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Sample records for allograft musculoskeletal tissue

  1. Micro-organisms isolated from cadaveric samples of allograft musculoskeletal tissue.

    PubMed

    Varettas, Kerry

    2013-12-01

    Allograft musculoskeletal tissue is commonly used in orthopaedic surgical procedures. Cadaveric donors of musculoskeletal tissue supply multiple allografts such as tendons, ligaments and bone. The microbiology laboratory of the South Eastern Area Laboratory Services (SEALS, Australia) has cultured cadaveric allograft musculoskeletal tissue samples for bacterial and fungal isolates since 2006. This study will retrospectively review the micro-organisms isolated over a 6-year period, 2006-2011. Swab and tissue samples were received for bioburden testing and were inoculated onto agar and/or broth culture media. Growth was obtained from 25.1 % of cadaveric allograft musculoskeletal tissue samples received. The predominant organisms isolated were coagulase-negative staphylococci and coliforms, with the heaviest bioburden recovered from the hemipelvis. The rate of bacterial and fungal isolates from cadaveric allograft musculoskeletal tissue samples is higher than that from living donors. The type of organism isolated may influence the suitability of the allograft for transplant.

  2. Broth versus solid agar culture of swab samples of cadaveric allograft musculoskeletal tissue.

    PubMed

    Varettas, Kerry

    2013-12-01

    As part of the donor assessment protocol, bioburden assessment must be performed on allograft musculoskeletal tissue samples collected at the time of tissue retrieval. Swab samples of musculoskeletal tissue allografts from cadaveric donors are received at the microbiology department of the South Eastern Area Laboratory Services (Australia) to determine the presence of bacteria and fungi. This study will review the isolation rate of organisms from solid agar and broth culture of swab samples of cadaveric allograft musculoskeletal tissue over a 6-year period, 2006-2011. Swabs were inoculated onto horse blood agar (anaerobic, 35 °C) and chocolate agar (CO2, 35 °C) and then placed into a cooked meat broth (aerobic, 35 °C). A total of 1,912 swabs from 389 donors were received during the study period. 557 (29.1 %) swabs were culture positive with the isolation of 713 organisms, 249 (34.9 %) from solid agar culture and an additional 464 (65.1 %) from broth culture only. This study has shown that the broth culture of cadaveric allograft musculoskeletal swab samples recovered a greater amount of organisms than solid agar culture. Isolates such as Clostridium species and Staphylococcus aureus would not have been isolated from solid agar culture alone. Broth culture is an essential part of the bioburden assessment protocol of swab samples of cadaveric allograft musculoskeletal tissue in this laboratory.

  3. Culture methods of allograft musculoskeletal tissue samples in Australian bacteriology laboratories.

    PubMed

    Varettas, Kerry

    2013-12-01

    Samples of allograft musculoskeletal tissue are cultured by bacteriology laboratories to determine the presence of bacteria and fungi. In Australia, this testing is performed by 6 TGA-licensed clinical bacteriology laboratories with samples received from 10 tissue banks. Culture methods of swab and tissue samples employ a combination of solid agar and/or broth media to enhance micro-organism growth and maximise recovery. All six Australian laboratories receive Amies transport swabs and, except for one laboratory, a corresponding biopsy sample for testing. Three of the 6 laboratories culture at least one allograft sample directly onto solid agar. Only one laboratory did not use a broth culture for any sample received. An international literature review found that a similar combination of musculoskeletal tissue samples were cultured onto solid agar and/or broth media. Although variations of allograft musculoskeletal tissue samples, culture media and methods are used in Australian and international bacteriology laboratories, validation studies and method evaluations have challenged and supported their use in recovering fungi and aerobic and anaerobic bacteria.

  4. RT-PCR testing of allograft musculoskeletal tissue: is it time for culture-based methods to move over?

    PubMed

    Varettas, Kerry

    2014-12-01

    Allograft musculoskeletal tissue samples are assessed for microbial bioburden to reduce the risk of post-transplant infection. Traditionally, solid agar and broth culture media have been used however, nucleic acid testing, such as real-time (RT) polymerase chain reaction (PCR), has been described as more sensitive. This study evaluated the recovery of low numbers of challenge organisms from inoculated swab and musculoskeletal biopsy samples using solid agar culture, cooked meat medium, blood culture bottles and a RT-PCR assay. It was found that broth culture methods were the most sensitive with RT-PCR unable to detect low numbers of bacteria from these samples. Investigation of other non-culture methods may be worthwhile.

  5. Musculoskeletal allograft risks and recalls in the United States.

    PubMed

    Mroz, Thomas E; Joyce, Michael J; Steinmetz, Michael P; Lieberman, Isador H; Wang, Jeffrey C

    2008-10-01

    There have been several improvements to the US tissue banking industry over the past decade. Tissue banks had limited active government regulation until 1993, at which time the US Food and Drug Administration began regulatory oversight because of reports of disease transmission from allograft tissues. Reports in recent years of disease transmission associated with the use of allografts have further raised concerns about the safety of such implants. A retrospective review of allograft recall data was performed to analyze allograft recall by tissue type, reason, and year during the period from January 1994 to June 30, 2007. During the study period, more than 96.5% of all allograft tissues recalled were musculoskeletal. The reasons underlying recent musculoskeletal tissue recalls include insufficient or improper donor evaluation, contamination, recipient infection, and positive serologic tests. Infectious disease transmission following allograft implantation may occur if potential donors are not adequately evaluated or screened serologically during the prerecovery phase and if the implant is not sterilized before implantation. PMID:18832599

  6. Allografts in Soft Tissue Reconstructive Procedures

    PubMed Central

    Giedraitis, Andrius; Arnoczky, Steven P.; Bedi, Asheesh

    2014-01-01

    Context Allografts offer several important advantages over autografts in musculoskeletal reconstructive procedures, such as anterior cruciate ligament reconstruction. Despite growing widespread use of allograft tissue, serious concerns regarding safety and functionality remain. We discuss the latest knowledge of the potential benefits and risks of allograft use and offer a critical review of allograft tissue regulation, management, and sterilization to enable the surgeon to better inform athletes considering reconstructive surgery options. Evidence Acquisition A review of sources published in the past 10 years is the primary basis of this research. Study Design: Observational analysis (cohort study). Level of Evidence: Level 3. Results Comparable outcome data for autografts and allografts do not support universal standards for anterior cruciate ligament reconstruction, and physician recommendation and bias appear to significantly influence patient preference and satisfaction. Sterilization by gamma and electron-beam irradiation diminishes the biomechanical integrity of allograft tissue, but radioprotective agents such as collagen cross-linking and free radical scavengers appear to have potential in mitigating the deleterious effects of irradiation and preserving tissue strength and stability. Conclusion Allografts offer greater graft availability and reduced morbidity in orthopaedic reconstructive procedures, but greater expansion of their use by surgeons is challenged by the need to maintain tissue sterility and biomechanical functionality. Advances in the radioprotection of irradiated tissue may lessen concerns regarding allograft safety and structural stability. PMID:24790696

  7. Demand for human allograft tissue in Canada.

    PubMed

    Lakey, Jonathan R T; Mirbolooki, Mohammadreza; Rogers, Christina; Mohr, Jim

    2007-01-01

    There is relatively little known about the demand for allograft tissues in Canada. The Canadian Council for Donation and Transplantation (CCDT) is a national advisory body that undertook a comprehensive "market survey" to estimate surgical demand for human allograft tissues in Canada. The report "Demand for Human Allograft Tissue in Canada" reflects survey results sent to 5 prominent User Groups. User Groups were identified as orthopaedic surgeons; neurosurgeons; corneal transplant surgeons; plastic surgeons, specifically those at Canadian Burn Units; and cardiac surgeons (adult and paediatric surgery). The demand for allograft grafts was determined and then extrapolated across the total User Group and then increases in allograft tissue use over the next 1-2 years across User Groups were predicted. The overall response rate for the survey was 21.4%. It varied from a low of 19.6% for the orthopaedic survey to a high of 40.5% for the corneal survey. The estimated current demand for allograft tissue in Canada ranges from a low of 34,442 grafts per year to a high of 62,098 grafts per year. The predicted increase in use of allograft tissue over the next 1-2 year period would suggest that annual demand could rise to somewhere in the range of 42,589-72,210 grafts. The highest rated preferences (98% and 94%) were for accredited and Canadian tissue banks, respectively. This study represents a key step in addressing the paucity of information concerning the demand for allograft tissue in Canada.

  8. Allograft Replacement for Absent Native Tissue

    PubMed Central

    Chaudhury, Salma; Wanivenhaus, Florian; Fox, Alice J.; Warren, Russell F.; Doyle, Maureen; Rodeo, Scott A.

    2013-01-01

    Context: Structural instability due to poor soft tissue quality often requires augmentation. Allografts are important biological substitutes that are used for the symptomatic patient in the reconstruction of deficient ligaments, tendons, menisci, and osteochondral defects. Interest in the clinical application of allografts has arisen from the demand to obtain stable anatomy with restoration of function and protection against additional injury, particularly for high-demand patients who participate in sports. Traditionally, allografts were employed to reinforce weakened tissue. However, they can also be employed to substitute deficient or functionally absent tissue, particularly in the sports medicine setting. Objective: This article presents a series of 6 cases that utilized allografts to restore functionally deficient anatomic architecture, rather than just simply augmenting the degenerated or damaged native tissue. Detailed discussions are presented of the use of allografts as a successful treatment strategy to replace functionally weakened tissue, often after failed primary repairs. PMID:24427387

  9. Radiation sterilization of tissue allografts: A review

    PubMed Central

    Singh, Rita; Singh, Durgeshwer; Singh, Antaryami

    2016-01-01

    Tissue substitutes are required in a number of clinical conditions for treatment of injured and diseased tissues. Tissues like bone, skin, amniotic membrane and soft tissues obtained from human donor can be used for repair or reconstruction of the injured part of the body. Allograft tissues from human donor provide an excellent alternative to autografts. However, major concern with the use of allografts is the risk of infectious disease transmission. Therefore, tissue allografts should be sterilized to make them safe for clinical use. Gamma radiation has several advantages and is the most suitable method for sterilization of biological tissues. This review summarizes the use of gamma irradiation technology as an effective method for sterilization of biological tissues and ensuring safety of tissue allografts. PMID:27158422

  10. Interface tissue engineering: next phase in musculoskeletal tissue repair.

    PubMed

    Sahoo, Sambit; Teh, Thomas Kh; He, Pengfei; Toh, Siew Lok; Goh, James Ch

    2011-05-01

    Increasing incidence of musculoskeletal injuries coupled with limitations in the current treatment options have necessitated tissue engineering and regenerative medicine- based approaches. Moving forward from engineering isolated musculoskeletal tissues, research strategies are now being increasingly focused on repairing and regenerating the interfaces between dissimilar musculoskeletal tissues with the aim to achieve seamless integration of engineered musculoskeletal tissues. This article reviews the state-of-the-art in the tissue engineering of musculoskeletal tissue interfaces with a focus on Singapore's contribution in this emerging field. Various biomimetic scaffold and cellbased strategies, the use of growth factors, gene therapy and mechanical loading, as well as animal models for functional validation of the tissue engineering strategies are discussed.

  11. Tissue engineering - nanomaterials in the musculoskeletal system.

    PubMed

    Egli, Rainer J; Luginbuehl, Reto

    2012-01-01

    The musculoskeletal tissues bone, cartilage and ligament/tendon are highly structured nanocomposites consisting of nanofibres embedded in a matrix of different composition. Thus, it was a logical step that during the hype of nano in the last decade, nanotechnology and nanomaterials became a hot topic in the field of musculoskeletal repair. Especially the fact that using nanomaterials would encompass a biomimetic approach, thus copying nature, was promising. However, it became evident that using nanomaterials in the repair of musculoskeletal tissues had a longer history than initially thought and its way was paved with failures, which are important to remember when applying current ideas. This current opinion paper summarises some fundamental aspects of nanomaterials to be used for musculoskeletal application and discusses where this field might move to in the near future.

  12. Silk scaffolds for musculoskeletal tissue engineering

    PubMed Central

    Yao, Danyu

    2015-01-01

    The musculoskeletal system, which includes bone, cartilage, tendon/ligament, and skeletal muscle, is becoming the targets for tissue engineering because of the high need for their repair and regeneration. Numerous factors would affect the use of musculoskeletal tissue engineering for tissue regeneration ranging from cells used for scaffold seeding to the manufacture and structures of materials. The essential function of the scaffolds is to convey growth factors as well as cells to the target site to aid the regeneration of the injury. Among the variety of biomaterials used in scaffold engineering, silk fibroin is recognized as an ideal material for its impressive cytocompatibility, slow biodegradability, and excellent mechanical properties. The current review describes the advances made in the fabrication of silk fibroin scaffolds with different forms such as films, particles, electrospun fibers, hydrogels, three-dimensional porous scaffolds, and their applications in the regeneration of musculoskeletal tissues. PMID:26445979

  13. Silk scaffolds for musculoskeletal tissue engineering.

    PubMed

    Yao, Danyu; Liu, Haifeng; Fan, Yubo

    2016-02-01

    The musculoskeletal system, which includes bone, cartilage, tendon/ligament, and skeletal muscle, is becoming the targets for tissue engineering because of the high need for their repair and regeneration. Numerous factors would affect the use of musculoskeletal tissue engineering for tissue regeneration ranging from cells used for scaffold seeding to the manufacture and structures of materials. The essential function of the scaffolds is to convey growth factors as well as cells to the target site to aid the regeneration of the injury. Among the variety of biomaterials used in scaffold engineering, silk fibroin is recognized as an ideal material for its impressive cytocompatibility, slow biodegradability, and excellent mechanical properties. The current review describes the advances made in the fabrication of silk fibroin scaffolds with different forms such as films, particles, electrospun fibers, hydrogels, three-dimensional porous scaffolds, and their applications in the regeneration of musculoskeletal tissues.

  14. [Musculoskeletal tissue banks in Mexico. Part I. Regulation and organization].

    PubMed

    Alvarez-San Martín, R

    2012-01-01

    Although Tissue Banks and their activities are not new in Mexico, the specific regulations for the activities of tissue banks and musculoskeletal tissues considered as health supplies are still under development. This review paper intends to provide information on the national situation of musculoskeletal tissue banks, major aspects concerning their regulation and organization, and the recognition of the national instances pertaining to the Coordination for Organ and Tissue Donation for Transplant Purposes for the obtention of (musculoskeletal) tissues from deceased donors.

  15. Autograft Versus Nonirradiated Allograft Tissue for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mariscalco, Michael W.; Magnussen, Robert A.; Mehta, Divyesh; Hewett, Timothy E.; Flanigan, David C.; Kaeding, Christopher C.

