsing aspiration pneumonia, low corticosteroid treatment compliance the patient has succumbed.
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Kuo, Yueh-Ting, Kuan-Ming Chiu, Yuk-Ming Tsang, Cheng-Ming Chiu, and Meng-Yueh Chien. "Influence of Chronic Kidney Disease on Physical Function and Quality of Life in Patients after Coronary Artery Bypass Grafting." Cardiorenal Medicine 5, no. 4 (2015): 237–45. http://dx.doi.org/10.1159/000433447.
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Aims: The purposes of this study were (1) to compare body composition, physical function, and quality of life (QOL) between patients after coronary artery bypass grafting (CABG) with and without chronic kidney disease (CKD) and (2) to analyze the factors associated with physical function and QOL domains in these patients. Methods: Thirty male post-CABG patients with CKD and 30 matched controls were recruited. All subjects underwent dual-energy X-ray absorptiometry for body composition evaluation. Physical function tests included the grip strength test, 30-second chair stand test (30CST), and 6-min walk test (6MWT). Physical activity and QOL were assessed using the long form of the International Physical Activity Questionnaire and the World Health Organization Quality of Life Instrument (WHOQOL)-BREF, respectively. Results: Post-CABG patients with CKD exhibited a lower arm lean mass and higher percent leg fat mass than those without CKD (p < 0.05). The patients with CKD also had lower 30CST scores, 6MWT distances, and QOL domain of social relationships scores than those without CKD after adjusting for covariates (p < 0.05). If NYHA class was considered in the model, NYHA class became the most important factor associated with 6MWT distances (β = -0.647, p < 0.001) and the QOL domains of psychological health (β = -0.285, p = 0.027) and environment (β = -0.406, p = 0.001). Conclusion: Post-CABG patients with CKD had worse body composition, physical function, and QOL than those without CKD, and this might be associated with a worse NYHA class.
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Lozano-Berges, Gabriel, Ángel Matute-Llorente, Alejandro Gómez-Bruton, Alex González-Agüero, Germán Vicente-Rodríguez, and José A. Casajús. "Do Serum 25-Hydroxyvitamin D Concentrations Affect Body Composition, Physical Fitness, Bone Strength and Bone Biomarkers in Female Children and Adolescent Football Players? A One-Season Study." International Journal of Environmental Research and Public Health 19, no. 22 (November 21, 2022): 15394. http://dx.doi.org/10.3390/ijerph192215394.
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The aim was to compare changes in body composition, physical fitness, and bone biomarkers in female children and adolescent football players with different Vitamin D levels. Twenty-two players were classified into two groups according to 25(OH)D concentrations: 11 with deficient/insufficient 25(OH)D levels (IVD; <30 ng/mL) and 11 with sufficient 25(OH)D levels (SVD; ≥30 ng/mL). Body composition parameters were measured using dual-energy X-ray absorptiometry and a peripheral quantitative computed tomography scanner. The following physical fitness tests were applied: maximal isometric knee extension (MIF), long jump, 30-m sprint, and 20-m shuttle run test (VO2max). Electrochemiluminescence immunoassays were used to analyze bone biomarkers and 25(OH)D. All variables were registered at the beginning and the end of the football season. The increase in subtotal bone mineral density (BMD) was higher in players with SVD than those with IVD (p = 0.030). Only players with SVD improved their MIF of the left leg (p = 0.005); whereas, only players with IVD decreased their 30-m sprint performance (p = 0.007) and VO2max (p = 0.046). No significant between- and within-group differences were found for bone biomarkers. SVD might cause an extra improvement of subtotal BMD in female children and adolescent football players. Moreover, it seems that the 25(OH)D concentration could be an important parameter for physical fitness improvement in this population.
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Westerhold, T., and U. Röhl. "High resolution cyclostratigraphy of the early Eocene – new insights into the origin of the Cenozoic cooling trend." Climate of the Past 5, no. 3 (July 6, 2009): 309–27. http://dx.doi.org/10.5194/cp-5-309-2009.
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Abstract. Here we present a high-resolution cyclostratigraphy based on X-ray fluorescence (XRF) core scanning data from a new record retrieved from the tropical western Atlantic (Demerara Rise, ODP Leg 207, Site 1258). The Eocene sediments from ODP Site 1258 cover magnetochrons C20 to C24 and show well developed cycles. This record includes the missing interval for reevaluating the early Eocene part of the Geomagnetic Polarity Time Scale (GPTS), also providing key aspects for reconstructing high-resolution climate variability during the Early Eocene Climatic Optimum (EECO). Detailed spectral analysis demonstrates that early Eocene sedimentary cycles are characterized by precession frequencies modulated by short (100 kyr) and long (405 kyr) eccentricity with a generally minor obliquity component. Counting of both the precession and eccentricity cycles results in revised estimates for the duration of magnetochrons C21r through C24n. Our cyclostratigraphic framework also corroborates that the geochronology of the Eocene Green River Formation (Wyoming, USA) is still questionable mainly due to the uncertain correlation of the "Sixth tuff" to the GPTS. Right at the onset of the long-term Cenozoic cooling trend the dominant eccentricity-modulated precession cycles of ODP Site 1258 are interrupted by strong obliquity cycles for a period of ~800 kyr in the middle of magnetochron C22r. These distinct obliquity cycles at this low latitude site point to (1) a high-latitude driving mechanism on global climate variability from 50.1 to 49.4 Ma, and (2) seem to coincide with a significant drop in atmospheric CO2 concentration below a critical threshold between 2- and 3-times the pre-industrial level (PAL). The here newly identified orbital configuration of low eccentricity in combination with high obliquity amplitudes during this ~800-kyr period and the crossing of a critical pCO2 threshold may have led to the formation of the first ephemeral ice sheet on Antarctica as early as ~50 Ma ago.
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Westerhold, T., and U. Röhl. "High resolution cyclostratigraphy of the early Eocene – new insights into the origin of the Cenozoic cooling trend." Climate of the Past Discussions 5, no. 1 (February 23, 2009): 495–534. http://dx.doi.org/10.5194/cpd-5-495-2009.
