Abstract Aim Management of osteoarthritis ( OA ) is basically symptomatic. Recently, stem cells ( SC ) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra‐articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA . Method This was a prospective, open‐label, phase I/ II clinical trial to assess the safety and efficacy of a single intra‐articular injection of autologous stimulated bone marrow stem cells ( BM ‐ SC ) in patients with knee OA . Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G‐ CSF ). SC were obtained by BM aspiration and administered in a single intra‐articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT 01485198. Results A total of 61 patients were included. Socio‐demographic characteristics, OA grades and initial scores were similar in both groups. The BM ‐ SC group showed significant improvement in knee pain and quality of life during the 6‐month follow‐up. Conclusion The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA .
Diabetes complications such as nephropathy, retinopathy, or cardiovascular disease arise from vascular dysfunction. In this context, it has been observed that past hyperglycemic events can induce long-lasting alterations, a phenomenon termed "metabolic memory." In this study, we evaluated the genome-wide gene expression and chromatin accessibility alterations caused by transient high-glucose exposure in human endothelial cells (ECs) in vitro. We found that cells exposed to high glucose exhibited substantial gene expression changes in pathways known to be impaired in diabetes, many of which persist after glucose normalization. Chromatin accessibility analysis also revealed that transient hyperglycemia induces persistent alterations, mainly in non-promoter regions identified as enhancers with neighboring genes showing lasting alterations. Notably, activation of the NRF2 pathway through NRF2 overexpression or supplementation with the plant-derived compound sulforaphane, effectively reverses the glucose-induced transcriptional and chromatin accessibility memories in ECs. These findings underscore the enduring impact of transient hyperglycemia on ECs' transcriptomic and chromatin accessibility profiles, emphasizing the potential utility of pharmacological NRF2 pathway activation in mitigating and reversing the high-glucose-induced transcriptional and epigenetic alterations.
Background: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. Methods: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. Results: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. Conclusion: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. Level of Evidence: Level I, therapeutic studies.
COMPEAN-MARTINEZ, G. A.; MORALES-AVALOS, R.; VILCHEZ-CAVAZOS, F.; ACOSTA-OLIVO, C.; MENDOZA-LEMUS, O. F.; GARZA-CASTRO, O.; ELIZONDO-OMANA, R. E. & GUZMAN-LOPEZ, S. Anthropometric landmarks forposterior cruciate ligament reconstruction in anatomical position. Int. J. Morphol., 33(2):678-684, 2015.SUMMARY: To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomicalposition during posterior cruciate ligament (PCL) reconstruction. Ten knees were dissected to analyze femoral and tibial PCL in sertionmeasurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral inserti ons. Themeniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its correspondingfascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between thecentral point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm ( ±3.94) and 17.73 mm ( ±4.11) for the rightand left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm ( ±5.08) between the posterior PCL borderand the anterior PCL border. The mean lengths were 33.52 mm ( ±3.49) from the medial border of the lateral meniscus to the lateral PCLborder and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposteriorviewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its cen tral portion. Aquantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various fem oral andtibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengthsreported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligam ent plasty. Wemust take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graftwith the surrounding structures.KEY WORDS: Posterior cruciate ligament; Femoral tunnels; Reconstruction; Anatomy; Landmark.
The objective of our study was to investigate the association between body weight, clinical signs and surgical time, and the severity of elbow fractures sustained exclusively by a ground-level fall in children.Patients aged 2-11 years with elbow fracture caused exclusively by a ground-level fall were included. BMI was plotted on the sex-specific BMI-for-age percentile growth chart to obtain the BMI percentile. The elbow fractures were classified according to Gartland Classification for supracondylar fractures and the Song Classification for lateral humeral condyle fracture. Our main outcome measurement was Body Mass Index and fracture severity according Gartland or Song classifications.A total of 175 patients with elbow fractures were included in this study. The mean age of total population was 5.4 years (±2.4). The majority of our patients were male (61.7%), nearly of 48% were overweight or obese patients. The ecchymosis and puckering were the clinical sign more frequent in more severe fractures.Our data presented did not observe a direct relation between obesity and the severity of elbow humeral fractures in the pediatric population with a ground-level fall.
Purpose: To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis. Methods: A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery. Results: A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved. Conclusion: Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement. Level of Evidence: Level 1. Treatment register: NCT03265561