    2014-01-01

    Background An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Hypothesis Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Study Design Systematic review. Methods A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Results Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone– patellar tendon–bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented

  16. An overview of recent patents on musculoskeletal interface tissue engineering.

    PubMed

    Rao, Rohit T; Browe, Daniel P; Lowe, Christopher J; Freeman, Joseph W

    2016-01-01

    Interface tissue engineering involves the development of engineered grafts that promote integration between multiple tissue types. Musculoskeletal tissue interfaces are critical to the safe and efficient transmission of mechanical forces between multiple musculoskeletal tissues, e.g., between ligament and bone tissue. However, these interfaces often do not physiologically regenerate upon injury, resulting in impaired tissue function. Therefore, interface tissue engineering approaches are considered to be particularly relevant for the structural restoration of musculoskeletal tissues interfaces. In this article, we provide an overview of the various strategies used for engineering musculoskeletal tissue interfaces with a specific focus on the recent important patents that have been issued for inventions that were specifically designed for engineering musculoskeletal interfaces as well as those that show promise to be adapted for this purpose.

  17. Quality control in tissue banking--ensuring the safety of allograft tissues.

    PubMed

    Humphries, Linda K; Mansavage, Vicki L

    2006-09-01

    DESPITE FEDERAL REGULATIONS for tissue-banking practices, inadequate quality control led to the largest allograft tissue recall in history in October 2005. THE RECALL INCLUDED all allograft tissues obtained from 761 donors and distributed by five tissue banks. Many of these tissues already had been implanted and were unrecoverable. THIS ARTICLE DESCRIBES the many tissue-banking industry variables, including donor selection and testing and tissue recovery, processing, and preservation. QUESTIONS THAT HEALTH CARE providers can ask to determine which tissue banks' quality control measures best ensure the safety of the allografts they provide also are included. PMID:17004664

  18. The Use of Scaffolds in Musculoskeletal Tissue Engineering

    PubMed Central

    Henson, Frances; Getgood, Alan

    2011-01-01

    The use of bioengineering scaffolds remains an integral part of the tissue engineering concept. A significant amount of basic science and clinical research has been focused on the regeneration of musculoskeletal tissues including bone, articular cartilage, meniscus, ligament and tendon. This review aims to provide the reader with a summary of the principals of using material scaffolds in musculoskeletal tissue engineering applications and how these materials may eventually come to be incorporated in clinical practice. PMID:21886690

  19. Immune response to nonspecific and altered tissue antigens in soft tissue allografts.

    PubMed

    Pinkowski, J L; Rodrigo, J J; Sharkey, N A; Vasseur, P B

    1996-05-01

    Soft tissue allografts have many uses in orthopaedic surgery, including knee ligament reconstruction, hand tendon surgery, shoulder instability, and rotator cuff reconstruction. The predictable biologic incorporation of soft tissue allografts without rejection or fear of disease transmission continues to be a goal of basic science researchers. A review of the current knowledge if the immune system response to donor specific, nonspecific, and altered tissue antigens in soft tissue or tendon allografts is presented. An in vitro study was done in an attempt to decrease immunogenicity of a frozen bone-ligament graft by adding irrigation with Betadine scrub solution and hydrogen peroxide to the conventional storage process of freezing. Although the irrigation with cytotoxic agents would undoubtedly further decrease immunogenicity, it also decreased stiffness and maximum load by 15%. Whether this decreased strength and stiffness would compromise the incorporation and long term success of soft tissue allografts would need to be studied by in vitro experiments.

  20. Donation FAQs (Bone and Tissue Allografts)

    MedlinePlus

    ... donor family services. Most organ, tissue and eye banks that are members of MTF send tissue to ... according to exact surgical specifications. Small, local tissue banks could not provide this level of quality in ...

  1. The safe and effective use of allograft tissue--an update.

    PubMed

    Barbour, Scott A; King, Warren

    2003-01-01

    The use of allograft tissue in orthopaedic surgery has increased tremendously over the last several years. Tissue availability, reduced surgical times, and lack of donor site morbidity are attractive characteristics to surgeons and patients alike. Although complications, such as disease transmission, are relatively uncommon when using allograft tissue, they do occur. This article will review the literature concerning the safe and effective use of allograft tissue, as well as present four case reports of Clostridium septicum infection caused by implantation of contaminated allograft tissue.

  2. The safe and effective use of allograft tissue--an update.

    PubMed

    Barbour, Scott A; King, Warren

    2003-01-01

    The use of allograft tissue in orthopaedic surgery has increased tremendously over the last several years. Tissue availability, reduced surgical times, and lack of donor site morbidity are attractive characteristics to surgeons and patients alike. Although complications, such as disease transmission, are relatively uncommon when using allograft tissue, they do occur. This article will review the literature concerning the safe and effective use of allograft tissue, as well as present four case reports of Clostridium septicum infection caused by implantation of contaminated allograft tissue. PMID:12975205

  3. Translational Models for Musculoskeletal Tissue Engineering and Regenerative Medicine

    PubMed Central

    Ratcliffe, Anthony

    2010-01-01

    The National Institutes of Health–sponsored workshop “Translational Models for Musculoskeletal Tissue Engineering and Regenerative Medicine” was held to describe the utility of various translational models for engineered tissues and regenerative medicine therapies targeting intervertebral disc, cartilage, meniscus, ligament, tendon, muscle, and bone. Participants included leaders in the various topics, as well as National Institutes of Health and Food and Drug Administration. The Food and Drug Administration representatives provided perspectives and needs for studies supported by animal models. Researchers described animal models for specific tissues and addressed the following questions: (1) What are the unmet musculoskeletal clinical needs that may be addressed by tissue engineering and regenerative medicine? (2) Are there appropriate models available? (3) Are there needs to develop standardized animal models? (4) What are the translational pathways that lead to clinical trials and therapeutic development? The workshop provided an effective and succinct summary of the status of various animal models in musculoskeletal regenerative medicine. Although many models are available and serve well to answer a variety of questions, the general consensus was that there is a substantial need for improved and standardized animal models for tissue engineering and regenerative medicine of the musculoskeletal system, and that animal models, especially large animal models, are critical to the preclinical step of translating research from bench to bedside. PMID:19905871

  4. Allograft update: the current status of tissue regulation, procurement, processing, and sterilization.

    PubMed

    McAllister, David R; Joyce, Michael J; Mann, Barton J; Vangsness, C Thomas

    2007-12-01

    Allografts are commonly used during sports medicine surgical procedures in the United States, and their frequency of use is increasing. Based on surgeon reports, it is estimated that more than 60 000 allografts were used in knee surgeries by members of the American Orthopaedic Society for Sports Medicine in 2005. In the United States, there are governmental agencies and other regulatory bodies involved in the oversight of tissue banks. In 2005, the Food and Drug Administration finalized its requirements for current good tissue practice and has mandated new rules regarding the "manufacture" of allogenic tissue. In response to well-publicized infections associated with the implantation of allograft tissue, some tissue banks have developed methods to sterilize allograft tissue. Although many surgeons have significant concerns about the safety of allografts, the majority believe that sterilized allografts are safe but that the sterilization process negatively affects tissue biology and biomechanics. However, most know very little about the principles of sterilization and the proprietary processes currently used in tissue banking. This article will review the current status of allograft tissue regulation, procurement, processing, and sterilization in the United States.

  5. Tissue allograft coding and traceability in USM Tissue Bank, Malaysia.

    PubMed

    Sheikh Ab Hamid, Suzina; Abd Rahman, Muhamad Nor Firdaus

    2010-11-01

    In Malaysia, tissue banking activities began in Universiti Sains Malaysia (USM) Tissue Bank in early 1990s. Since then a few other bone banks have been set up in other government hospitals and institutions. However, these banks are not governed by the national authority. In addition there is no requirement set by the national regulatory authority on coding and traceability for donated human tissues for transplantation. Hence, USM Tissue Bank has taken the initiatives to adopt a system that enables the traceability of tissues between the donor, the processed tissue and the recipient based on other international standards for tissue banks. The traceability trail has been effective and the bank is certified compliance to the international standard ISO 9001:2008. PMID:20582480

  6. Tissue engineering and regenerative medicine in musculoskeletal oncology.

    PubMed

    Holzapfel, Boris Michael; Wagner, Ferdinand; Martine, Laure Christine; Reppenhagen, Stephan; Rudert, Maximilian; Schuetz, Michael; Denham, Jim; Schantz, Jan-Thorsten; Hutmacher, Dietmar Werner

    2016-09-01

    Currently used surgical techniques to reconstruct tissue defects after resection of musculoskeletal tumours are associated with high complication rates. This drives a strong demand for innovative therapeutic concepts that are able to improve the clinical outcomes of patients suffering from bone and soft tissue tumours. Tissue engineering and regenerative medicine (TE&RM) provides a technology platform based on biochemical, molecular, cellular and biomaterials modules to selectively direct tissue healing processes for improved defect regeneration. At the same time, precautionary measures have to be taken when these instruments are used in cancer patients to prevent any promotion of tumour growth or metastatic spread. On the other hand, several innovative TE&RM tools are being developed such as multi-functionalized biomaterials, drug-delivering nanomaterials or genetically engineered stem cells that per se have the potential to mediate anti-cancer effects, act synergistically with currently used chemotherapeutics and/or radiotherapy regimens and reduce their side effects. Recently, scientists became conscious that TE&RM strategies may not only be utilized to advance contemporary tissue reconstruction techniques but also to develop personalized diagnostic tools and clinically relevant disease models for cancer patients. Eventually, prospective randomized clinical trials combined with comparative outcome analyses are a conditio sine qua non to shape the benefits of personalized regenerative therapies for the standardized management of patients with musculoskeletal tumours. PMID:27566370

  7. Tissue engineering and regenerative medicine in musculoskeletal oncology.

    PubMed

    Holzapfel, Boris Michael; Wagner, Ferdinand; Martine, Laure Christine; Reppenhagen, Stephan; Rudert, Maximilian; Schuetz, Michael; Denham, Jim; Schantz, Jan-Thorsten; Hutmacher, Dietmar Werner

    2016-09-01

    Currently used surgical techniques to reconstruct tissue defects after resection of musculoskeletal tumours are associated with high complication rates. This drives a strong demand for innovative therapeutic concepts that are able to improve the clinical outcomes of patients suffering from bone and soft tissue tumours. Tissue engineering and regenerative medicine (TE&RM) provides a technology platform based on biochemical, molecular, cellular and biomaterials modules to selectively direct tissue healing processes for improved defect regeneration. At the same time, precautionary measures have to be taken when these instruments are used in cancer patients to prevent any promotion of tumour growth or metastatic spread. On the other hand, several innovative TE&RM tools are being developed such as multi-functionalized biomaterials, drug-delivering nanomaterials or genetically engineered stem cells that per se have the potential to mediate anti-cancer effects, act synergistically with currently used chemotherapeutics and/or radiotherapy regimens and reduce their side effects. Recently, scientists became conscious that TE&RM strategies may not only be utilized to advance contemporary tissue reconstruction techniques but also to develop personalized diagnostic tools and clinically relevant disease models for cancer patients. Eventually, prospective randomized clinical trials combined with comparative outcome analyses are a conditio sine qua non to shape the benefits of personalized regenerative therapies for the standardized management of patients with musculoskeletal tumours.

  8. The appropriateness of swab cultures for the release of human allograft tissue.

    PubMed

    Ronholdt, Chad J; Bogdansky, Simon

    2005-08-01

    Surgeries utilizing human allograft tissues have increased dramatically in recent years. With this increase has come a greater reliance on the use of swab culturing to assess allograft tissues for microbial contamination prior to distribution. In contrast to the typical industrial microbiological uses for swabs, the tissue banking industry has relied on swab cultures as a sterility release method for allograft tissues. It has been reported in the literature that swabs have limitations, both in sensitivity and reproducibility, so their suitability as a final sterility release method was evaluated in this study. Two different swab-culturing systems were evaluated (COPAN, EZ Culturette) using human allograft tissues spiked with low levels of multiple bacterial and fungal microorganisms. The average microbial recoveries for all challenge microorganisms for each tissue type and each swab system were calculated. Percent recoveries for each challenge microorganism were also calculated and reported. The results indicated that both swab systems exhibited low and highly variable recoveries from the seeded allograft tissues. Further analysis indicated there was no statistical difference ( proportional, variant=0.05) between the two swab systems. It is the recommendation of the authors that swab culturing not be used to assess relatively low levels of microbial contamination on allografts. Instead, alternative validated microbial detection methods with improved sensitivity and reproducibility should be employed and validated for this critical task. PMID:15973533

  9. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections.

  10. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections. PMID:11770503

  11. Is Duplex-Ultrasound a useful tool in defining rejection episodes in composite tissue allograft transplants?

    PubMed

    Loizides, Alexander; Kronberger, Irmgard-Elisabeth; Plaikner, Michaela; Gruber, Hannes

    2015-12-01

    Immunologic reactions in transplanted organs are in more or less all allograft patients detectable: clear parameters exist as e.g. in renal transplants where the clearance power reduces by rejection. On the contrary, in composite tissue allografts clear and objective indicators stating a rejection episode lack. We present the case of a hand-transplanted subject with signs of acute transplant rejection diagnosed by means of Duplex Ultrasound and confirmed by biopsy.