Full textAbstract:
Abstract. Here we present a high-resolution cyclostratigraphy based on X-ray fluorescence (XRF) core scanning data from a new record retrieved from the tropical western Atlantic (Demerara Rise, ODP Leg 207, Site 1258). The Eocene sediments from ODP Site 1258 cover magnetochrons C20 to C24 and show well developed cycles. This record includes the missing interval for reevaluating the early Eocene part of the Geomagnetic Polarity Time Scale (GPTS), also providing key aspects for reconstructing high-resolution climate variability during the Early Eocene Climatic Optimum (EECO). Detailed spectral analysis demonstrates that early Eocene sedimentary cycles are characterized by precession frequencies modulated by short (100 kyr) and long (405 kyr) eccentricity with a generally minor obliquity component. Counting of both the precession and eccentricity cycles results in revised estimates for the duration of magnetochrons C21r through C24n. Our cyclostratigraphic framework also corroborates that the geochronology of the Eocene Green River Formation (Wyoming, USA) is still questionable mainly due to the uncertain correlation of the "Sixth Tuff" to the GPTS. Right at the onset of the long-term Cenozoic cooling trend the dominant eccentricity-modulated precession cycles of ODP Site 1258 are interrupted by strong obliquity cycles for a period of ~800 kyr in the middle of magnetochron C22r. These distinct obliquity cycles at this low latitude site point to (1) a high-latitude driving mechanism on global climate variability from 50.1 to 49.4 Ma, and (2) seem to coincide with a significant drop in atmospheric CO2 concentration below a critical threshold between 2- and 3-times the pre-industrial level (PAL). The here newly identified orbital configuration of low eccentricity in combination with high obliquity amplitudes during this ~800-kyr period and the crossing of a critical pCO2 threshold may have led to the formation of the first ephemeral ice sheet on Antarctica as early as ~50 Ma ago.
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Surendra, Bunker, Dixit Neetu, and Dash Babita. "EFFECT OF MAJJA BASTI AND BAHYA SNEHANA (PIZICHIL) IN AVASCULAR NECROSIS - A CASE REPORT." International Ayurvedic Medical Journal 9, no. 10 (October 15, 2021): 2572–77. http://dx.doi.org/10.46607/iamj4609102021.
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Avascular necrosis (AVN) also called osteonecrosis or a disorder resulting from a temporary or permanent loss of blood supply or interruption of supply to the bone. AVN is found in the age of 30- 40 years mostly. Blood carries essential nutrients and oxygen to the bone. When the supply is disrupted, the bone tissue became necrosed. AVN can occur at any bone but most commonly affects the ends (epiphysis) of a long bone such as thigh region bone i.e. femur characterized by the collapse of bone, pain, bone destruction, limping off the leg, loss of function of affected bone (temporary or permanent). Modern medical science has surgical treatment modalities like Arthroplasty, hip replacement and osteotomy etc having a higher failure rate is also cost worthy and has a poor prognosis. As per Ayurveda, the cases were diagnosed as Asthimajjagata vata vikara. In the present study, two male patients one is 45 years old another is 30 years old having signs and symptoms of Avascular necrosis and X- ray of bilateral hip joint showing AVN of the femoral head were taken into consideration and administered the therapy, Majja Basti, bahya snehana (pizichil) and the Shaman Kashaya i.e. Guggulu Tiktak Kashaya 20 ml BD for 15 days.significant relief with increasing functional femoral activities in the necrosed femoral head. Based on these case study it can be concluded that the Panchakarma treatment along with Shamana chikitsa is effective in the management of AVN of the femoral head. Keywords: Avascular necrosis, Asthimajja gata vata vikar, Majja Basti, Pizichil.
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Setiawan, A., D. Mulyadi, MNS Budi, and FA Tandjung. "Challenging Knee Reconstruction After Resection of Cavernous Hemangioma in Young Patient – A case Report." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0007. http://dx.doi.org/10.1177/2325967120s00075.
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Background: One of the most challenging problem of limb salvage is a large tumour involving knee joint. Large aggressive hemangioma could disrupt soft tissue and bone surrounding. Meticulous wide surgical resection was mandatory perfomed to ensure adequate resection in order to minimized recurrence. Reconstructive procedure should be individualized and aiming functional restoration. Knee Reconstruction using arthroplasty should considered Stability, Range of Motion and Longlive survival. Method: We are presenting a case 19 years girl who had pain, unable to extent the knee and dislocated patella laterally. Valgus knee deformity 30 ֯ with Range of motion limited extension 30֯ and flexion 45֯ Wide resection was done 2 years ago with clinical large of mass at harmstring muscle, pushed patella to lateral and large of cartilage erosions. The patients was prepared second operation for knee reconstruction. Knee reconstruction using standard Posterior Stabilized implant (Implancast) Approach anterior of knee, osteotomy and anteromedialisation tibial tubercle ( Fulkerson procedure) with lateral retincular release to restore patellar tracking. Exposing Joint line very narrow and fully filled with arthrofibrosis, was identified and did osteotomy . Mostly femoral and tibial cartilage has been damaged. Post operation protocol using long leg cast and delayed weight bearing for 3 weeks. Isometric exercise on the bed to maintance and regain muscle power. During 3 – 6 weeks cast was removed and patient was allowed to partial weight bearing using 2 crutches. Extensor muscle strengthening was performed gradually. Followed up until 6 months post operation. Results: After 6 months we evaluate no pain at full weight bearing, x ray no sign of loosening nor progressive deformity, good stability with varus valgus test. Range of motion full extension and 90֯ flexion. Knee Society Score was significantly increase from poor to good. Conclusion: Knee Reconstruction following tumor resection using standard implant Posterior Stabilized (PS) is possible to perfomed as long as using meticulous technique combined with selective procedures as needed to regain functional restoration.
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Travis, Sophie M., Kevin DAmico, I.-Mei Yu, Conor McMahon, Safraz Hamid, Gabriel Ramirez-Arellano, Philip D. Jeffrey, and Frederick M. Hughson. "Structural basis for the binding of SNAREs to the multisubunit tethering complex Dsl1." Journal of Biological Chemistry 295, no. 30 (May 14, 2020): 10125–35. http://dx.doi.org/10.1074/jbc.ra120.013654.
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Multisubunit-tethering complexes (MTCs) are large (250 to >750 kDa), conserved macromolecular machines that are essential for soluble N-ethylmaleimide–sensitive factor attachment protein receptor (SNARE)–mediated membrane fusion in all eukaryotes. MTCs are thought to organize membrane trafficking by mediating the initial long-range interaction between a vesicle and its target membrane and promoting the formation of membrane-bridging SNARE complexes. Previously, we reported the structure of the yeast Dsl1 complex, the simplest known MTC, which is essential for coat protein I (COPI) mediated transport from the Golgi to the endoplasmic reticulum (ER). This structure suggests how the Dsl1 complex might tether a vesicle to its target membrane by binding at one end to the COPI coat and at the other to ER-associated SNAREs. Here, we used X-ray crystallography to investigate these Dsl1–SNARE interactions in greater detail. The Dsl1 complex comprises three subunits that together form a two-legged structure with a central hinge. We found that distal regions of each leg bind N-terminal Habc domains of the ER SNAREs Sec20 (a Qb-SNARE) and Use1 (a Qc-SNARE). The observed binding modes appear to anchor the Dsl1 complex to the ER target membrane while simultaneously ensuring that both SNAREs are in open conformations, with their SNARE motifs available for assembly. The proximity of the two SNARE motifs, and therefore their ability to enter the same SNARE complex, will depend on the relative orientation of the two Dsl1 legs. These results underscore the critical roles of SNARE N-terminal domains in mediating interactions with other elements of the vesicle docking and fusion machinery.
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Larsen, Malte Nejst, Claus Malta Nielsen, Eva Wulff Helge, Mads Madsen, Vibeke Manniche, Lone Hansen, Peter Riis Hansen, Jens Bangsbo, and Peter Krustrup. "Positive effects on bone mineralisation and muscular fitness after 10 months of intense school-based physical training for children aged 8–10 years: the FIT FIRST randomised controlled trial." British Journal of Sports Medicine 52, no. 4 (June 13, 2016): 254–60. http://dx.doi.org/10.1136/bjsports-2016-096219.
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ObjectivesWe investigated whether musculoskeletal fitness of school children aged 8–10 years was affected by frequent intense PE sessions.Design and participants295 Danish school children aged 8–10 years were cluster randomised to a small-sided ball game group (SSG) (n=96, four schools, five classes), a circuit strength training group (CST) (n=83, four schools, four classes) or a control group (CON, n=116, two schools, five classes).InterventionSSG or CST was performed 3×40 min/week over 10 months. Whole-body dual-energy X-ray absorptiometry (DXA) scans were used to determine areal bone mineral density (aBMD), bone mineral content (BMC) and lean body mass (LBM). Flamingo balance, standing long jump and 20-m sprint tests were used to determine muscular fitness.ResultsAnalysis of baseline-to-10 months change scores showed between-group differences in favour of the interventions in whole-body aBMD (SSG vs CON: 8 mg/cm2, 95% CI 3 to 13; CST vs CON: 7 mg/cm2, 95% CI 2 to 13, p<0.05) and leg BMC (SSG vs CON: 11 g, 95% CI 4 to 18; CST vs CON: 11 g, 95% CI 3 to 18, p<0.05). SSG had higher change scores in leg aBMD compared with CON and CST (SSG vs CON: 19 mg/cm2, 95% CI 11 to 39, p<0.05; SSG vs CST: 12 mg/cm2, 95% CI 3 to 21, p<0.05), and CST had higher change scores in whole-body BMC compared with CON (CST vs CON: 25 g, 95% CI 10 to 39, p<0.05). Both training types resulted in higher change scores in postural balance (SSG vs CON: 2.4 fewer falls/min, 95% CI 0.3 to 4.5, CST vs CON: 3.6 fewer falls/min, 95% CI 1.3 to 5.9, p<0.05) and jump length (SSG vs CON: 10%, 95% CI 5 to 16%; CST vs CON: 9%, 95% CI 3 to 15%, p<0.05). No between-group differences were observed for sprint performance or LBM (p>0.05).ConclusionsIn conclusion, 3×40 min/week with SSG or CST over a full school year improves bone mineralisation and several aspects of muscular fitness of children aged 8–10 years, suggesting that well-organised intense physical education classes can contribute positively to develop musculoskeletal health in young children.Trial registration numberNCT02000492, post results.
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Bonde, Jesper, David A. Hess, Dustin J. Maxwell, Ryan Lahey, Michael H. Creer, David Piwnica-Worms, and Jan A. Nolta. "Comparison of Human Stem Cell Homing after Intravenous or Intra-Femoral Transplantation Using Multimodal In Vivo Imaging of Repopulating Human CD34+ Cells Labeled with Far-Red Fluorescent-Conjugated Nanoparticles." Blood 106, no. 11 (November 16, 2005): 2196. http://dx.doi.org/10.1182/blood.v106.11.2196.2196.
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Abstract The use of novel nano-sized iron particles and magnetic imaging techniques are ideal for studies of homing and trafficking after labeling and transplantation of long-term repopulating, pluripotent human hematopoietic stem cells (HSC). Whereas the use of luciferase as a reporter for in vivo imaging requires transfection or viral transduction of the target cells to generate a measurable signal, we present an in vivo imaging system based upon the measurement of deep tissue penetrating, near far-red Alexa 750 nm organic dye conjugated to nano-sized ferum oxide particles (FE [750]), transiently introduced into highly purified human hematopoietic stem/progenitor subsets through complexing to the cationic agent protamine sulphate (Pro). Previous results from our group demonstrate that we can track the FE-Pro [750] labeled cells for a minimum of 30 days post transplantation using flow cytometry, before the signal diminishes due to cell division. We used a Kodak 4000MM multimodal imaging unit, which allows a precise anatomical localization of the signal measured through overlaying of the high resolution luminescent profile with x-ray images. NOD/SCID Beta2M null mice were transplanted using intravenous (IV) or intra femural (IF) injection with 1 x 105 or 2 x 105 human cord blood CD34+ cells labeled with the FE-Pro[750] nano particles. The animals were imaged directly after the injections to confirm successful transplantation, and then were subsequently imaged over a period of 8 days (cohort 1), 20 days (cohort 2) or 30 days (cohort 3). At the end point of each time period, animals were sacrificed and flow cytometry was performed to assess and confirm the location of the human engraftment in right and left leg bones as well as in spleens. Our imaging data shows that the human stem cells transplanted IF reside in the injection site for up to 10 days post transplantation, before the dilution of the signal becomes evident, with migration to the spleen at that time point indicating active engraftment, but without noticeable spreading of labeled cells to the non-injected leg. IV injected animals showed an initial strong repopulation of the spleens, with subsequent however asymmetric homing to the femur-tibiae of the legs over 8 days post transplantation, indicating a delayed homing as compared to the more direct IF delivery of the transplantation dose. Flow cytometry results confirmed the asymmetric homing to the femur-tibia bones of IV transplanted animals with one mouse in particular showing a 0.6% CD45+/Fe-Pro[750]low engraftment in the left femur-tibia whereas the right femur-tibia showed a stronger 1.3% CD45+/Fe-Pro[750]low engraftment at day 8. In conclusion, we present a novel system for imaging of human hematopoietic stem cell homing and engraftment post transplantation using dye conjugated nano-particles. This system allow an unprecedented capacity to observe and assess the in vivo dynamics of the engraftment process with high resolution, following intravenous or intrafemoral injection of different purified human stem cell populations.
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Magee, Lawrence, Patrick McCulloch, and Bradley Lambert. "Poster 124: Intrinsic Anthropometric Factors are Associated with Bone Stress Injuries in Collegiate Distance Runners: New Risk Metrics & Screening Tools?" Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0068. http://dx.doi.org/10.1177/2325967121s00685.