  12. Increased Risk of Revision after ACL Reconstruction with Soft Tissue Allograft Compared to Autograft

    PubMed Central

    Maletis, Gregory; Chen, Jason; Inacio, Maria Carolina Secorun; Love, Rebecca; Funahashi, Tadashi Ted

    2016-01-01

    Objectives: The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. Numerous meta-analysis and systematic reviews of small clinical studies have not found differences between autograft and allograft outcomes but large registry studies have shown an increased risk of revision with allografts. The purpose of this study was to compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts, hamstring tendon autografts and soft tissue allografts. Methods: A retrospective cohort study of prospectively collected data was conducted using an US ACLR Registry. A cohort of primary unilateral ACLR cases reconstructed with BPTB autografts, hamstring autografts and soft tissue allografts (from any site) was identified. Aseptic revision was the end point of the study. Type of graft and allograft processing methods (non-processed, <1.8Mrads with and without chemical processing (Allowash or AlloTrue methods), >1.8 Mrads irradiation with and without chemical processing, and chemical processing alone (BioCleanse)) were the exposures of interest evaluated. Time from surgery was evaluated as an effect modifier. All analyses were adjusted for age, gender, and race. Kaplan-Meier curves and Cox proportional hazard models were employed. Hazard ratios (HR), 95% confidence intervals (CI) are provided. Results: The cohort had 14015 cases, 8924 (63.7%) were male, 6397 (45.6%) were White, 4557 (32.5%) cases used BPTB autograft, 3751 (26.8%) cases used soft tissue allograft and 5707 (40.7%) cases used hamstring autograft. The median age was 34.6 years-old (IQR 24.1-43.2) for allograft cases and 24.3 years-old (IQR 17.7-33.8) for hamstring autograft cases, and 22.0 years-old (IQR 17.6-30.0) for BPTB autograft cases. Compared to hamstring tendon autografts, an increased risk of revision was found in allografts processed with >1.8Mrads without chemical processing after 2.5 years (HR: 3.88 95%CI 1.48-10.12), and >1.8Mrads with

  13. Stem Cell-based Tissue Engineering Approaches for Musculoskeletal Regeneration

    PubMed Central

    Brown, Patrick T.; Handorf, Andrew M.; Jeon, Won Bae; Li, Wan-Ju

    2014-01-01

    The field of regenerative medicine and tissue engineering is an ever evolving field that holds promise in treating numerous musculoskeletal diseases and injuries. An important impetus in the development of the field was the discovery and implementation of stem cells. The utilization of mesenchymal stem cells, and later embryonic and induced pluripotent stem cells, opens new arenas for tissue engineering and presents the potential of developing stem cell-based therapies for disease treatment. Multipotent and pluripotent stem cells can produce various lineage tissues, and allow for derivation of a tissue that may be comprised of multiple cell types. As the field grows, the combination of biomaterial scaffolds and bioreactors provides methods to create an environment for stem cells that better represent their microenvironment for new tissue formation. As technologies for the fabrication of biomaterial scaffolds advance, the ability of scaffolds to modulate stem cell behavior advances as well. The composition of scaffolds could be of natural or synthetic materials and could be tailored to enhance cell self-renewal and/or direct cell fates. In addition to biomaterial scaffolds, studies of tissue development and cellular microenvironments have determined other factors, such as growth factors and oxygen tension, that are crucial to the regulation of stem cell activity. The overarching goal of stem cell-based tissue engineering research is to precisely control differentiation of stem cells in culture. In this article, we review current developments in tissue engineering, focusing on several stem cell sources, induction factors including growth factors, oxygen tension, biomaterials, and mechanical stimulation, and the internal and external regulatory mechanisms that govern proliferation and differentiation. PMID:23432679

  14. [Skin and tissue bank: Operational model for the recovery and preservation of tissues and skin allografts].

    PubMed

    Martínez-Flores, Francisco; Sandoval-Zamora, Hugo; Machuca-Rodriguez, Catalina; Barrera-López, Araceli; García-Cavazos, Ricardo; Madinaveitia-Villanueva, Juan Antonio

    2016-01-01

    Tissue storage is a medical process that is in the regulation and homogenisation phase in the scientific world. The international standards require the need to ensure safety and efficacy of human allografts such as skin and other tissues. The activities of skin and tissues banks currently involve their recovery, processing, storage and distribution, which are positively correlated with technological and scientific advances present in current biomedical sciences. A description is presented of the operational model of Skin and Tissue Bank at INR as successful case for procurement, recovery and preservation of skin and tissues for therapeutic uses, with high safety and biological quality. The essential and standard guidelines are presented as keystones for a tissue recovery program based on scientific evidence, and within an ethical and legal framework, as well as to propose a model for complete overview of the donation of tissues and organ programs in Mexico. Finally, it concludes with essential proposals for improving the efficacy of transplantation of organs and tissue programs. PMID:26259741

  15. [Skin and tissue bank: Operational model for the recovery and preservation of tissues and skin allografts].

    PubMed

    Martínez-Flores, Francisco; Sandoval-Zamora, Hugo; Machuca-Rodriguez, Catalina; Barrera-López, Araceli; García-Cavazos, Ricardo; Madinaveitia-Villanueva, Juan Antonio

    2016-01-01

    Tissue storage is a medical process that is in the regulation and homogenisation phase in the scientific world. The international standards require the need to ensure safety and efficacy of human allografts such as skin and other tissues. The activities of skin and tissues banks currently involve their recovery, processing, storage and distribution, which are positively correlated with technological and scientific advances present in current biomedical sciences. A description is presented of the operational model of Skin and Tissue Bank at INR as successful case for procurement, recovery and preservation of skin and tissues for therapeutic uses, with high safety and biological quality. The essential and standard guidelines are presented as keystones for a tissue recovery program based on scientific evidence, and within an ethical and legal framework, as well as to propose a model for complete overview of the donation of tissues and organ programs in Mexico. Finally, it concludes with essential proposals for improving the efficacy of transplantation of organs and tissue programs.

  16. Effect of tissue culture storage on the in vivo survival of canine osteochondral allografts.

    PubMed

    Oates, K M; Chen, A C; Young, E P; Kwan, M K; Amiel, D; Convery, F R

    1995-07-01

    In vitro studies in our laboratory have shown that the biomechanical and biochemical characteristics of osteochondral grafts can be preserved for as long as 28 days under tissue culture conditions. This study represents an attempt to extend these results to an in vivo model. In adult mongrel dogs, either an autograft, a fresh allograft, or a stored allograft was placed in a standardized defect on the weight-bearing surface of the medial femoral condyle. The stored grafts were kept at 4 degrees C in tissue culture medium for 14 days prior to implantation. The animals were killed at 12 weeks. Cartilage from the contralateral knee served as a control. The modulus and permeability of the cartilage were assessed with confined compression creep tests. The collagen and glycosaminoglycan contents were measured, and the cartilage was analyzed histologically with hematoxylin and eosin and safranin O stains. Grossly, the cartilage appeared viable at harvest. The histologic results were similar in the treatment groups, with the same spectrum of mild degenerative changes being noted in each group. The glycosaminoglycan content was significantly less in the autograft group than in its control group and than in the fresh allograft group. The glycosaminoglycan content did not differ significantly between fresh and stored allografts. The collagen content, modulus, and permeability did not differ either between experimental and control groups or between graft types. Our results support the conclusion that osteochondral allografts can be stored for as many as 14 days without significantly affecting the results of the procedure.

  17. Human flexor tendon tissue engineering: revitalization of biostatic allograft scaffolds.

    PubMed

    Woon, Colin Y L; Farnebo, Simon; Schmitt, Taliah; Kraus, Armin; Megerle, Kai; Pham, Hung; Yan, Xinrui; Gambhir, Sanjiv S; Chang, James

    2012-12-01

    Cadaveric tendon allografts form a readily available and underutilized source of graft material. Because of their material properties, allografts are biomechanically and biologically superior to synthetic scaffolds. However, before clinical use, allografts must undergo decellularization to reduce immunogenicity and oxidation to increase porosity, leaving a nonvital biostatic scaffold. Ex vivo seeding, or revitalization, is thought to hasten graft incorporation and stimulate intrinsic tendon healing, permitting early mobilization and return to function. In this study, we examined physical and biochemical augmentation methods, including scaffold surface scoring (physical) and rehydration of lyophilized scaffolds in serum (biochemical). Scaffolds were divided into four groups: (1) scored scaffolds, (2) lyophilized scaffolds rehydrated in fetal calf serum (FCS), (3) scaffolds both scored and rehydrated in FCS, and (4) control scaffolds. Scaffolds were reseeded with adipose-derived stem cells (ADSCs). Reseeding efficacy was quantified by a live cell and total cell assays and qualified histologically with hematoxylin and eosin, live/dead and SYTO green nucleic acid stains, TUNEL apoptosis stains, procollagen stains, and transmission electron microscopy. Scaffold-seeded cell viability at up to 2 weeks in vitro and up to 4 weeks in vivo was demonstrated with bioluminescent imaging of scaffolds seeded with luciferase-positive ADSCs. The effect of seeding on scaffold biomechanical properties was demonstrated with evaluation of ultimate tensile stress (UTS) and an elastic modulus (EM). We found that scaffold surface scoring led to an increase in live and total cell attachment and penetration (MTS assay, p<0.001 and DNA assay, p=0.003, respectively). Histology confirmed greater total cell number in both construct core and surface in scored compared with unscored constructs. Cells reseeded on scored constructs displayed reduced apoptosis, persistent procollagen production, and

  18. Infrared fiber optic probes for evaluation of musculoskeletal tissue pathology

    NASA Astrophysics Data System (ADS)

    Padalkar, Mugdha; McGoverin, Cushla; Onigbanjo, Quam; Spencer, Richard; Barbash, Scott; Kropf, Eric; Pleshko, Nancy

    2014-03-01

    Musculoskeletal pathology of the knee commonly occurs with aging and as a result of injury. The incidence of anterior cruciate ligament (ACL) injuries continues to increase annually, and may precede the eventual onset of osteoarthritis (OA), a debilitating and prevalent disease characterized by cartilage degeneration. Early detection of OA remains elusive, with current imaging methods lacking adequate sensitivity to detect early pathologic cartilage changes. We used mid- and near- infrared (IR) spectroscopy through arthroscopic-based fiber-optic devices to assess cartilage damage and differentiate tendon from ligament. Mid-IR spectroscopy is characterized by distinct bands and low penetration depth (< 10 μm) and near-IR spectroscopy is characterized by complex overlapping bands and greater penetration depths (< 1 cm). We have found that combined mid- and near-IR analysis greatly extends the information available through either in the analysis of soft tissues, including cartilage, ligaments and tendons. We discuss here basic science studies and the potential for translation to clinical research with novel arthroscopic probes.

  19. Characterization of acute renal allograft rejection by proteomic analysis of renal tissue in rat.

    PubMed

    Chen, Gang; Huang, Jing-Bin; Mi, Jie; He, Yun-Feng; Wu, Xiao-Hou; Luo, Chun-Li; Liang, Si-Min; Li, Jia-Bing; Tang, Ya-Xiong; Li, Jie

    2012-02-01

    Rapid and reliable biomarkers of renal allograft rejection have not been available. This study aimed to investigate biomarkers in renal allograft tissue using proteomic analysis. Orthotopic kidney transplantations were performed using Fisher (F344) or Lewis rats as donors and Lewis rats as recipients. Syngenic control group (Group I) constituted F344-to-F344 orthotopic kidney allo-transplantations (n = 8); and allogenic group (Group II) consisted of F344-to-Lewis orthotopic kidney allo-transplantations (n = 8). Renal tissues were harvested 7 days after transplantation. Samples were analyzed using 2-D electrophoresis and matrix assisted laser desorption ionization-time of flight mass spectrometry. 6 differentially expressed proteins were identified between allogenic group and syngenic control group. A rat model of acute renal allograft rejection was successfully set up. Differentially expressed proteins in renal allograft tissue of rat were detected using proteomic analysis and might serve as novel diagnostic and therapeutic targets in human. Quantitative proteomics, using MALDL-TOF-MS methodology has the potential to provide a profiling and a deeper understanding of acute renal rejection.

  20. Emergence of scaffold-free approaches for tissue engineering musculoskeletal cartilages.

    PubMed

    DuRaine, Grayson D; Brown, Wendy E; Hu, Jerry C; Athanasiou, Kyriacos A

    2015-03-01

    This review explores scaffold-free methods as an additional paradigm for tissue engineering. Musculoskeletal cartilages-for example articular cartilage, meniscus, temporomandibular joint disc, and intervertebral disc-are characterized by low vascularity and cellularity, and are amenable to scaffold-free tissue engineering approaches. Scaffold-free approaches, particularly the self-assembling process, mimic elements of developmental processes underlying these tissues. Discussed are various scaffold-free approaches for musculoskeletal cartilage tissue engineering, such as cell sheet engineering, aggregation, and the self-assembling process, as well as the availability and variety of cells used. Immunological considerations are of particular importance as engineered tissues are frequently of allogeneic, if not xenogeneic, origin. Factors that enhance the matrix production and mechanical properties of these engineered cartilages are also reviewed, as the fabrication of biomimetically suitable tissues is necessary to replicate function and ensure graft survival in vivo. The concept of combining scaffold-free and scaffold-based tissue engineering methods to address clinical needs is also discussed. Inasmuch as scaffold-based musculoskeletal tissue engineering approaches have been employed as a paradigm to generate engineered cartilages with appropriate functional properties, scaffold-free approaches are emerging as promising elements of a translational pathway not only for musculoskeletal cartilages but for other tissues as well.

  1. Tissue elasticity quantification by acoustic radiation force impulse for the assessment of renal allograft function.

    PubMed

    He, Wan-Yuan; Jin, Yun-Jie; Wang, Wen-Ping; Li, Chao-Lun; Ji, Zheng-Biao; Yang, Cheng

    2014-02-01

    Acoustic radiation force impulse (ARFI) quantification, a novel ultrasound-based elastography method, has been used to measure liver fibrosis. However, few studies have been performed on the use of ARFI quantification in kidney examinations. We evaluated renal allograft stiffness using ARFI quantification in patients with stable renal function (n = 52) and those with biopsy-proven allograft dysfunction (n = 50). ARFI quantification, given as shear wave velocity (SWV), was performed. The resistance index (RI) was calculated by pulsed-wave Doppler ultrasound, and clinical and laboratory data were collected. Morphologic changes in transplanted kidneys were diagnosed by an independent pathologist. Mean SWV was more significantly negatively correlated with estimated glomerular filtration rate (eGFR) (r = -0.657, p < 0.0001) than was RI (r = -0.429, p = 0.0004) in transplanted kidneys. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of quantitative ultrasound in the diagnosis of renal allograft dysfunction were 72.0% and 86.5% (cutoff value = 2.625), respectively. The latter values were better than those of RI, which were 62.0% and 69.2% (cutoff value = 0.625), respectively. The coefficient of variation for repeat SWV measurements of the middle part of transplanted kidney was 8.64%, and inter-observer agreement on SWV was good (Bland-Altman method, ICC = 0.890). In conclusion, tissue elasticity quantification by ARFI is more accurate than the RI in diagnosing renal allograft function.

  2. Seeing through Musculoskeletal Tissues: Improving In Situ Imaging of Bone and the Lacunar Canalicular System through Optical Clearing

    PubMed Central

    Berke, Ian M.; Miola, Joseph P.; David, Michael A.; Smith, Melanie K.; Price, Christopher

    2016-01-01

    In situ, cells of the musculoskeletal system reside within complex and often interconnected 3-D environments. Key to better understanding how 3-D tissue and cellular environments regulate musculoskeletal physiology, homeostasis, and health is the use of robust methodologies for directly visualizing cell-cell and cell-matrix architecture in situ. However, the use of standard optical imaging techniques is often of limited utility in deep imaging of intact musculoskeletal tissues due to the highly scattering nature of biological tissues. Drawing inspiration from recent developments in the deep-tissue imaging field, we describe the application of immersion based optical clearing techniques, which utilize the principle of refractive index (RI) matching between the clearing/mounting media and tissue under observation, to improve the deep, in situ imaging of musculoskeletal tissues. To date, few optical clearing techniques have been applied specifically to musculoskeletal tissues, and a systematic comparison of the clearing ability of optical clearing agents in musculoskeletal tissues has yet to be fully demonstrated. In this study we tested the ability of eight different aqueous and non-aqueous clearing agents, with RIs ranging from 1.45 to 1.56, to optically clear murine knee joints and cortical bone. We demonstrated and quantified the ability of these optical clearing agents to clear musculoskeletal tissues and improve both macro- and micro-scale imaging of musculoskeletal tissue across several imaging modalities (stereomicroscopy, spectroscopy, and one-, and two-photon confocal microscopy) and investigational techniques (dynamic bone labeling and en bloc tissue staining). Based upon these findings we believe that optical clearing, in combination with advanced imaging techniques, has the potential to complement classical musculoskeletal analysis techniques; opening the door for improved in situ investigation and quantification of musculoskeletal tissues. PMID:26930293

  3. Seeing through Musculoskeletal Tissues: Improving In Situ Imaging of Bone and the Lacunar Canalicular System through Optical Clearing.