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Objectives: Lower limb bone stress injuries (BSI) of the pelvis, femur, and tibia are prevalent in collegiate track & field distance runners. However, it is not known the population’s bone, body composition (BComp), and anthropometric parameters prior to first respective collegiate injury compared to non-injured counterpart. This respective injury has been reported to require an extended timeframe for recovery as well as increases the risk, prospectively, for sustaining another similar injury. Extrinsic factors such as greater running frequency, mileage, pace, and change in terrain is known to influence risk which, during a competitive season, commonly occurs in collegiate runners. Intrinsic risk factors related to bone health and body composition of the runner have also been identified as important factors that further influence risk indicating proper screening of these respective intrinsic factors are necessary and recommended in order to better identify risk and prompt further evaluation. In light of previous observations and a clinical need in this unique population, the purpose of this study was to characterize bone mineral density, body composition, and skeletal dimensions assessed vai dual energy x-ray absorpitometry (DXA) in collegiate male and female distance runners prior to lower limb BSI status (i.e. injured or non-injured) during a competitive season as well as provide indices of risk specific DXA assessment. We hypothesized that 1) collegiate distance runners with a lower limb BSI will exhibit lower BMD relative to runners without injury; 2) total and regional body composition (i.e. fat and lean) as well as skeletal dimension differences will be observed between respective BSI status groups thus, allowing for identification of potential threshold cutoffs for this population; 3) measures of body composition and skeletal dimensions could be used to develop prediction models for regional and total BMD that may be utilized in the abscence of DXA for those with out readily available access. Methods: This was a retrospective case-control study design that was conducted at a University athletic training facility during the fall (August-November) 2013-2019 cross country seasons. Study measurements included a total body (TB) DXA scan, weight (kg), height (cm), and body mass index (BMI; kg/m2). The inclusion scan for the study participants with a lower limb BSI was the scan before first respective injury of collegiate career while study participants with no injury during collegiate career had their last scan of eligible fall season included. This study included male and female distance running athletes who were members of a NCAA D1A collegiate track and field team at a single University. Inclusion criteria included participation in sport-related activity prior to and after DXA scan for three months as well as only scans prior to first collegiate lower limb BSI. Exclusion criteria included any bone-related injury or recovery from such injury at time of DXA scan that prohibited prospective sport-related activities as well as scans prior to reoccurring lower limb BSI. Enrolled runners completed a DXA scan (August-November) and participated in sport activities before scan. Three months following scan, electronic medical records were reviewed to determine whether or not a BSI occurred. Independent samples t-test was used to compare BMD, BComp, and anthropometric measures between BSI vs non-injured (included subgroup analysis by sex). Multiple linear regression with stepwise removal was used to determine measures most predictive of BMD. Significance was set at p<0.05. Results: Demographics are shown in Table 1. Figure 1 shows athlete BMD characteristics among athletes (i.e. all, males, and females) with or without lower limb BSI. Overall, those in the NoBSI group had significantly higher BMD values for total, spine, pelvis, and legs (p<0.001). In males, the NoBSI group had significantly higher total, pelvis, and leg BMD (p<0.05) while no difference was observed in spine BMD compared to BSI group. Within females, the NoBSI group had significantly higher BMD in all respective measures compared to BSI group (p<0.001). Regression analysis revealed BComp and anthropometric measures were predictive of total bone mass [BM = (0.046 x age, yrs) + (0.024 x weight, kg) + (0.014 x %Fat) + (-0.017 x ARML) + (0.017 x SHWIDTH) + (-0.009 x TRNKL) + (0.037 x LL)]; P<0.05, R2 = 0.61 g/cm2, percent error = 11.01). In addition to predicted BM, as shown in Figure 2, other BComp and anthropometric measures [age, height, weight, BMI, FM, %Fat, BM, LL, SHWIDTH, TRNKL, and ARML) were predictive of total and regional BMD (P<0.05, R2 = 0.64-0.80 g/cm2, %error = 3.8-4.8). A physiologic comparison of those with and without long bone BSIs is shown in Table 2. No differences were found between BSI and NoBSI group demographics (i.e. height, weight, age, and BMI) in all athletes including males and females. BComp values in males found FM to be significantly lower in BSI compared to NoBSI while women leg LM in BSI group was significantly lower than NoBSI. Among all athletes, the BSI group had significantly shorter arm and leg limb lengths as well as a lower leg/trunk ratio compared to NoBSI group. Conclusions: Lower limb bone stress injuries are common in collegiate distance runners wherby total and regional BMD measures tend to be lower compared to runners who were not injured. Shorter limb lengths, lower fat mass (male), and lower leg lean mass (female) may also be indicative of BSI risk in this population. Interestingly, BComp and anthropometric measures are highly predictive of BMD in this sport population. These metrics may serve as sport-specific benchmarks for lower limb BSI risk and the equations developed here may be suitable for BMD screening in collegiate distance runners without readily availalbe access to DXA. [Figure: see text][Figure: see text][Table: see text][Table: see text]
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Woodhouse, Linda J., Suzanne Reisz-Porszasz, Marjan Javanbakht, Thomas W. Storer, Martin Lee, Hrant Zerounian, and Shalender Bhasin. "Development of models to predict anabolic response to testosterone administration in healthy young men." American Journal of Physiology-Endocrinology and Metabolism 284, no. 5 (May 1, 2003): E1009—E1017. http://dx.doi.org/10.1152/ajpendo.00536.2002.
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Considerable heterogeneity exists in the anabolic response to androgen administration; however, the factors that contribute to variation in an individual's anabolic response to androgens remain unknown. We investigated whether testosterone dose and/or any combination of baseline variables, including concentrations of hormones, age, body composition, muscle function, and morphometry or polymorphisms in androgen receptor could explain the variability in anabolic response to testosterone. Fifty-four young men were treated with a long-acting gonadotropin-releasing hormone (GnRH) agonist and one of five doses (25, 50, 125, 300, or 600 mg/wk) of testosterone enanthate (TE) for 20 wk. Anabolic response was defined as a change in whole body fat-free mass (FFM) by dual-energy X-ray absorptiometry (DEXA), appendicular FFM (by DEXA), and thigh muscle volume (by magnetic resonance imaging) during TE treatment. We used univariate and multivariate analysis to identify the subset of baseline measures that best explained the variability in anabolic response to testosterone supplementation. The three-variable model of TE dose, age, and baseline prostate-specific antigen (PSA) level explained 67% of the variance in change in whole body FFM. Change in appendicular FFM was best explained (64% of the variance) by the linear combination of TE dose, baseline PSA, and leg press strength, whereas TE dose, log of the ratio of luteinizing hormone to testosterone concentration, and age explained 66% of the variation in change in thigh muscle volume. The models were further validated by using Ridge analysis and cross-validation in data subsets. Only the model using testosterone dose, age, and PSA was a consistent predictor of change in FFM in subset analyses. The length of CAG tract was only a weak predictor of change in thigh muscle volume and lean body mass. Hence, the anabolic response of healthy, young men to exogenous testosterone administration can largely be predicted by the testosterone dose.
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Khan, Mohammad Shahnewaz Hossain, Rezaul Karim, SM Eqbal, Abdullah Masum, and ASM Kowser. "Stress Fracture Tibia among Military Recruits Management by Patellar Tendon Bearing Cast." Journal of Armed Forces Medical College, Bangladesh 15, no. 2 (December 20, 2020): 196–99. http://dx.doi.org/10.3329/jafmc.v15i2.50834.
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Introduction: Lower limb overuse injuries are common features of military training. Female recruits have significantly higher incidence of fracture than male recruits. In addition to the cost and time of rehabilitation, injury leads to disillusionment among recruits. Conventionally stress fracture tibia is treated with long leg posterior cast for 6-8 weeks but little is known about the length of time required for rehabilitation and to return to pre-injury level.
Objectives: To see the outcome of management of stress fracture tibia among military recruits treated with Patellar Tendon Bearing (PTB) cast for 8 weeks and to find out the rehabilitation time to return to pre-injury level.
Materials and Methods: This prospective study was conducted in Combined Military Hospital, Bogura, Bangladesh, from January 2015 to December 2016. Out of 2600 recruits 74 (male 60 females 14) were diagnosed as case of stress fracture tibia during the period. They were treated by PTB cast for 08 weeks and their treatment and rehabilitation to pre-injury level (follow-up) were recorded prospectively.
Results: Total 85 patients were clinically suspected to have stress fracture tibia, out of them 74(87.06%) patients were finally diagnosed as case of stress fracture. Of these 74 patients 44(59.46%) were diagnosed by initial x-ray and 30(40.54%) were diagnosed by MRI scan. Prevalence of stress fracture in male was 2.45% and in female recruits 9.33%, overall prevalence was 2.85%.About 56(75.67%) patients developed stress fracture in 0-8 weeks of training, mean rehabilitation time to return to pre-injury level was 15.51 weeks, there was no recurrence of stress fracture and all the patients completed 12 months training, none of them was relegated or withdrawn from training on medical ground.
Conclusion:Patellar tendon bearing cast is an effective, technically simple method for treating stress fracture of tibia in military recruits with excellent outcome. This method not only treats the fracture but also prevents depressive disorders.
JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 196-199
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Maharaul, Mashrutee S., Maya P. Raghuwanshi, Rehan Umar, and Reza Pishdad. "Thyroid Storm: A Diagnostic Conundrum." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A963. http://dx.doi.org/10.1210/jendso/bvab048.1969.
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Abstract Thyroid storm is a life threatening complication of hyperthyroidism which comes with multi-system involvement and is associated with a mortality of 8-25% despite modern advancements in treatment and supportive measures. A 47 year old woman with past medical history of hypertension and morbid obesity presented to the emergency room with 3 week history of shortness of breath and chest pain associated with productive cough, bilateral leg swelling, orthopnea and palpitations. Upon evaluation, she was in moderate respiratory distress, restless, tachypneic and tachycardic. She had bilateral proptosis and visible jugular venous pulsation along-with bibasilar crackles and pitting edema bilaterally. Lab tests revealed BNP 539 pg/ml and D-Dimer 6401 ng/ml. ECG showed atrial flutter, Chest X-Ray showed bilateral pleural effusions, and CT Chest was negative for pulmonary embolism but revealed anterior mediastinal mass, differential of which included thymoma or teratoma. She was admitted to CCU for aggressive diuresis, control of heart rate and was started on anticoagulation. A review of medical records from outside hospital revealed patient was hyperthyroid 8 months ago, however, was not on any medications. Given a Burch-Wartofsky score >70, she was started on IV hydrocortisone and cholestyramine for severe thyrotoxicosis. Endocrinology was consulted and added PTU to management. TFTs revealed a TSH 0.006 IU/ml, FT4 4 ng/dL and T3 2.5 ng/ml. Bedside ECHO showed LVEF of 14% with global hypokinesis and thyroid ultrasound revealed an enlarged, heterogenous thyroid with a solid, isoechoic, calcified left lobe nodule measuring 0.8 x 0.4 x 0.5 cm. Her serum TSI and thyrotropin receptor antibodies were elevated at 17.20 IU/L and 20.20 IU/L, respectively. She responded to treatment and was discharged on metoprolol, losartan, spironolactone, and furosemide for new-onset heart failure, apixaban for atrial flutter, and PTU and cholestyramine for hyperthyroidism, with Cardiology and Endocrinology follow-ups. Thyroid disease is a common illness affecting 9 to 15 percent of the adults. Thyrotoxicosis refers to the clinical syndrome of hyper-metabolism due to excessive amount of circulating thyroid hormones. The incidence of thyroid storm is 0.57 to 0.76 per 100,000 people per year in the US. It most commonly occurs in women and is more common in patients with underlying Grave’s Disease. The exact underlying mechanism that leads to thyroid storm is not well understood but adrenergic activation seems to have a major role. Our patient had long standing untreated hyperthyroidism with a solid nodule which led to the crisis. The most common cause of death is cardiopulmonary failure and hence treatment should be initiated as soon as diagnosis is suspected owing to high mortality. Awareness of thyroid pathology affecting the heart is important to remember in evaluating the etiology of heart failure in patients.
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Badour, Sanaa, Rodrigo Valderrãbano, Juliana Ferri-Guerra, Diana Barb, and Rajesh Garg. "PSUN55 Abnormal Body Fat Distribution in Lean Individuals with Metabolic Abnormalities." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A255—A256. http://dx.doi.org/10.1210/jendso/bvac150.525.
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Abstract Background Truncal obesity has long been considered an essential driver of metabolic abnormalities, but it is common for lean individuals with body mass index (BMI) <25 kg/m2 to have one or more metabolic abnormalities. We hypothesized that metabolically unhealthy lean (MUL) individuals have a different distribution of fat compared to their metabolically healthy lean (MHL) counterparts. Methods We performed a retrospective analysis of body composition data obtained from a repository of dual-energy X-ray absorptiometry scans performed during routine clinical practice at a University Bone Clinic. Metabolic data were retrieved from electronic medical records within one calendar year of the index scan. Those with at least 2 components of the metabolic syndrome: blood pressure >130/85 mmHg, triglyceride >150 mg/dL, HDL <50 mg/dL for women and <40 mg/dL for men, fasting plasma glucose >100 mg/dL (or HbA1c >5.7) were considered MUL, while those with 1 component or less were considered MHL. Waist circumference was not considered in this study. Adults with a BMI less than 25 kg/m2 were included in the analysis. Unadjusted and adjusted binary logistic regression were used to analyze the association between metabolic abnormalities and various anthropometric indexes. Results The study population consisted of 119 lean adults with a mean age of 62±14 years and a mean BMI of 22±1.9 kg/m2. Majority of participants were white (88%, n=105) and included postmenopausal women (85%, n=101). A large proportion were of Hispanic ethnicity (41%, n=70). There were 69 (58%) MHL and 50 (42%) MUL individuals. MUL and MHL groups had comparable percentage of total body fat (34±6.6 versus 34±5.6, p=0.360), fat mass index (8.2±1.6 versus 8.1±1.5, p=0.360) and appendicular lean mass (kg/m2) (5.9±0.8 versus 5.8±0.7, p=0.420). However, compared to MHL, MUL subjects had significantly higher visceral adipose tissue (cm2) (87±40 versus 9±29, p=0.004), trunk-to-leg fat ratio (0.89±0.18 versus 0.77±0.13, p<0.001), trunk-to-limb fat ratio (1.00±0.29 versus 0.82±0.18, p<0.001) and android-to-gynoid fat ratio (0.90±0.16 versus 0.81±0.15, p=0.010). After adjusting for age and sex, the odds of being MUL compared to MHL (odds ratio [OR (95% confidence interval (CI))]) increased for every standard deviation increase in visceral adipose tissue (OR=1.75 [1.13-2.73]), trunk-to-leg fat ratio (OR=2.28 [1.30-4.00]), trunk-to-limb fat ratio (OR=2.43 [1.37-4.32]) and android-to-gynoid fat ratio (OR=1.80 [1.07-3.03]). Conclusion Metabolically unhealthy subjects with normal BMI had markedly increased visceral adipose tissue and truncal redistribution of body fat without an increase in total body fat. These findings highlight the importance of using body morphometry measures, rather than total body fat, to assess CVD risk in lean individuals. Our findings suggest that the phenotype of lean individuals with metabolic derangements is not very different from that of obese individuals who have metabolic syndrome as per the National Cholesterol Education Program Adult Treatment Panel-III definition. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Pilone, Carola, Federico Verdone, Roberto Rossi, Davide Bonasia, and Federica Rosso. "Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0046. http://dx.doi.org/10.1177/2325967120s00466.