    PubMed

    Berke, Ian M; Miola, Joseph P; David, Michael A; Smith, Melanie K; Price, Christopher

    2016-01-01

    In situ, cells of the musculoskeletal system reside within complex and often interconnected 3-D environments. Key to better understanding how 3-D tissue and cellular environments regulate musculoskeletal physiology, homeostasis, and health is the use of robust methodologies for directly visualizing cell-cell and cell-matrix architecture in situ. However, the use of standard optical imaging techniques is often of limited utility in deep imaging of intact musculoskeletal tissues due to the highly scattering nature of biological tissues. Drawing inspiration from recent developments in the deep-tissue imaging field, we describe the application of immersion based optical clearing techniques, which utilize the principle of refractive index (RI) matching between the clearing/mounting media and tissue under observation, to improve the deep, in situ imaging of musculoskeletal tissues. To date, few optical clearing techniques have been applied specifically to musculoskeletal tissues, and a systematic comparison of the clearing ability of optical clearing agents in musculoskeletal tissues has yet to be fully demonstrated. In this study we tested the ability of eight different aqueous and non-aqueous clearing agents, with RIs ranging from 1.45 to 1.56, to optically clear murine knee joints and cortical bone. We demonstrated and quantified the ability of these optical clearing agents to clear musculoskeletal tissues and improve both macro- and micro-scale imaging of musculoskeletal tissue across several imaging modalities (stereomicroscopy, spectroscopy, and one-, and two-photon confocal microscopy) and investigational techniques (dynamic bone labeling and en bloc tissue staining). Based upon these findings we believe that optical clearing, in combination with advanced imaging techniques, has the potential to complement classical musculoskeletal analysis techniques; opening the door for improved in situ investigation and quantification of musculoskeletal tissues.

  4. Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Dashe, Jesse; Parisien, Robert L; Cusano, Antonio; Curry, Emily J; Bedi, Asheesh; Li, Xinning

    2016-01-01

    AIM: To evaluate whether anterior cruciate ligament (ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate. METHODS: A literature search was conducted using PubMed, Cochrane, and Google. The following search terms were used: “Gamma irradiation AND anterior cruciate ligament AND allograft” with a return of 30 items. Filters used included: English language, years 1990-2015. There were 6 hits that were not reviewed, as there were only abstracts available. Another 5 hits were discarded, as they did not pertain to the topic of interest. There were 9 more articles that were excluded: Three studies were performed on animals and 6 studies were meta-analyses. Therefore, a total of 10 articles were applicable to review. RESULTS: There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft. Of note, low dose irradiation is considered less than 2.0 Mrad, moderate dose is between 2.1-2.4 Mrad, and high dose is greater than or equal to 2.5 Mrad. Based upon the results of the literature search, the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures. The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion. Utilization of higher dose (≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction. CONCLUSION: Allograft ACL graft gamma irradiated with less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age. PMID:27335815

  5. Acknowledging tissue donation: Human cadaveric specimens in musculoskeletal research.

    PubMed

    Winkelmann, Andreas; Heinze, Anne-Kathrin; Hendrix, Sven

    2016-01-01

    Human cadaveric specimens are an important resource for research, particularly in biomechanical studies, but their use also raises ethical questions and cannot simply be taken for granted. It was asked how much information authors publishing musculoskeletal research actually give about such specimens and about how they were acquired. The aim was to formulate recommendations on how this reporting might be improved. Relevant articles published between 2009 and 2012 in four North American or European journals were scanned for information regarding the characteristics of the human specimens used, their institutional source and the ethical or legal context of their acquisition. While the majority of articles report biological characteristics of specimens (sex, age at death, preservation method), only 40% of articles refer to body donation, only 23% report the institution that provided specimens, and only 17% refer to some kind of formalized approval of their research. There were regional and journal-to-journal differences. No standard for reporting studies involving human specimens could be detected. It is suggested that such a standard be developed by researchers and editors. Information on the source of specimens and on the ethical or legal basis should be regularly reported to acknowledge this unique research resource and to preserve the good relationship between researchers and the communities, that provide the required specimens by body donation and upon which researchers depend.

  6. Segmentation of joint and musculoskeletal tissue in the study of arthritis.

    PubMed

    Pedoia, Valentina; Majumdar, Sharmila; Link, Thomas M

    2016-04-01

    As the most frequent cause of physical disability, musculoskeletal diseases such as arthritis and osteoporosis have a great social and economical impact. Quantitative magnetic resonance imaging (MRI) biomarkers are important tools that allow clinicians to better characterize, monitor, and even predict musculoskeletal disease progression. Post-processing pipelines often include image segmentation. Manually identifying the border of the region of interest (ROI) is a difficult and time-consuming task. Manual segmentation is also affected by inter- and intrauser variability, thus limiting standardization. Fully automatic or semi-automatic methods that minimize the user interaction are highly desirable. Unfortunately, an ultimate, highly reliable and extensively evaluated solution for joint and musculoskeletal tissue segmentation has not yet been proposed, and many clinical studies still adopt fully manual procedures. Moreover, the clinical translation of several promising quantitative MRI techniques is highly affected by the lack of an established, fast, and accurate segmentation method. The goal of this review is to present some of the techniques proposed in recent literature that have been adopted in clinical studies for joint and musculoskeletal tissue analyses in arthritis patients. The most widely used MRI sequences and image processing algorithms employed to accomplish segmentation challenges will be discussed in this paper.

  7. Tissue transplantation. The PA's role in donation and recovery.

    PubMed

    Kraft, J

    1992-02-01

    The use of musculoskeletal and soft-tissue allografts for reconstructive procedures has become routine. The demand has doubled over the past several years, and will surely continue to rise. However, the availability of allografts has not kept pace with this demand. Physician assistants, by virtue of their position on specialty teams and their commitment to community service, can play a leading role in increasing the availability of allografts through the identification, evaluation, and referral of appropriate donor candidates to local recovery agencies.

  8. Experiences using IAEA Code of practice for radiation sterilization of tissue allografts: Validation and routine control

    NASA Astrophysics Data System (ADS)

    Hilmy, N.; Febrida, A.; Basril, A.

    2007-11-01

    Problems of tissue allografts in using International Standard (ISO) 11137 for validation of radiation sterilization dose (RSD) are limited and low numbers of uniform samples per production batch, those are products obtained from one donor. Allograft is a graft transplanted between two different individuals of the same species. The minimum number of uniform samples needed for verification dose (VD) experiment at the selected sterility assurance level (SAL) per production batch according to the IAEA Code is 20, i.e., 10 for bio-burden determination and the remaining 10 for sterilization test. Three methods of the IAEA Code have been used for validation of RSD, i.e., method A1 that is a modification of method 1 of ISO 11137:1995, method B (ISO 13409:1996), and method C (AAMI TIR 27:2001). This paper describes VD experiments using uniform products obtained from one cadaver donor, i.e., cancellous bones, demineralized bone powders and amnion grafts from one life donor. Results of the verification dose experiments show that RSD is 15.4 kGy for cancellous and demineralized bone grafts and 19.2 kGy for amnion grafts according to method A1 and 25 kGy according to methods B and C.

  9. Resident tissue-specific mesenchymal progenitor cells contribute to fibrogenesis in human lung allografts.

    PubMed

    Walker, Natalie; Badri, Linda; Wettlaufer, Scott; Flint, Andrew; Sajjan, Uma; Krebsbach, Paul H; Keshamouni, Venkateshwar G; Peters-Golden, Marc; Lama, Vibha N

    2011-06-01

    Fibrotic obliteration of the small airways leading to progressive airflow obstruction, termed bronchiolitis obliterans syndrome (BOS), is the major cause of poor outcomes after lung transplantation. We recently demonstrated that a donor-derived population of multipotent mesenchymal stem cells (MSCs) can be isolated from the bronchoalveolar lavage (BAL) fluid of human lung transplant recipients. Herein, we study the organ specificity of these cells and investigate the role of local mesenchymal progenitors in fibrogenesis after lung transplantation. We demonstrate that human lung allograft-derived MSCs uniquely express embryonic lung mesenchyme-associated transcription factors with a 35,000-fold higher expression of forkhead/winged helix transcription factor forkhead box (FOXF1) noted in lung compared with bone marrow MSCs. Fibrotic differentiation of MSCs isolated from normal lung allografts was noted in the presence of profibrotic mediators associated with BOS, including transforming growth factor-β and IL-13. MSCs isolated from patients with BOS demonstrated increased expression of α-SMA and collagen I when compared with non-BOS controls, consistent with a stable in vivo fibrotic phenotype. FOXF1 mRNA expression in the BAL cell pellet correlated with the number of MSCs in the BAL fluid, and myofibroblasts present in the fibrotic lesions expressed FOXF1 by in situ hybridization. These data suggest a key role for local tissue-specific, organ-resident, mesenchymal precursors in the fibrogenic processes in human adult lungs.

  10. Ballistics and gunshot wounds: effects on musculoskeletal tissues.

    PubMed

    Bartlett, C S; Helfet, D L; Hausman, M R; Strauss, E

    2000-01-01

    As a result of the increasing number of weapons in this country, as many as 500,000 missile wounds occur annually, resulting in 50,000 deaths, significant morbidity, and striking socioeconomic costs. Wounds are generally classified as low-velocity (less than 2,000 ft/sec) or high-velocity (more than 2,000 ft/sec). However, these terms can be misleading; more important than velocity is the efficiency of energy transfer, which is dependent on the physical characteristics of the projectile, as well as kinetic energy, stability, entrance profile and path traveled through the body, and the biologic characteristics of the tissues injured. Although bullets are not sterilized on discharge, most low-velocity gunshot wounds can be safely treated nonoperatively with local wound care and outpatient management. Typically, associated fractures are treated according to accepted protocols for each area of injury. Treatment of low-velocity, low-energy fractures is generally dictated by the osseous injuries, as these are similar in many regards to closed fractures. Soft tissues play a more critical role in high-velocity and shotgun fractures, which are essentially open injuries. Aside from perioperative prophylaxis, antibiotics are probably required only for grossly contaminated wounds; however, because contamination is not always apparent, most authors still recommend routine prophylaxis. High-energy injuries and grossly contaminated wounds mandate aggressive irrigation and debridement, including a thorough search for foreign material. Open fracture protocols including external fixation or intramedullary nailing and intravenous antibiotic therapy for 48 to 72 hours should be instituted. If there is vascular damage, exploration and repair are best performed after prompt fracture stabilization. Evaluation of the "four Cs"-color, consistency, contractility, and capacity to bleed-provides valuable information regarding the viability of muscle. Skin grafting is preferable when tension

  11. Monitoring of human liver and kidney allograft tolerance: a tissue/histopathology perspective.

    PubMed

    Demetris, Anthony J; Lunz, John G; Randhawa, Parmjeet; Wu, Tong; Nalesnik, Michael; Thomson, Angus W

    2009-01-01

    Several factors acting together have recently enabled clinicians to seriously consider whether chronic immunosuppression is needed in all solid organ allograft recipients. This has prompted a dozen or so centers throughout the world to prospectively wean immunosuppression from conventionally treated liver allograft recipients. The goal is to lessen the impact of chronic immunosuppression and empirically identify occasional recipients who show operational tolerance, defined as gross phenotype of tolerance in the presence of an immune response and/or immune deficit that has little or no significant clinical impact. Rare operationally tolerant kidney allograft recipients have also been identified, usually by single case reports, but only a couple of prospective weaning trials in conventionally treated kidney allograft recipients have been attempted and reported. Pre- and postweaning allograft biopsy monitoring of recipients adds a critical dimension to these trials, not only for patient safety but also for determining whether events in the allografts can contribute to a mechanistic understanding of allograft acceptance. The following is based on a literature review and personal experience regarding the practical and scientific aspects of biopsy monitoring of potential or actual operationally tolerant human liver and kidney allograft recipients where the goal, intended or attained, was complete withdrawal of immunosuppression.

  12. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    PubMed

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented.

  13. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    PubMed

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

  14. Inflammation reduces physiological tissue tolerance in the development of work-related musculoskeletal disorders.

    PubMed

    Barr, Ann E; Barbe, Mary F

    2004-02-01

    Work-related musculoskeletal disorders (MSDs) cause substantial worker discomfort, disability and loss of productivity. Due to the difficulty in analyzing the tissues of patients in the early stages of work-related MSD, there is controversy concerning the pathomechanisms of the development of these disorders. The pathophysiology of work-related MSD can be studied more easily in animal models. The purpose of this review is to relate theories of the development of tissue injury due to repeated motion to findings of recent investigations in animals that address the role of the inflammatory response in propagating tissue injury and contributing to chronic or recurring tissue injury. These tissue effects are related to behavioral indicators of discomfort and movement dysfunction with the aim of clarifying key time points for specific intervention approaches. The results from animal models of MSD are discussed in the light of findings in patients, whose tissues are examined at a much later phase of MSD development. Finally, a conceptual model of the potentially negative impact of inflammation on tissue tolerance is proposed along with suggestions for future research directions.

  15. Evaluation Criteria for Musculoskeletal and Craniofacial Tissue Engineering Constructs: A Conference Report

    PubMed Central

    2008-01-01

    Over the past 20 years, tissue engineering (TE) has evolved into a thriving research and commercial development field. However, applying TE strategies to musculoskeletal (MSK) and craniofacial tissues has been particularly challenging since these tissues must also transmit loads during activities of daily living. To address this need, organizers invited a small group of bioengineers, surgeons, biologists, and material scientists from academia, industry, and government to participate in a 2½-day conference to develop general and tissue-specific criteria for evaluating new concepts and tissue-engineered constructs, including threshold values of success. Participants were assigned to four breakout groups representing commonly injured tissues, including tendon and ligament, articular cartilage, meniscus and temporomandibular joint, and bone and intervertebral disc. Working in multidisciplinary teams, participants first carefully defined one or two important unmet clinical needs for each tissue type, including current standards of care and the potential impact of TE solutions. The groups then sought to identify important parameters for evaluating repair outcomes in preclinical studies and to specify minimally acceptable values for these parameters. The importance of in vitro TE studies was then discussed in the context of these preclinical studies. Where data were not currently available from clinical, preclinical, or culture studies, the groups sought to identify important areas of preclinical research needed to speed the development process. This report summarizes the findings of the conference. PMID:19093294

  16. Developing functional musculoskeletal tissues through hypoxia and lysyl oxidase-induced collagen cross-linking

    PubMed Central

    Makris, Eleftherios A.; Responte, Donald J.; Hu, Jerry C.; Athanasiou, Kyriacos A.