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Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]
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De Sanctis, Vincenzo, and Mohamed Yassin. "FINAL HEIGHT AND ENDORINE COMPLICATIONS IN PATIENTS WITH β-THALASSSEMIA INTERMEDIA: OUR EXPERIENCE IN NON-TRANSFUSED VERSUS INFREQUENTLY TRANSFUSED PATIENTS AND CORRELATIONS WITH LIVER IRON CONTENT." Mediterranean Journal of Hematology and Infectious Diseases 11, no. 1 (April 25, 2019): e2019026. http://dx.doi.org/10.4084/mjhid.2019.026.
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Abstract. Backgrond: β-thalassemia intermedia (TI) spans a wide spectrum of severity and carries higher morbidity than previously recognized, including extramedullary hematopoeisis, leg ulcers, gallstones, thrombosis, secondary heart failure, pulmonary hypertension, skeletal deformity, growth retardation and endocrine abnormalities, such as diabetes mellitus, hypothyroidism, osteoporosis, and hypogonadism.
Objectives: To evaluate the final height and the endocrine complications encountered in young adult patients with TI followed at Hematology Section, Doha (Qatar) in relation to liver iron content in non-transfused versus infrequently transfused TI patients.
Patients and Methods: This retrospective cohort study was performed on 28 young adults with TI who were randomly selected from the Hematology Clinic of the Hematology Section, National Centre for Cancer Care and Research, Hamad Medical Corporation of Doha (Qatar).
Eligibility criteria for this retrospective analysis included TI patients diagnosed by complete blood count, hemoglobin electrophoresis and young adult age ( ≥ 18 years).
Group 1 included 9 patients who did not receive any blood transfusion and Group 2 included 19 patients who infrequently received blood transfusion.
Data recorded from charts included demographic characteristics (gender, date of birth, ethnicity), disease and treatment characteristics (e.g., transfusion frequency, history of chelation therapy, and splenectomy), auxological and pubertal data [growth percentiles and pubertal stages, and body mass index (BMI)], laboratory data and target organ complications (including endocrinopathies and liver disease). Iron overload was assessed by direct (liver iron content; LIC) and indirect methods (SF), and bone mass index (BMA) by dual-energy X-ray absorptiometry (DXA).
Results: Short stature [Final Height (Ht) SDS < -2] occurred in 25% of patients with no difference between the two groups of patients. Insulin growth factor 1 (IGF-1) SDS was low in 35.7 % of patients with no statistical difference among the two groups. Impaired fasting blood glucose occurred in 17.8% of patients, diabetes mellitus in 25% and hypogonadotropic hypogonadism in 10.7% of them. Morning cortisol was low in one patient. No thyroid or hypoparathyroid abnormalities were detected in any patient. Liver iron content (LIC) > 15 mg/g dry weight and SF > 2,000 ng/mL were detected in 75% of the patients. The values resulted significantly higher in the transfused group (Group 2). High liver enzyme level (ALT) was detected in 42.8 % of patients and the values were significantly higher in the transfused group (Group 2).Total and fetal Hb was significantly higher in group 1 versus group 2. Osteopenia was diagnosed in 14.3% of patients. Females had significantly better final height SDS, higher IGF-1 SDS, lower LIC and fasting blood glucose level compared to males. Ht-SDS was correlated significantly with IGF-1 SDS. LIC was correlated significantly with SF level. ALT concentrations were correlated significantly with LIC and SF levels. Total and fetal Hb did not correlate significantly with Ht-SDS or IGF-1 level.
Conclusions: A significant number of TI patients have high LIC, short stature and endocrine disorders. Patients who require occasional transfusions have more liver iron overload and higher hepatic dysfunction. Females appear to attain better final adult height and have higher IGF1- SDS versus males. Our data emphasize the need for long term surveillance for identification of organ-specific risk factors and early disease manifestations.We also recommend a close monitoring of endocrine and other complications, according to the international guidelines.
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Ioskevich, N. N., L. F. Vasilchuk, P. E. Vankovich, S. P. Antonenko, V. A. Cherniy, and A. R. Obuhovich. "NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES." Journal of the Grodno State Medical University 18, no. 6 (December 31, 2020): 710–15. http://dx.doi.org/10.25298/2221-8785-2020-18-6-710-715.
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Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).
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Adityawardhana, Taufan, and Sulis Bayusentono. "Long Term Evaluation of Radiographically Undetected Acute Osteomyelitis Resulting Chronic Osteomyelitis with MRSA." Medical and Health Science Journal 4, no. 2 (August 28, 2020): 91–96. http://dx.doi.org/10.33086/mhsj.v4i2.1546.
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Osteomyelitis is an infection and inflammation of the bone that can spread into all parts of the bone. Methicillin-resistant Staphylococcus aureus or MRSA made the disease’s management far more complex and constrained and 28% of hospitals in Indonesia are suspected to be MRSA endemic. Osteomyelitis combined with MRSA have obscured prognosis knowing its assessment and management are still being developed.
Presenting a case of Chronic Osteomyelitis and MRSA of 11-year old girl that has been monitored for 5 years after the reported onset since July 2015.
The patient complained of severe pain in the left hip region causing her to stop using her left limb in July 2015. Signs of acute osteomyelitis couldn’t be confirmed by sequential assessments of X-Ray and USG examination. Cefazolin and Gentamicin injections were administered for 23 days. The family requested the patient to be sent home, due to no significant clinical improvement as indicated by them. Antibiotic regimens changed into oral regimens, which were Co-Amoxiclav and Gentamicin. The patient never appeared for routine check-up, her family conceded that they went to traditional alternative medication and stated the patient's clinical outcomes were showing signs of improvement; where the patient was able to walk normally. 6 months after, the patient's mother observed abnormal gait, however the patient didn't mention nor complain anything. X-ray assessment was then performed, with the result of the entire left femoral head being reportedly destroyed. In January 2016 the patient was referred to dr. Soetomo Academic General Hospital, the patient was diagnosed with chronic osteomyelitis and pathological fracture of 1/3 proximal left femur with a suspicion of avascular necrosis.
The patient was given prophylactics antibiotics. Closed biopsy couldn't be performed hence open biopsy was suggested. The patient had routine check-ups to monitor the disease progression, alongside radiologic assessment and laboratory assessment prior to the operation. Episodes of localised swollen and tenderness in the hip area were accounted. Scenes of seropurulent discharges were additionally reported. In june 2017 patients had surgical debridement and sequestrectomy alongside an open biopsy, where MRSA was diagnosed. No antibiotics had been given after the surgery and the patient routinely washed up with Chlorhexidine Gluconate 4%. The patient still does routine check-ups at the outpatient facility, as radiologic and laboratory examination are routinely observed.
As of now, the patient has no issue in its daily living activities. There is still limited range of movement at the infected site, with 90 degree of hip flexion and constrained internal rotation. A lower limb length discrepancy is present due to local growth aggravation at the left hip, currently patient using shoe with lift modifications on her left leg. In any case, there has been no complaint of pain, swollen or seropurulent releases throughout the last 18 months
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Völgyi, Eszter, Markku Alén, Leiting Xu, Arja Lyytikäinen, Qin Wang, Eveliina Munukka, Petri Wiklund, Frances A. Tylavsky, and Sulin Cheng. "Effect of long-term leisure time physical activity on lean mass and fat mass in girls during adolescence." Journal of Applied Physiology 110, no. 5 (May 2011): 1211–18. http://dx.doi.org/10.1152/japplphysiol.00996.2010.
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The purpose of this 7-yr prospective longitudinal study was to examine if the level and consistency of leisure-time physical activity (LTPA) during adolescence affected the quantity and distribution of lean mass (LM) and fat mass (FM) at early adulthood. The study subjects were 202 Finnish girls who were 10–13 yr old at baseline. LM and FM of the total body (TB), arms, legs, and trunk were assessed by dual-energy X-ray absorptiometry. Muscle cross-sectional area (mCSA) of the left leg was assessed by peripheral quantitative computed tomography. Scores of LTPA were obtained by questionnaire. Girls were divided into four groups comprising those with consistently low (GLL) or consistently high (GHH) physical activity, or those whose physical activity changed from low to high (GLH), or from high to low (GHL), over the 7 yr of follow-up. At baseline, no differences were found in LM, FM, and FM% among the groups in any of the body segments. By the end of the study GHH and GLH had higher values of LM of the TB, arms, legs, and trunk than that of the GHL and GLL groups ( P < 0.05, respectively). High FM% of the TB was associated with low level of LTPA, but no significant differences were found in the absolute amount of FM and mCSA among the LTPA groups. Our results suggest that a consistently high level of LTPA during the transition from prepuberty to early adulthood has a positive effect on lean mass gain in girls. Participating in 5 h of LTPA per week had a significant effect on FM% but not on the absolute amount of fat mass.
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Faruq, Mohammad Omar, Syed Muhammad Shahin ur Hayat, Rezaul Karim, Tahsin Salam, Aslam Uddin Sardar, Faisal Kabir, Arifur Rahman Khan, et al. "Bilateral pulmonary embolism and ilio-femoral DVT associated with recent amputation of lower limb, long distance air travel and suspected thrombophilia." Bangladesh Critical Care Journal 4, no. 1 (June 1, 2016): 46–50. http://dx.doi.org/10.3329/bccj.v4i1.27981.
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We present a 36 years old Bangladeshi male, known smoker, while working in Bahrain, suffered from arterial thromboembolism on left lower extremity resulting in gangrene of left leg. He underwent above knee amputation of the affected limb. After 16 days stay in the hospital with an open amputated stump wound, he was sent back to Bangladesh by air. While in the airplane, he complained of chest discomfort about two hours before landing at Dhaka airport of Bangladesh. Following disembarkation he was admitted into local cardiac hospital where a diagnosis of left ventricular failure with unstable angina was made. Five days later he was transferred to ICU of Ibn Sina Hospital for better management. Patient had high serum D-dimer level and fibrin degradation products (FDP) level. negative antinuclear antibody (ANA) test, negative anti-cardiolipin antibody test, normal troponin I, Homocysteine, antithrombin III, protein S, & protein C levels. Initial X-ray chest showed left lower zone wedge shaped density. ECG showed sinus tachycardia. CT angiogram of chest showed bilateral pulmonary embolism (PE) and large left pleural effusion. Contrast CT abdomen showed bilateral iliac vein thrombus extending to lower inferior vena cava. Left pleural effusion was found to be grossly hemorrhagic. Patient was treated with low molecular weight heparin and warfarin. As thrombolysis was not feasible, he was advised to have thrombo-embolectomy. He refused surgical option and left hospital against medical advice. This case illustrates that multiple risk factors can be responsible for PE, and appropriate & timely interventions are always needed to prevent morbidity and or mortalityBangladesh Crit Care J March 2016; 4 (1): 46-50
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Hjorth, Mette Holm, Inger Mechlenburg, Frederik Nicolai Foldager, Marianne Tjur, and Maiken Stilling. "A Comparison of Hip Muscle Mass, Muscle Power, and Clinical Outcomes with Long-Term Follow-Up in Patients with Metal-on-Metal Hip Arthroplasty Compared to Metal-on-Polyethylene Hip Arthroplasty." Applied Sciences 12, no. 24 (December 13, 2022): 12772. http://dx.doi.org/10.3390/app122412772.
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(1) Background: Metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) was presumed to provide superior functional outcomes compared to metal-on-polyethylene (MoP) THA. (2) Methods: We compared muscle mass, power, step test asymmetry, and patient-reported outcomes between MoM THA/HRA and MoP THA. A total of 51 MoM THA/HRAs and 23 MoP THAs participated in the cross-sectional study at a mean of 6.5 (2.4–12.5) years postoperatively. Muscle mass was measured by Dual energy X-ray Absorption (DXA) scans and muscle power in a Leg Extensor Power Rig. Step test asymmetry was obtained with an Inertial Measurement Unit (IMU). The patients completed the Harris Hip Score (HHS) and the Copenhagen Hip and Groin Outcome Score (HAGOS). (3) Results: The MoM THA/HRA group had a greater inter-limb difference in hip muscle mass compared to the MoP THA group (p = 0.02). Other inter-limb differences in muscle mass and power were similar (p > 0.05). Muscle mass of the thigh and calf area and muscle power in both legs were higher in MoM THA/HRA compared to MoP THA (p < 0.009). Step test time asymmetry when ascending was lower in MoM THA/HRA compared to MoP THA (p = 0.03). HHS and HAGOS scores were similar between groups (p > 0.05). (4) Conclusion: Overall, we could not verify the hypothesis that MoM THA/HRA contributes to superior functional outcomes compared to MoP THA.