    2014-01-01

    The inability to recapitulate native tissue biomechanics, especially tensile properties, hinders progress in regenerative medicine. To address this problem, strategies have focused on enhancing collagen production. However, manipulating collagen cross-links, ubiquitous throughout all tissues and conferring mechanical integrity, has been underinvestigated. A series of studies examined the effects of lysyl oxidase (LOX), the enzyme responsible for the formation of collagen cross-links. Hypoxia-induced endogenous LOX was applied in multiple musculoskeletal tissues (i.e., cartilage, meniscus, tendons, ligaments). Results of these studies showed that both native and engineered tissues are enhanced by invoking a mechanism of hypoxia-induced pyridinoline (PYR) cross-links via intermediaries like LOX. Hypoxia was shown to enhance PYR cross-linking 1.4- to 6.4-fold and, concomitantly, to increase the tensile properties of collagen-rich tissues 1.3- to 2.2-fold. Direct administration of exogenous LOX was applied in native cartilage and neocartilage generated using a scaffold-free, self-assembling process of primary chondrocytes. Exogenous LOX was found to enhance native tissue tensile properties 1.9-fold. LOX concentration- and time-dependent increases in PYR content (∼16-fold compared with controls) and tensile properties (approximately fivefold compared with controls) of neocartilage were also detected, resulting in properties on par with native tissue. Finally, in vivo subcutaneous implantation of LOX-treated neocartilage in nude mice promoted further maturation of the neotissue, enhancing tensile and PYR content approximately threefold and 14-fold, respectively, compared with in vitro controls. Collectively, these results provide the first report, to our knowledge, of endogenous (hypoxia-induced) and exogenous LOX applications for promoting collagen cross-linking and improving the tensile properties of a spectrum of native and engineered tissues both in vitro and in

  17. Developing functional musculoskeletal tissues through hypoxia and lysyl oxidase-induced collagen cross-linking.

    PubMed

    Makris, Eleftherios A; Responte, Donald J; Paschos, Nikolaos K; Hu, Jerry C; Athanasiou, Kyriacos A

    2014-11-11

    The inability to recapitulate native tissue biomechanics, especially tensile properties, hinders progress in regenerative medicine. To address this problem, strategies have focused on enhancing collagen production. However, manipulating collagen cross-links, ubiquitous throughout all tissues and conferring mechanical integrity, has been underinvestigated. A series of studies examined the effects of lysyl oxidase (LOX), the enzyme responsible for the formation of collagen cross-links. Hypoxia-induced endogenous LOX was applied in multiple musculoskeletal tissues (i.e., cartilage, meniscus, tendons, ligaments). Results of these studies showed that both native and engineered tissues are enhanced by invoking a mechanism of hypoxia-induced pyridinoline (PYR) cross-links via intermediaries like LOX. Hypoxia was shown to enhance PYR cross-linking 1.4- to 6.4-fold and, concomitantly, to increase the tensile properties of collagen-rich tissues 1.3- to 2.2-fold. Direct administration of exogenous LOX was applied in native cartilage and neocartilage generated using a scaffold-free, self-assembling process of primary chondrocytes. Exogenous LOX was found to enhance native tissue tensile properties 1.9-fold. LOX concentration- and time-dependent increases in PYR content (∼ 16-fold compared with controls) and tensile properties (approximately fivefold compared with controls) of neocartilage were also detected, resulting in properties on par with native tissue. Finally, in vivo subcutaneous implantation of LOX-treated neocartilage in nude mice promoted further maturation of the neotissue, enhancing tensile and PYR content approximately threefold and 14-fold, respectively, compared with in vitro controls. Collectively, these results provide the first report, to our knowledge, of endogenous (hypoxia-induced) and exogenous LOX applications for promoting collagen cross-linking and improving the tensile properties of a spectrum of native and engineered tissues both in vitro and in

  18. Comparison of Potentials of Stem Cells Isolated from Tendon and Bone Marrow for Musculoskeletal Tissue Engineering

    PubMed Central

    Tan, Qi; Rui, Yun Feng; Wong, Yin Mei

    2012-01-01

    The use of tendon-derived stem cells (TDSCs) as a cell source for musculoskeletal tissue engineering has not been compared with that of bone marrow stromal cells (BMSC). This study compared the mesenchymal stem cell (MSC) and embryonic stem cells (ESC) markers, clonogenicity, proliferative capacity, and multilineage differentiation potential of rat TDSC and BMSC in vitro. The MSC and ESC marker profiles of paired TDSC and BMSC were compared using flow cytometry and quantitative real-time polymerase chain reaction (qRT-PCR), respectively. Their clonogenicity and proliferative capacity were compared using colony-forming and 5-bromo-2′-deoxyuridine assays, respectively. The expression of tenogenic, osteogenic, and chondrogenic markers at basal state were examined using qRT-PCR. Their osteogenic, chondrogenic, and adipogenic differentiation potentials were compared using standard assays. TDSC and BMSC showed similar expression of CD90 and CD73. TDSC expressed higher levels of Oct4 than BMSC. TDSC exhibited higher clonogenicity, proliferated faster, and expressed higher tenomodulin, scleraxis, collagen 1 α 1 (Col1A1), decorin, alkaline phosphatase, Col2A1, and biglycan messenger RNA levels than BMSC. There was higher calcium nodule formation and osteogenic marker expression in TDSC than BMSC upon osteogenic induction. More chondrocyte-like cells and higher glycosaminoglycan deposition and chondrogenic marker expression were observed in TDSC than BMSC upon chondrogenic induction. There were more oil droplets and expression of an adipogenic marker in TDSC than BMSC upon adipogenic induction. TDSC expressed higher Oct4 levels, which was reported to positively regulate mesendodermal lineage differentiation, showed higher clonogenicity and proliferative capacity, and had greater tenogenic, osteogenic, chondrogenic, and adipogenic markers and differentiation potential than BMSC. TDSC might be a better cell source than BMSC for musculoskeletal tissue regeneration. PMID

  19. Comparison of the risk of viral infection between the living and nonliving musculoskeletal tissue donors in Australia.

    PubMed

    Yao, Felix; Seed, Clive; Farrugia, Albert; Morgan, David; Wood, David; Zheng, Ming-Hao

    2008-10-01

    Screening of musculoskeletal tissue donors with nucleic acid testing (NAT) for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been implemented in the United States and other developed nations. However, in contrast to the donor demographics in the United States, the majority of Australian musculoskeletal tissue donations are primarily from living surgical donors. The objective of our study was to determine and compare the risk of viral infection associated with musculoskeletal tissue donation from living and nonliving donors in Australia. We studied serum samples from 12 415 consecutive musculoskeletal tissue donors between 1993 and 2004. This included 10 937 surgical donations, and 1478 donations obtained from postmortem organ donation patients and cadaveric donors. Current mandatory retesting of surgical donors 6 months postdonation reduces the risk of viral infection by approximately 95% by eliminating almost all donors in the window period. The addition of nucleic acid amplification testing for nonliving donors would similarly reduce the window period, and consequently the residual risk by approximately 50% for hepatitis B virus, 55% for HIV, and 90% for HCV. NAT, using appropriately validated assays for nonliving donors, would reduce the residual risk to levels comparable to that in living donors (where the 95% reduction for quarantining pending the 180-day re-test is included). PMID:18537922

  20. Arthroscopic Meniscal Allograft Transplantation With Soft-Tissue Fixation Through Bone Tunnels

    PubMed Central

    Spalding, Tim; Parkinson, Ben; Smith, Nick A.; Verdonk, Peter

    2015-01-01

    Meniscal allograft transplantation improves clinical outcomes for patients with symptomatic meniscus-deficient knees. We describe an established arthroscopic technique for meniscal allograft transplantation without the need for bone fixation of the meniscal horns. After preparation of the meniscal bed, the meniscus is parachuted into the knee through a silicone cannula and the meniscal horns are fixed with sutures through bone tunnels. The body of the meniscus is then fixed with a combination of all-inside and inside-out sutures. This technique is reliable and reproducible and has clinical outcomes comparable with those of bone plug fixation techniques. PMID:26900554

  1. Evidence for tissue-resident mesenchymal stem cells in human adult lung from studies of transplanted allografts.

    PubMed

    Lama, Vibha N; Smith, Lisa; Badri, Linda; Flint, Andrew; Andrei, Adin-Cristian; Murray, Susan; Wang, Zhuo; Liao, Hui; Toews, Galen B; Krebsbach, Paul H; Peters-Golden, Marc; Pinsky, David J; Martinez, Fernando J; Thannickal, Victor J

    2007-04-01

    The origin and turnover of connective tissue cells in adult human organs, including the lung, are not well understood. Here, studies of cells derived from human lung allografts demonstrate the presence of a multipotent mesenchymal cell population, which is locally resident in the human adult lung and has extended life span in vivo. Examination of plastic-adherent cell populations in bronchoalveolar lavage samples obtained from 76 human lung transplant recipients revealed clonal proliferation of fibroblast-like cells in 62% (106 of 172) of samples. Immunophenotyping of these isolated cells demonstrated expression of vimentin and prolyl-4-hydroxylase, indicating a mesenchymal phenotype. Multiparametric flow cytometric analyses revealed expression of cell-surface proteins, CD73, CD90, and CD105, commonly found on mesenchymal stem cells (MSCs). Hematopoietic lineage markers CD14, CD34, and CD45 were absent. Multipotency of these cells was demonstrated by their capacity to differentiate into adipocytes, chondrocytes, and osteocytes. Cytogenetic analysis of cells from 7 sex-mismatched lung transplant recipients harvested up to 11 years after transplant revealed that 97.2% +/- 2.1% expressed the sex genotype of the donor. The presence of MSCs of donor sex identity in lung allografts even years after transplantation provides what we believe to be the first evidence for connective tissue cell progenitors that reside locally within a postnatal, nonhematopoietic organ.

  2. Use of Cis-[18F]Fluoro-Proline for Assessment of Exercise-Related Collagen Synthesis in Musculoskeletal Connective Tissue

    PubMed Central

    Skovgaard, Dorthe; Kjaer, Andreas; Heinemeier, Katja Maria; Brandt-Larsen, Malene; Madsen, Jacob; Kjaer, Michael

    2011-01-01

    Protein turnover in collagen rich tissue is influenced by exercise, but can only with difficulty be studied in vivo due to use of invasive procedure. The present study was done to investigate the possibility of applying the PET-tracer, cis-[18F]fluoro-proline (cis-Fpro), for non-invasive assessment of collagen synthesis in rat musculoskeletal tissues at rest and following short-term (3 days) treadmill running. Musculoskeletal collagen synthesis was studied in rats at rest and 24 h post-exercise. At each session, rats were PET scanned at two time points following injection of cis-FPro: (60 and 240 min p.i). SUV were calculated for Achilles tendon, calf muscle and tibial bone. The PET-derived results were compared to mRNA expression of collagen type I and III. Tibial bone had the highest SUV that increased significantly (p<0.001) from the early (60 min) to the late (240 min) PET scan, while SUV in tendon and muscle decreased (p<0.001). Exercise had no influence on SUV, which was contradicted by an increased gene expression of collagen type I and III in muscle and tendon. The clearly, visible uptake of cis-Fpro in the collagen-rich musculoskeletal tissues is promising for multi-tissue studies in vivo. The tissue-specific differences with the highest basal uptake in bone are in accordance with earlier studies relying on tissue incorporation of isotopic-labelled proline. A possible explanation of the failure to demonstrate enhanced collagen synthesis following exercise, despite augmented collagen type I and III transcription, is that SUV calculations are not sensitive enough to detect minor changes in collagen synthesis. Further studies including kinetic compartment modeling must be performed to establish whether cis-Fpro can be used for non-invasive in-vivo assessment of exercise-induced changes in musculoskeletal collagen synthesis. PMID:21347251

  3. Skin donors and human skin allografts: evaluation of an 11-year practice and discard in a referral tissue bank.

    PubMed

    Gaucher, Sonia; Khaznadar, Zena; Gourevitch, Jean-Claude; Jarraya, Mohamed

    2016-03-01

    The Saint Louis hospital tissue bank provides skin allografts to pediatric and adult burn units in the Paris area. The aim of this study was to analyze our activity during the last 11 years focusing on the reasons for skin discard. Skin is procured solely from the back of the body, which is divided into 10 zones that are harvested and processed separately. This retrospective study included all skin donors harvested between June 2002 and June 2013, representing a total of 336 donors and 2770 zones. The donors were multiorgan heart-beating donors in 91 % of cases (n = 307). The main reason for discarding harvested skin was microbial contamination, detected in 99 donors (29 %). Most contaminants were of low pathogenicity. Other reasons for discard included positive serologic tests for 2 donors [17 zones (0.61 %)], unsuitable physical skin characteristics for 3 zones (0.11 %), the donor's medical history for 53 zones (1.91 %), and technical issues with processing or distribution for 61 zones (2.2 %). In our experience, microbial contamination continues to be the main reason for discarding potential skin allografts. However, discards are limited by separate harvesting and processing of multiple zones in each donor. PMID:26275343

  4. State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue tumors.

    PubMed

    Widmann, Gerlig; Riedl, Andreas; Schoepf, Daniel; Glodny, Bernhard; Peer, Siegfried; Gruber, Hannes

    2009-07-01

    High resolution ultrasound (HR-US) including color Doppler ultrasound (CD-US), power Doppler ultrasound (PD-US), and spectral wave analysis (SWA), is a broadly available, non-invasive and relatively low-cost modality without ionizing radiation. It is increasingly used for initial assessment of an ambiguous musculoskeletal soft-tissue lesion and for sonographically guided core biopsy. The aim of this review is to provide sonographic findings of the most frequent benign and malign soft-tissue lesions. By this essay, we can show that combined with clinical features, with information on tumor-localization and patient age, many musculoskeletal lesions may be successfully characterized by HR-US. In contrast, a mere morphologic assignment of some fibrous tumors and malignant lesions remains often impossible; however, certain CD-US signs such as anarchic vascular architecture or arteriovenous shunting may be very helpful indicators for malignancy. HR-US offers a simple, quick, and reliable first-line examination of musculoskeletal soft-tissue lesions and may have an important role in the diagnostic work-up followed by magnetic resonance or multimodality imaging and guided core biopsy.

  5. A miniature tension sensor to measure surgical suture tension of deformable musculoskeletal tissues during joint motion.

    PubMed

    Kiriyama, Yoshimori; Matsumoto, Hideo; Toyama, Yoshiaki; Nagura, Takeo

    2014-02-01

    The aim of this study was to develop a new suture tension sensor for musculoskeletal soft tissue that shows deformation or movements. The suture tension sensor was 10 mm in size, which was small enough to avoid conflicting with the adjacent sensor. Furthermore, the sensor had good linearity up to a tension of 50 N, which is equivalent to the breaking strength of a size 1 absorbable suture defined by the United States Pharmacopeia. The design and mechanism were analyzed using a finite element model prior to developing the actual sensor. Based on the analysis, adequate material was selected, and the output linearity was confirmed and compared with the simulated result. To evaluate practical application, the incision of the skin and capsule were sutured during simulated total knee arthroplasty. When conventional surgery and minimally invasive surgery were performed, suture tensions were compared. In minimally invasive surgery, the distal portion of the knee was dissected, and the proximal portion of the knee was dissected additionally in conventional surgery. In the skin suturing, the maximum tension was 4.4 N, and this tension was independent of the sensor location. In contrast, the sensor suturing the capsule in the distal portion had a tension of 4.4 N in minimally invasive surgery, while the proximal sensor had a tension of 44 N in conventional surgery. The suture tensions increased nonlinearly and were dependent on the knee flexion angle. Furthermore, the tension changes showed hysteresis. This miniature tension sensor may help establish the optimal suturing method with adequate tension to ensure wound healing and early recovery.

  6. Novel bio-synthetic hybrid materials and coculture systems for musculoskeletal tissue engineering

    NASA Astrophysics Data System (ADS)

    Lee, Hyeseung Janice

    Tissue Engineering is a truly exciting field of this age, trying to regenerate and repair impaired tissues. Unlike the old artificial implants, tissue engineering aims at making a long-term functional biological replacement. One strategy for such tissue engineering requires the following three components: cells, scaffolds, and soluble factors. Cells are cultured in a three-dimensional (3D) scaffold with medium containing various soluble factors. Once a tissue is developed in vitro, then it is implanted in vivo. The overall goal of this thesis was to develop novel bio-synthetic hybrid scaffolds and coculture system for musculoskeletal tissue engineering. The most abundant cartilage extracellular matrix (ECM) components are collagen and glycosaminoglycan (GAG), which are the natural scaffold for chondrocytes. As two different peptides, collagen mimetic peptide (CMP) and hyaluronic acid binding peptide (HABPep) were previously shown to bind to collagen and hyaluronic acid (HA) of GAG, respectively, it was hypothesized that immobilizing CMP and HABP on 3D scaffold would results in an interaction between ECM components and synthetic scaffolds via peptide-ECM bindings. CMP or HABPep-conjugated photopolymerizable poly(ethylene oxide) diacrylate (PEODA) hydrogels were synthesized and shown to retain encapsulated collagen or HA, respectively. This result supported that conjugated CMP and HABPep can interact with collagen and HA, respectively, and can serve as biological linkers in 3D synthetic hydrogels. When chondrocytes or mesenchymal stem cells (MSCs) were seeded, cells in CMP-conjugated scaffolds produced significantly more amount of type II collagen and GAG, compared to those in control scaffolds. Moreover, MSCs cultured in CMP-conjugated scaffolds exhibited lower level of hypertrophic markers, cbfa-1 and type X collagen. These results demonstrated that enhanced interaction between collagen and scaffold via CMP improves chondrogenesis of chondrocytes and MSCs and

  7. Rat Cytomegalovirus Gene Expression in Cardiac Allograft Recipients Is Tissue Specific and Does Not Parallel the Profiles Detected In Vitro▿

    PubMed Central

    Streblow, Daniel N.; van Cleef, Koen W. R.; Kreklywich, Craig N.; Meyer, Christine; Smith, Patricia; Defilippis, Victor; Grey, Finn; Früh, Klaus; Searles, Robert; Bruggeman, Cathrien; Vink, Cornelis; Nelson, Jay A.; Orloff, Susan L.

    2007-01-01

    Rat cytomegalovirus (RCMV) is a β-herpesvirus with a 230-kbp genome containing over 167 open reading frames (ORFs). RCMV gene expression is tightly regulated in cultured cells, occurring in three distinct kinetic classes (immediate early, early, and late). However, the extent of viral-gene expression in vivo and its relationship to the in vitro expression are unknown. In this study, we used RCMV-specific DNA microarrays to investigate the viral transcriptional profiles in cultured, RCMV-infected endothelial cells, fibroblasts, and aortic smooth muscle cells and to compare these profiles to those found in tissues from RCMV-infected rat heart transplant recipients. In cultured cells, RCMV expresses approximately 95% of the known viral ORFs with few differences between cell types. By contrast, in vivo viral-gene expression in tissues from rat heart allograft recipients is highly restricted. In the tissues studied, a total of 80 viral genes expressing levels twice above background (5,000 to 10,000 copies per μg total RNA) were detected. In each tissue type, there were a number of genes expressed exclusively in that tissue. Although viral mRNA and genomic DNA levels were lower in the spleen than in submandibular glands, the number of individual viral genes expressed was higher in the spleen (60 versus 41). This finding suggests that the number of viral genes expressed is specific to a given tissue and is not dependent upon the viral load or viral mRNA levels. Our results demonstrate that the profiles, as well as the amplitude, of viral-gene expression are tissue specific and are dramatically different from those in infected cultured cells, indicating that RCMV gene expression in vitro does not reflect viral-gene expression in vivo. PMID:17251289

  8. Allograft inflammatory factor-1 in disk abalone (Haliotis discus discus): molecular cloning, transcriptional regulation against immune challenge and tissue injury.

    PubMed

    De Zoysa, Mahanama; Nikapitiya, Chamilani; Kim, Yucheol; Oh, Chulhong; Kang, Do-Hyung; Whang, Ilson; Kim, Se-Jae; Lee, Jae-Seong; Choi, Cheol Young; Lee, Jehee

    2010-08-01

    Here, we report the identification and characterization of allograft inflammatory factor-1 (AIF-1) from disk abalone Haliotis discus discus that was denoted as AbAIF-1. The full-length cDNA of AbAIF-1 consists of a coding region (453 bp) for 151 amino acids with a 17 kDa molecular mass. Analysis of AbAIF-1 sequence showed that it shares characteristic two EF hand Ca(+2)-binding motifs. Results from phylogenetic analysis further confirm that AbAIF-1 is a member of the AIF-1 family similar to invertebrate and vertebrate counterparts suggesting it has high evolutional conservation. Tissue-specific expression and transcriptional regulation of AbAIF-1 were analyzed after bacteria (Vibrio alginolyticus, Vibrio parahemolyticus and Lysteria monocytogenes), viral hemorrhagic septicemia virus (VHSV) immune challenge and during tissue injury by quantitative real-time PCR. It is shown that the expression of AbAIF-1 mRNA was expressed ubiquitously in all selected tissues in constitutive manner showing the highest level in hemocytes. Upon bacteria and VHSV challenge, AbAIF-1 showed the significant up-regulation in hemocytes than gills. After the tissue injury in shell and mantle, AbAIF-1 and antioxidant selenium-dependant glutathione peroxidase (SeGPx) transcripts were significantly upregulated in abalone hemocytes. Taken together, these findings suggest that AIF-1 could response against the pathogenic challenge or tissue injury in abalone like mollusks. Also, AbAIF-1 may involve in wound healing and shell repair after the tissue injury of abalone.

  9. Invasive Streptococcus pyogenes after allograft implantation--Colorado, 2003.

    PubMed

    2003-12-01

    Allograft tissues are used for various orthopedic procedures (e.g., ligament reconstruction, meniscal transplantation, and spinal surgery). In 2002, approximately one million allografts were distributed for transplantation (American Association of Tissue Banks [AATB], unpublished data, 2002). Recent reports of allograft-associated infections have prompted evaluation of the processing and quality-control methods employed by tissue processors. This report describes a case of invasive disease with Streptococcus pyogenes (i.e., group A streptococcus [GAS]), after reconstructive knee surgery using contaminated allograft tissue and provides recommendations to reduce the risk for allograft-associated infections. Although allograft infections are rare, they highlight the need for improved tissue evaluation and processing standards.

  10. Both rejection and tolerance of allografts can occur in the absence of secondary lymphoid tissues.

    PubMed

    Kant, Cavit D; Akiyama, Yoshinobu; Tanaka, Katsunori; Shea, Susan; Yamada, Yohei; Connolly, Sarah E; Marino, Jose; Tocco, Georges; Benichou, Gilles

    2015-02-01

    In this study, we showed that aly/aly mice, which are devoid of lymph nodes and Peyer's patches, acutely rejected fully allogeneic skin and heart grafts. They mounted potent inflammatory direct alloresponses but failed to develop indirect alloreactivity after transplantation. Remarkably, skin allografts also were rejected acutely by splenectomized aly/aly (aly/aly-spl(-)) mice devoid of all secondary lymphoid organs. In these recipients, the rejection was mediated by alloreactive CD8(+) T cells presumably primed in the bone marrow. In contrast, cardiac transplants were not rejected by aly/aly-spl(-) mice. Actually, aly/aly-spl(-) mice that spontaneously accepted a heart allotransplant and displayed donor-specific tolerance also accepted skin grafts from the same, but not a third-party, donor via a mechanism involving CD4(+) regulatory T cells producing IL-10 cytokine. Therefore, direct priming of alloreactive T cells, as well as rejection and regulatory tolerance of allogeneic transplants, can occur in recipient mice lacking secondary lymphoid organs.

  11. Computed tomography of the musculoskeletal system

    SciTech Connect

    Scott, W.W. Magid, D. Fishman, E.K. )

    1987-01-01

    This book contain 10 chapters. The chapter titles are: Soft Tissue Masses; Primary Bone Tumors; The Role of CT in the Therapeutic Management of Soft Tissue Sarcomas; Assessment of Musculoskeletal Inflammation; Assessment of Musculoskeletal Trauma; The Foot and Ankle; The Shoulder; Measurement of Bone Mineral for Early Detection of Osteoporosis; MRI of the Musculoskeletal System; and Advances in CT Imaging of Musculoskeletal Pathology.

  12. The amelioration of composite tissue allograft rejection by TIM-3-modified dendritic cell: Regulation of the balance of regulatory and effector T cells.

    PubMed

    Wang, Yaojun; Zheng, Zhao; Zhu, Xiongxiang; Han, Juntao; Dong, Maolong; Tao, Ke; Wang, Hongtao; Wang, Yunchuan; Hu, Dahai

    2016-01-01

    T cell-dependent immune responses play a central role in allograft rejection. Exploring ways to disarm alloreactive T cells represents a potential strategy to promote long-term allograft acceptance and survival. T cell Ig domain and mucin domain 3 (TIM-3) has previously been demonstrated as a central regulator of T helper 1 (Th1) responses and immune tolerance. Hence, TIM-3 may be an important molecule for decreasing immunological rejection during composite tissue allotransplantation (CTA). In this study, BALB/c and C57BL/6 mice were chosen as the experimental animals. The effects of TIM-3 on allograft rejection were explored using TIM-3-modified mature dendritic cells (TIM-3 mDCs). A laser speckle blood flow (LSBF) imager was used to evaluate blood distribution of the BALB/c mice. ELISA, MTT, ELISPOT assays and flow cytometry analysis were carried out for further researches. We found that TIM-3 could obviously prolong the survival time of the transplanted limbs. And TIM-3 could mitigate the immune response and thus enhance immune tolerance after CTA. Also, TIM-3 can induce lymphocyte hyporesponsiveness, including facilitating lymphocyte apoptosis, decreasing lymphocyte proliferation, and influencing the secretion of inflammatory cytokines by CD4(+) T cells. Furthermore, TIM-3 overexpression could induce CD4(+) T cells to differentiate into regulatory T cells (Tregs), which recalibrate the effector and regulatory arms of the alloimmune response. In summary, we concluded that TIM-3 can mitigate allograft rejection and thus enhance immune tolerance by inducing lymphocyte hyporesponsiveness and increasing the number of Tregs of the alloimmune response. TIM-3 may be a potential therapeutic molecule for allograft rejection in CTA.

  13. Musculoskeletal and adipose tissue hydatidosis based on the iatrogenic spreading of cystic fluid during surgery: report of a case.

    PubMed

    Iuliano, L; Gurgo, A; Polettini, E; Gualdi, G; De Marzio, P

    2000-01-01

    Hydatidosis or echinococcosis is a parasitic disease caused by Echinococcus granulosus or E. multilocularis, which forms cysts in the liver and lung after penetrating the duodenal mucosa and entering the portal circulation. The liver and lung act as a filter but some embryos enter the general circulation and disseminate throughout the body. Musculoskeletal involvement is a rare manifestation of hydatidosis, which is usually reported to affect a single muscle. We report here a rare case of a 68-year-old man with widespread hydatidosis of the retroperitoneum and the subcutaneous adipose tissue, and with multiple muscle involvement in the absence of liver, lung, and spleen involvement. The patient underwent surgical excision of a subcutaneous hydatid cyst 7 years earlier. It is likely that the large dissemination of parasites resulted from accidental rupture of the primary focus during surgery with consequent release and spreading of scolices via lymphatics.

  14. The synthesis and activity of lipoprotein lipase in the subcutaneous adipose tissue of patients with musculoskeletal sarcomas.

    PubMed

    Sakayama, Kenshi; Kidani, Teruki; Tanji, Nozomu; Yamamoto, Haruyasu; Masuno, Hiroshi

    2008-01-01

    The purpose of this study was to explore the triacylglycerol (TG) deposition and lipoprotein lipase (LPL) activity in the adipose tissue of patients with muculoskeletal sarcoma. Subcutaneous adipose tissue was obtained from the thighs of 19 patients with musculoskeletal sarcomas (sarcoma group) and 20 patients with osteoarthritis of the hip joint (control group) at surgery. The adipose tissue was homogenized and aliquots of the homogenate were used to measure the TG content and to prepare an acetone/ether powder to measure the LPL activity. The TG content was higher, but not significantly, in the sarcoma group than in the control group. The LPL activity of the sarcoma group was significantly higher than that of the control group. The TG content of the sarcoma group correlated positively with the LPL activity. [35S]Methionine incorporation investigation showed that the rate of LPL synthesis was significantly higher in the sarcoma group than in the control group. These results indicated that LPL was up-regulated at the transcriptional/translational level, thus resulting in an increased TG deposition in the adipose tissue of patients with muculoskeletal sarcoma.

  15. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used.

  16. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used. PMID:12735200

  17. Multiplexed color-coded probe-based gene expression assessment for clinical molecular diagnostics in formalin-fixed paraffin-embedded human renal allograft tissue.