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Gorgey, Ashraf S., Refka E. Khalil, Malak Alrubaye, Ranjodh Gill, Jeannie Rivers, Lance L. Goetz, David X. Cifu, et al. "Testosterone and long pulse width stimulation (TLPS) for denervated muscles after spinal cord injury: a study protocol of randomised clinical trial." BMJ Open 12, no. 10 (October 2022): e064748. http://dx.doi.org/10.1136/bmjopen-2022-064748.
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IntroductionLong pulse width stimulation (LPWS; 120–150 ms) has the potential to stimulate denervated muscles and to restore muscle size in denervated people with spinal cord injury (SCI). We will determine if testosterone treatment (TT)+LPWS would increase skeletal muscle size, leg lean mass and improve overall metabolic health in persons with SCI with denervation. We hypothesise that the 1-year TT+LPWS will upregulate protein synthesis pathways, downregulate protein degradation pathways and increase overall mitochondrial health.Methods and analysisTwenty-four male participants (aged 18–70 years with chronic SCI) with denervation of both knee extensor muscles and tolerance to the LPWS paradigm will be randomised into either TT+neuromuscular electrical stimulation via telehealth or TT+LPWS. The training sessions will be twice weekly for 1 year. Measurements will be conducted 1 week prior training (baseline; week 0), 6 months following training (postintervention 1) and 1 week after the end of 1 year of training (postintervention 2). Measurements will include body composition assessment using anthropometry, dual X-ray absorptiometry and MRI to measure size of different muscle groups. Metabolic profile will include measuring of basal metabolic rate, followed by blood drawn to measure fasting biomarkers similar to hemoglobin A1c, lipid panels, C reactive protein, interleukin-6 and free fatty acids and then intravenous glucose tolerance test to test for insulin sensitivity and glucose effectiveness. Finally, muscle biopsy will be captured to measure protein expression and intracellular signalling; and mitochondrial electron transport chain function. The participants will fill out 3 days dietary record to monitor their energy intake on a weekly basis.Ethics and disseminationThe study was approved by Institutional Review Board of the McGuire Research Institute (ID # 02189). Dissemination plans will include the Veteran Health Administration and its practitioners, the national SCI/D services office, the general healthcare community and the veteran population, as well as the entire SCI community via submitting quarterly letters or peer-review articles.Trial registration numberNCT03345576.
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Khare, Rahul, and Branislav Jaramaz. "Accuracy of leg alignment measurements from antero-posterior radiographs." Biomedical Engineering / Biomedizinische Technik 62, no. 3 (January 1, 2017). http://dx.doi.org/10.1515/bmt-2015-0221.
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AbstractAfter a knee replacement procedure, postoperative radiological assessment is carried out to evaluate outcome and predict procedure success. For this assessment, long-standing load-bearing antero-posterior radiographs are used to carry out manual identification of anatomic landmarks. These landmarks are subsequently used to estimate leg alignment. The positions of the landmarks in the radiographs are affected by the patient pose and the X-ray projection center. Although there is some past work exploring the impact of patient pose on the landmarks in the radiographs, there is no previous work on the impact of the X-ray projection center on the estimated leg alignment. In this work, we carried out a study of the impact of patient foot rotation, and X-ray projection center on landmark measurement errors, and estimation of leg alignment. In this evaluation, landmarks were first identified in three-dimensional computed tomography scans. Digitally reconstructed radiographs were then obtained from these scans under varying rotation and projection centers. Subsequently, landmarks were manually identified in these radiographs and leg alignment was estimated from these landmarks. We found that foot rotation leads to increased errors in certain landmarks. We also found that variations in the X-ray projection center do not lead to significant (p<0.01) errors in landmark measurements. Also, errors as large as 13.1 mm for the femoral knee center and 13.6 mm for the lateral malleolus led to a maximum error of 1.46° for the femoral mechanical axis and 0.66° for the tibial mechanical axis.
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Roche, Martin W., Rushabh M. Vakharia, Tsun Y. Law, and Karim G. Sabeh. "Accuracy of Intraoperative Mechanical Axis Alignment to Long-Leg Radiographs following Robotic-Arm–Assisted Unicompartmental Knee Arthroplasty." Journal of Knee Surgery, February 3, 2022. http://dx.doi.org/10.1055/s-0042-1742647.
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AbstractImproper alignment and implant positioning following unicompartmental knee arthroplasty (UKA) has been shown to lead to postoperative pain and increase the incidence of revision procedures. The use of robotic-arm assistance for UKA (RAUKA) has become an area of interest to help overcome these challenges. The accuracy of intraoperative alignment compared with standing long-leg X-rays postoperatively following medial RAUKA has been in question. Therefore, the purpose of this study was to (1) determine final mean intraoperative coronal alignment in extension utilizing an image based intraoperative navigation system, and (2) compare final intraoperative alignment to 6-week weight-bearing (WB) long-leg X-rays. Patients who underwent RAUKA for medial compartmental osteoarthritis were identified from January 1, 2018, to August 31, 2019, through our institution's joint registry. The query yielded 136 (72 right and 64 left) patients with a mean age of 72.02 years and mean body mass index (BMI) of 28.65 kg/m2 who underwent RAUKA. Final intraoperative alignment was compared with WB long leg X-rays 6 weeks postoperatively by measuring the mechanical alignment. Statistical analysis was primarily descriptive. Pearson's correlation coefficient was used to determine the relationship between intraoperative alignment to 6-week alignment. A p-value of <0.05 was considered statistically significant. Mean intraoperative coronal alignment after resections and trialing was 4.39 varus ± 2.40 degrees for the right knee, and 4.81 varus ± 2.29 degrees for the left knee. WB long-leg X-rays 6 weeks postoperatively demonstrated mechanical axis alignment for the right and left knees to be 3.01 varus ± 2.10 and 3.7 varus ± 2.38 degrees, respectively. This resulted in a change in alignment of 1.36 ± 1.76 and 1.12 ± 1.84 degrees for the right and left knees, respectively (p < 0.05). Pearson's correlation coefficient demonstrated a correlation of 0.69 between intraoperative to long-leg-X-ray alignment. RAUKA demonstrates excellent consistency when comparing postoperative WB long-leg X-rays to final intraoperative image-based non-WB alignment.