    PubMed

    Adam, Benjamin; Afzali, Bahman; Dominy, Katherine M; Chapman, Erin; Gill, Reeda; Hidalgo, Luis G; Roufosse, Candice; Sis, Banu; Mengel, Michael

    2016-03-01

    Histopathologic diagnoses in transplantation can be improved with molecular testing. Preferably, molecular diagnostics should fit into standard-of-care workflows for transplant biopsies, that is, formalin-fixed paraffin-embedded (FFPE) processing. The NanoString(®) gene expression platform has recently been shown to work with FFPE samples. We aimed to evaluate its methodological robustness and feasibility for gene expression studies in human FFPE renal allograft samples. A literature-derived antibody-mediated rejection (ABMR) 34-gene set, comprised of endothelial, NK cell, and inflammation transcripts, was analyzed in different retrospective biopsy cohorts and showed potential to molecularly discriminate ABMR cases, including FFPE samples. NanoString(®) results were reproducible across a range of RNA input quantities (r = 0.998), with different operators (r = 0.998), and between different reagent lots (r = 0.983). There was moderate correlation between NanoString(®) with FFPE tissue and quantitative reverse transcription polymerase chain reaction (qRT-PCR) with corresponding dedicated fresh-stabilized tissue (r = 0.487). Better overall correlation with histology was observed with NanoString(®) (r = 0.354) than with qRT-PCR (r = 0.146). Our results demonstrate the feasibility of multiplexed gene expression quantification from FFPE renal allograft tissue. This represents a method for prospective and retrospective validation of molecular diagnostics and its adoption in clinical transplantation pathology.

  18. Adipose tissue derived mesenchymal stem cells for musculoskeletal repair in veterinary medicine

    PubMed Central

    Arnhold, Stefan; Wenisch, Sabine

    2015-01-01

    Adipose tissue derived stem cells (ASCs) are mesenchymal stem cells which can be obtained from different adipose tissue sources within the body. It is an abundant cell pool, which is easy accessible and the cells can be obtained in large numbers, cultivated and expanded in vitro and prepared for tissue engineering approaches, especially for skeletal tissue repair. In the recent years this cell population has attracted a great amount of attention among researchers in human as well as in veterinary medicine. In the meantime ASCs have been well characterized and their use in regenerative medicine is very well established. This review focuses on the characterization of ASCs for their use for tissue engineering approaches especially in veterinary medicine and also highlights a selection of clinical trials on the basis of ASCs as the relevant cell source. PMID:25973326

  19. Legal changes necessitate proactive management of Musculoskeletal Disorders: the role of electrodiagnostic functional assessment Soft Tissue Management program.

    PubMed

    Cusimano-Reaston, MaryRose; Carney, Brendan

    2011-01-01

    Musculoskeletal Disorders (MSD) often classified as sprains and strains to the low back, neck, shoulder or knee are the leading cost drivers in the workers compensation system. In 2009, soft tissue muscle injuries accounted for 40% of total injury cases requiring days away from work. The demand on U.S. employers to comply with all applicable mandates has exponentially increased as the regulatory landscape grows more complex evidenced by recent legislation from Equal Employment Opportunity Commission (EEOC), American With Disability Act 2.0 and Center for Medicare and Medicaid Services (CMS) Mandatory Reporting Act. Employers should revisit their return to work policies and engage in the interactive process to stay in compliance and avoid legal quagmire. EFA Soft Tissue Management (STM) is a comprehensive and compliant risk management program for objective diagnosis of work-related injuries that directs timely and proper allocation of resources to optimize injured worker (IW) outcomes. This bookend solution comparing pre- and post-loss data is a best practice to accurately determine between compensable acute workplace injury and exacerbation of a preexisting injury from chronic unrelated conditions. The EFA is an evidenced-based objective tool to assist in measuring functional status of the IW and make return to work determinations.

  20. Exposed and transcutaneous measurement of musculoskeletal tissues using fiber optic coupled Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Esmonde-White, Francis W. L.; Esmonde-White, Karen A.; Morris, Michael D.

    2010-02-01

    Raman spectroscopic measurement of bone composition has shown promise as a medical diagnostic by measuring the molecular composition of the bone mineral and matrix. We previously demonstrated proof-of-principle transcutaneous Raman spectroscopy bone measurements in human cadavers. In this paper, we discuss further optimization of the instrumental configuration for efficient collection of bone signal using contact fiber-optic probe designs. To optimize collection of Raman signal through overlaying soft tissue, novel geometrically-accurate tissue phantoms were prepared. MRI and CT images of the human cadaveric specimens were used to create solid tissue phantoms with accurate geometric dimensions. In these tissue phantoms, optical properties can be varied systematically. Raman spectra of the prepared tissue phantoms were used to optimize the positions of the fibers in the fiber optic system, and the laser illumination sequence in the measurements. Three fiber optic probes were developed and tested with both novel tissue phantoms and human cadaveric specimens. The contact fiber optic probes were developed for arthroscopic measurements of joints, for transcutaneous measurements of bone in situ, and for contact measurements of exposed bone. By coupling the fiber optic probe to an imaging spectrograph, spectra were collected simultaneously at many positions on the tissue. Furthermore, spectra were collected with several different excitation laser patterns to enhance the effective spatial resolution of the measurements. Finally, a series of improvements were made in the data preprocessing to improve the recovered spectral signal. Together, these modifications improve signal-to-noise and spatial resolution.

  1. Prevalence of microbiological markers in bone tissue from live and cadaver donors in the musculoskeletal tissue bank of Passo Fundo☆☆☆

    PubMed Central

    Dutra Roos, Bruno; Valdomiro Roos, Milton; Camisa Júnior, Antero; Moreno Ungaretti Lima, Ezequiel; Noshang Pereira, Rafael; Luciano Zangirolami, Maurício; Machado de Albuquerque, Gisela

    2014-01-01

    Objective To conduct an epidemiological analysis on the main microbiological markers in bone tissue that was processed at the musculoskeletal tissue bank of Hospital São Vicente de Paulo, in Passo Fundo, between August 2007 and October 2011. Methods Between August 2007 and October 2011, 202 musculoskeletal tissue samples were collected for the tissue bank. Among these, 159 samples were from living donor patients and 43 were from cadaver donors. The following serological tests were requested: hepatitis B, hepatitis C, syphilis, cytomegalovirus, Chagas disease, toxoplasmosis, HIV and HTLV. Results Among the 159 living donors, 103 (64.75%) were men and 56 (35.25%) were women. The patients’ mean age was 59.35 ± 8.87 years. Out of this total, 76 tissue samples (47.8%) from donors were rejected. There was no difference in the number of rejections in relation to sex (p = 0.135) or age (p = 0.523). The main cause of rejection was serologically positive findings for the hepatitis B virus, which was responsible for 48 rejections (63.15%). Among the 43 cadaver donors, the mean age was 37.84 ± 10.32 years. Of these, 27 (62.8%) were men and 16 (37.2%) were women. Six of the samples collected from cadaver donors were rejected (13.9%), and the main cause of rejection was serologically positive findings for the hepatitis C virus, which was responsible for three cases (50%). There was no significant difference in the number of rejections in relation to sex (p = 0.21) or age (p = 0.252). Conclusion There were a greater number of rejections of tissues from living donors (47.8%) than from cadaver donors (13.9%). Among the living donors, the main cause of rejection was the presence of serologically positive findings of the hepatitis B virus, while among the cadaver donors, it was due to the hepatitis C virus. PMID:26229832

  2. Engineering cellular fibers for musculoskeletal soft tissues using directed self-assembly.

    PubMed

    Schiele, Nathan R; Koppes, Ryan A; Chrisey, Douglas B; Corr, David T

    2013-05-01

    Engineering strategies guided by developmental biology may enhance and accelerate in vitro tissue formation for tissue engineering and regenerative medicine applications. In this study, we looked toward embryonic tendon development as a model system to guide our soft tissue engineering approach. To direct cellular self-assembly, we utilized laser micromachined, differentially adherent growth channels lined with fibronectin. The micromachined growth channels directed human dermal fibroblast cells to form single cellular fibers, without the need for a provisional three-dimensional extracellular matrix or scaffold to establish a fiber structure. Therefore, the resulting tissue structure and mechanical characteristics were determined solely by the cells. Due to the self-assembly nature of this approach, the growing fibers exhibit some key aspects of embryonic tendon development, such as high cellularity, the rapid formation (within 24 h) of a highly organized and aligned cellular structure, and the expression of cadherin-11 (indicating direct cell-to-cell adhesions). To provide a dynamic mechanical environment, we have also developed and characterized a method to apply precise cyclic tensile strain to the cellular fibers as they develop. After an initial period of cellular fiber formation (24 h postseeding), cyclic strain was applied for 48 h, in 8-h intervals, with tensile strain increasing from 0.7% to 1.0%, and at a frequency of 0.5 Hz. Dynamic loading dramatically increased cellular fiber mechanical properties with a nearly twofold increase in both the linear region stiffness and maximum load at failure, thereby demonstrating a mechanism for enhancing cellular fiber formation and mechanical properties. Tissue engineering strategies, designed to capture key aspects of embryonic development, may provide unique insight into accelerated maturation of engineered replacement tissue, and offer significant advances for regenerative medicine applications in tendon

  3. The physical response of soft musculoskeletal tissues to short-pulsed laser irradiation

    NASA Astrophysics Data System (ADS)

    Dark, Marta Lyselle

    An experimental study was performed to determine the physical properties of knee meniscus using a low energy laser technique. Following irradiation by a 10 ns laser pulse, tissue undergoes thermoelastic expansion in response to laser-induced stresses. The stresses evolve, propagating through the tissue. If they exceed the material's strength, ablation occurs-the material ruptures. Below ablation threshold, the material remains in an expanded state until thermal relaxation occurs. We use numerical methods to solve the 3-D thermoelastic wave equation for a hydrated sample. In addition to thermoelastic expansion, expansion due to the formation of cavitation bubbles within the tissue was modeled. Cavitation occurs when tensile stresses rupture fluid. The laser-induced response of a gelatin phantom was measured with a Michelson interferometer and compared with predictions. Using gelatin as a tissue model provided a consistent experimental model of meniscus. Meniscus, like all biological tissue, is highly heterogeneous. By adapting the time dependent numerical solution of the wave equation, the measurement of physical properties of a hydrated sample became possible. The thermoelastic model depends on sound speed, Poisson's ratio, thermal expansion coefficient, and optical penetration depth. Once the behavior of gelatin was understood, human knee meniscus was studied. The thermoelastic model and experiment, allows measurement of physical properties of meniscus. Also, a numerical model of cavitation based on Rayleigh's equations was developed. By comparing experiment and theory in menicus and water, we determined properties important to cavitation: threshold pressure, bubble density, surface tension and nucleation size. Finally, histology was compared with experiment. The presence and amount of cavitation displacement was correlated with the condition of meniscus. Physical properties can be used to diagnose degenerative cartilage. This research has increased understanding

  4. Future of allografts in sports medicine.

    PubMed

    Harner, Christopher D; Lo, Marvin Y

    2009-04-01

    Allografts play a prominent role in sports medicine, and their usage has increased dramatically over the past few decades, but the role of allograft in the future of sports medicine largely depends on several factors: (1) the ability of the tissue banking industry to convince both surgeons and the general population that tissue procurement is safe and nearly disease-free, (2) the ability to sterilize tissue with minimal compromise to tissue integrity, (3) successful clinical outcomes with allograft, and (4) the advent of artificial scaffolds and ligaments that function as well. PMID:19306738

  5. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction.

  6. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction. PMID:17920955

  7. Musculoskeletal Injection

    PubMed Central

    Wittich, Christopher M.; Ficalora, Robert D.; Mason, Thomas G.; Beckman, Thomas J.

    2009-01-01

    Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints. This article reviews the clinical presentations of these problems. It also discusses musculoskeletal injections for these problems in terms of medications, indications, injection technique, and supporting evidence from the literature. Experience with joint injection and the pharmacological principles described in this article should allow primary care physicians to become comfortable and proficient with musculoskeletal injections. PMID:19720781

  8. Musculoskeletal discipline science plan

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Life sciences research in the musculoskeletal discipline must identify possible consequences of weightlessness on this system, understand the mechanisms of these effects, and develop effective and operationally practical countermeasures to protect crewmembers. The musculoskeletal system is highly plastic in that is possesses the inherent capability to adapt its structural and functional properties in accordance with the type and degree of stimuli imposed on it. Prolonged space travel is essentially a period of significant unloading of the musculoskeletal system. This results in adaptive responses in the structure and function of this system, placing it on the low end of a continuum from one of complete disuse to one of maximal use. There is a high probability that the musculoskeletal system is functionally impaired with increasing duration of weightlessness. The purpose of this Discipline Science Plan is to provide a conceptual strategy for NASA's Life Sciences division research and development activities in the area of musculoskeletal function. This document summarizes the current status of the program, outlines available knowledge, establishes goals and objectives, identifies science priorities, and defines research opportunities, which encompass critical questions in the subdiscipline areas (e.g., muscle, bone, and other musculoskeletal connective tissues). These science activities include ground-based and flight; basic, applied, and operational; and animal and human research and development. This document contains a general plan that will be used by both NASA Headquarters Program Offices and the field centers to review and plan basic, applied, and operational intramural and extramural research and development activities in this area.

  9. Invasive Streptococcus pyogenes after allograft implantation--Colorado, 2003.

    PubMed

    2003-12-01

    Allograft tissues are used for various orthopedic procedures (e.g., ligament reconstruction, meniscal transplantation, and spinal surgery). In 2002, approximately one million allografts were distributed for transplantation (American Association of Tissue Banks [AATB], unpublished data, 2002). Recent reports of allograft-associated infections have prompted evaluation of the processing and quality-control methods employed by tissue processors. This report describes a case of invasive disease with Streptococcus pyogenes (i.e., group A streptococcus [GAS]), after reconstructive knee surgery using contaminated allograft tissue and provides recommendations to reduce the risk for allograft-associated infections. Although allograft infections are rare, they highlight the need for improved tissue evaluation and processing standards. PMID:14654764

  10. Musculoskeletal Imaging

    PubMed Central

    Connell, Douglas G.

    1986-01-01

    Musculoskeletal problems account for a significant portion of primary care medicine. Increase in the public awareness of physical fitness has led to an increase in both the incidence and appreciation of musculoskeletal disorders. This discussion considers the investigation of disorders involving the shoulder, wrist, foot, knee and pelvis. Emphasis is placed on new imaging techniques and their place in the investigation of these problems, as well as on their relationship to the more traditional modalities. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9 PMID:21267198

  11. Musculoskeletal Pathology.

    PubMed

    Peat, Frances J; Kawcak, Christopher E

    2015-08-01

    The current understanding of pathology as it relates to common diseases of the equine musculoskeletal system is reviewed. Conditions are organized under the fundamental categories of developmental, exercise-induced, infectious, and miscellaneous pathology. The overview of developmental pathology incorporates the new classification system of juvenile osteochondral conditions. Discussion of exercise-induced pathology emphasizes increased understanding of the contribution of cumulative microdamage caused by repetitive cyclic loading. Miscellaneous musculoskeletal pathology focuses on laminitis, which current knowledge indicates should be regarded as a clinical syndrome with a variety of possible distinct mechanisms of structural failure that are outlined in this overview. PMID:26037607

  12. Validation of cold chain shipping environment for transport of allografts as part of a human tissue bank returns policy.

    PubMed

    Rooney, P; Eagle, M J; Kearney, J N

    2015-12-01

    Human tissue is shipped to surgeons in the UK in either a freeze-dried or frozen state. To ensure quality and safety of the tissue, frozen tissue must be shipped in insulated containers such that tissue is maintained at an appropriate temperature. UK Blood Transfusion Service regulations state "Transportation systems must be validated to show maintenance of the required storage temperature" and also state that frozen, non-cryopreserved tissue "must be transported… at -20 °C or lower" (Guidelines for the Blood Transfusion Services in the United Kingdom, 8th Edn. 2013). To maintain an expiry date for frozen tissue longer than 6 months, the tissue must be maintained at a temperature of -40 °C or below. The objective of this study was to evaluate and validate the capability of a commercially available insulated polystyrene carton (XPL10), packed with dry ice, to maintain tissue temperature below -40 °C. Tissue temperature of a single frozen femoral head or a single frozen Achilles tendon, was recorded over a 4-day period at 37 °C, inside a XPL10 carton with dry ice as refrigerant. The data demonstrate that at 37 °C, the XPL10 carton with 9.5 kg of dry ice maintained femoral head and tendon tissue temperature below -55 °C for at least 48 h; tissue temperature did not rise above -40 °C until at least 70 h. Data also indicated that at a storage temperature lower than 37 °C, tissue temperature was maintained for longer periods. PMID:25700692

  13. Efficacy of a Human Amniotic Tissue-derived Allograft, NuCel, in Patients Undergoing Posteriolateral Lumbar Fusions for Degenerative Disc Disease

    ClinicalTrials.gov

    2016-10-13

    Lumbar Degenerative Disc Disease; Spinal Stenosis; Spondylolisthesis; Spondylosis; Intervertebral Disk Displacement; Intervertebral Disk Degeneration; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Spondylolysis

  14. Musculoskeletal MRI.

    PubMed

    Sage, Jaime E; Gavin, Patrick

    2016-05-01

    MRI has the unique ability to detect abnormal fluid content, and is therefore unparalleled in its role of detection, diagnosis, prognosis, treatment planning and follow-up evaluation of musculoskeletal disease. MRI in companion animals should be considered in the following circumstances: a definitive diagnosis cannot be made on radiographs; a patient is nonresponsive to medical or surgical therapy; prognostic information is desired; assessing surgical margins and traumatic and/or infectious joint and bone disease; ruling out subtle developmental or early aggressive bone lesions. The MRI features of common disorders affecting the shoulder, elbow, stifle, carpal, and tarsal joints are included in this chapter.

  15. Experimental validations of in vivo human musculoskeletal tissue conductivity images using MR-based electrical impedance tomography.

    PubMed

    Jeong, Woo Chul; Meng, Zi Jun; Kim, Hyung Joong; Kwon, Oh In; Woo, Eung Je

    2014-07-01

    Magnetic resonance (MR)-based electrical impedance tomography (MREIT) is a widely used imaging technique that provides high-resolution conductivity images at DC or below the 1 kHz frequency range. Using an MR scanner, this technique injects imaging currents into the human body and measures induced internal magnetic flux density data. By applying the recent progress of MREIT techniques, such as chemical shift artifact correction, multi-echo pulse sequence, and improved reconstruction algorithm, we can successfully reconstruct conductivity images of the human body. Meanwhile, numerous studies reported that the electrical conductivity of human tissues could be inferred from in vitro or ex vivo measurements of different species. However, in vivo tissues may differ from in vitro and/or ex vivo state due to the complicated tissue responses in living organs. In this study, we performed in vivo MREIT imaging of a human lower extremity and compared the resulting conductivity images with ex vivo biological tissue phantom images. The human conductivity images showed unique contrast between two different types of bones, muscles, subcutaneous adipose tissues, and conductive body fluids. Except for muscles and adipose tissues, the human conductivity images showed a similar pattern when compared with phantom results due to the anisotropic characteristic of muscle and the high conductive fluids in the adipose tissue.

  16. Small molecule delivery through nanofibrous scaffolds for musculoskeletal regenerative engineering

    PubMed Central

    Carbone, Erica J.; Jiang, Tao; Nelson, Clarke; Henry, Nicole; Lo, Kevin W.-H.

    2014-01-01

    Musculoskeletal regenerative engineering approach using small bioactive molecules in conjunction with advanced materials has emerged as a highly promising strategy for musculoskeletal repair and regeneration. Advanced biomaterials technologies have revealed nanofiber-based scaffolds for musculoskeletal tissue engineering as vehicles for the controlled delivery of small molecule drugs. This review article highlights recent advances in nanofiber-based delivery of small molecules for musculoskeletal regenerative engineering. The article concludes with perspectives on the challenges and future directions. PMID:24907464

  17. Expression of allograft inflammatory factor-1 (AIF-1) in response to bacterial challenge and tissue injury in the pearl oyster, Pinctada martensii.

    PubMed

    Li, Jun; Chen, Jinhui; Zhang, Yang; Yu, Ziniu

    2013-01-01

    Allograft inflammatory factor-1 (AIF-1), an interferon (IFN)-γ-inducible calcium-binding cytokine, is associated with the inflammatory response and defense. We cloned and analyzed the expression pattern of the AIF-1 gene of the pearl oyster Pinctada martensii, hereafter designated PmAIF-1. The full-length PmAIF-1 cDNA is 946 bp in length and consists of a 5'-untranslated region (UTR) of 120 bp, a 3'-UTR of 376 bp, and an open reading frame (ORF) of 450 bp encoding a polypeptide of 149 amino acids with an estimated molecular mass of 17 kDa. Sequence analysis reveals that PmAIF-1 contains two EF hand Ca(+2)-binding motifs like those in previously characterized AIF-1s while alignment with known AIF-1 protein sequences reveals higher similarity to invertebrate orthologs than to those of vertebrates. Quantitative PCR analysis reveals that PmAIF-1 is constitutively expressed, with the highest expression detected in hemocytes, and the expression level of PmAIF-1 mRNA was significantly up-regulated in hemocytes, gill, digestive gland under bacterial challenge and tissue injury. After challenged by gram-negative bacteria Vibrio alginolyticus and Vibrio parahaemolyticus, gram-positive bacteria Bacillus subtilis, the expression level of this gene in hemocytes were all up-regulated and reached the maximum point at 12h (5.80 folds, P<0.01), 6h (5.02 folds, P<0.01) and 12h (5.49 folds, P<0.01), respectively. Under shell damage and mantle injury, PmAIF-1 mRNA increased gradually in the first 3h and reached a peak of expression at 6h post-injury. These findings suggest that PmAIF-1 is an acute-response protein involved in the innate immune responses of pearl oysters, and provide general information about the mechanisms of innate immune defense against bacterial infection in pearl oysters.

  18. Development of mRuby2-Transfected C3H10T1/2 Fibroblasts for Musculoskeletal Tissue Engineering

    PubMed Central

    Yang, Yunzhi Peter

    2015-01-01

    Mouse C3H10T1/2 fibroblasts are multipotent, mesenchymal stem cell (MSC)-like progenitor cells that are widely used in musculoskeletal research. In this study, we have established a clonal population of C3H10T1/2 cells stably-transfected with mRuby2, an orange-red fluorescence reporter gene. Flow cytometry analysis and fluorescence imaging confirmed successful transfection of these cells. Cell counting studies showed that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells proliferated at similar rates. Adipogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for Oil Red O and showed increased expression of adipogenic genes including adiponectin and lipoprotein lipase. Chondrogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for Alcian Blue and showed increased expression of chondrogenic genes including aggrecan. Osteogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for alkaline phosphatase (ALP) as well as Alizarin Red and showed increased expression of osteogenic genes including alp, ocn and osf-1. When seeded on calcium phosphate-based ceramic scaffolds, mRuby2-transfected C3H10T1/2 cells maintained even fluorescence labeling and osteogenic differentiation. In summary, mRuby2-transfected C3H10T1/2 cells exhibit mRuby2 fluorescence and showed little-to-no difference in terms of cell proliferation and differentiation as untransfected C3H10T1/2 cells. These cells will be available from American Type Culture Collection (ATCC; CRL-3268™) and may be a valuable tool for preclinical studies. PMID:26407291

  19. Development of mRuby2-Transfected C3H10T1/2 Fibroblasts for Musculoskeletal Tissue Engineering.

    PubMed

    Ker, Dai Fei Elmer; Sharma, Rashmi; Wang, Evelyna Tsi Hsin; Yang, Yunzhi Peter

    2015-01-01

    Mouse C3H10T1/2 fibroblasts are multipotent, mesenchymal stem cell (MSC)-like progenitor cells that are widely used in musculoskeletal research. In this study, we have established a clonal population of C3H10T1/2 cells stably-transfected with mRuby2, an orange-red fluorescence reporter gene. Flow cytometry analysis and fluorescence imaging confirmed successful transfection of these cells. Cell counting studies showed that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells proliferated at similar rates. Adipogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for Oil Red O and showed increased expression of adipogenic genes including adiponectin and lipoprotein lipase. Chondrogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for Alcian Blue and showed increased expression of chondrogenic genes including aggrecan. Osteogenic differentiation experiments demonstrated that untransfected C3H10T1/2 cells and mRuby2-transfected C3H10T1/2 cells stained positive for alkaline phosphatase (ALP) as well as Alizarin Red and showed increased expression of osteogenic genes including alp, ocn and osf-1. When seeded on calcium phosphate-based ceramic scaffolds, mRuby2-transfected C3H10T1/2 cells maintained even fluorescence labeling and osteogenic differentiation. In summary, mRuby2-transfected C3H10T1/2 cells exhibit mRuby2 fluorescence and showed little-to-no difference in terms of cell proliferation and differentiation as untransfected C3H10T1/2 cells. These cells will be available from American Type Culture Collection (ATCC; CRL-3268™) and may be a valuable tool for preclinical studies. PMID:26407291

  20. Decoding the Regulatory Landscape of Ageing in Musculoskeletal Engineered Tissues Using Genome-Wide DNA Methylation and RNASeq.

    PubMed

    Peffers, Mandy Jayne; Goljanek-Whysall, Katarzyna; Collins, John; Fang, Yongxiang; Rushton, Michael; Loughlin, John; Proctor, Carole; Clegg, Peter David

    2016-01-01

    Mesenchymal stem cells (MSC) are capable of multipotent differentiation into connective tissues and as such are an attractive source for autologous cell-based regenerative medicine and tissue engineering. Epigenetic mechanisms, like DNA methylation, contribute to the changes in gene expression in ageing. However there was a lack of sufficient knowledge of the role that differential methylation plays during chondrogenic, osteogenic and tenogenic differentiation from ageing MSCs. This study undertook genome level determination of the effects of DNA methylation on expression in engineered tissues from chronologically aged MSCs. We compiled unique DNA methylation signatures from chondrogenic, osteogenic, and tenogenic engineered tissues derived from young; n = 4 (21.8 years ± 2.4 SD) and old; n = 4 (65.5 years±8.3SD) human MSCs donors using the Illumina HumanMethylation 450 Beadchip arrays and compared these to gene expression by RNA sequencing. Unique and common signatures of global DNA methylation were identified. There were 201, 67 and 32 chondrogenic, osteogenic and tenogenic age-related DE protein-coding genes respectively. Findings inferred the nature of the transcript networks was predominantly for 'cell death and survival', 'cell morphology', and 'cell growth and proliferation'. Further studies are required to validate if this gene expression effect translates to cell events. Alternative splicing (AS) was dysregulated in ageing with 119, 21 and 9 differential splicing events identified in chondrogenic, osteogenic and tenogenic respectively, and enrichment in genes associated principally with metabolic processes. Gene ontology analysis of differentially methylated loci indicated age-related enrichment for all engineered tissue types in 'skeletal system morphogenesis', 'regulation of cell proliferation' and 'regulation of transcription' suggesting that dynamic epigenetic modifications may occur in genes associated with shared and distinct pathways dependent

  1. Decoding the Regulatory Landscape of Ageing in Musculoskeletal Engineered Tissues Using Genome-Wide DNA Methylation and RNASeq

    PubMed Central

    Peffers, Mandy Jayne; Goljanek-Whysall, Katarzyna; Collins, John; Fang, Yongxiang; Rushton, Michael; Loughlin, John; Proctor, Carole; Clegg, Peter David

    2016-01-01

    Mesenchymal stem cells (MSC) are capable of multipotent differentiation into connective tissues and as such are an attractive source for autologous cell-based regenerative medicine and tissue engineering. Epigenetic mechanisms, like DNA methylation, contribute to the changes in gene expression in ageing. However there was a lack of sufficient knowledge of the role that differential methylation plays during chondrogenic, osteogenic and tenogenic differentiation from ageing MSCs. This study undertook genome level determination of the effects of DNA methylation on expression in engineered tissues from chronologically aged MSCs. We compiled unique DNA methylation signatures from chondrogenic, osteogenic, and tenogenic engineered tissues derived from young; n = 4 (21.8 years ± 2.4 SD) and old; n = 4 (65.5 years±8.3SD) human MSCs donors using the Illumina HumanMethylation 450 Beadchip arrays and compared these to gene expression by RNA sequencing. Unique and common signatures of global DNA methylation were identified. There were 201, 67 and 32 chondrogenic, osteogenic and tenogenic age-related DE protein-coding genes respectively. Findings inferred the nature of the transcript networks was predominantly for ‘cell death and survival’, ‘cell morphology’, and ‘cell growth and proliferation’. Further studies are required to validate if this gene expression effect translates to cell events. Alternative splicing (AS) was dysregulated in ageing with 119, 21 and 9 differential splicing events identified in chondrogenic, osteogenic and tenogenic respectively, and enrichment in genes associated principally with metabolic processes. Gene ontology analysis of differentially methylated loci indicated age-related enrichment for all engineered tissue types in ‘skeletal system morphogenesis’, ‘regulation of cell proliferation’ and ‘regulation of transcription’ suggesting that dynamic epigenetic modifications may occur in genes associated with shared and

  2. Meniscal Allograft Transplantation: State of the Art.

    PubMed

    Trentacosta, Natasha; Graham, William C; Gersoff, Wayne K

    2016-06-01

    Meniscal allograft transplantation has evolved over the years to provide a state-of-the-art technique for the sports medicine surgeon to utilize in preserving contact mechanics and function of the knee in irreparable meniscal pathology. However, this procedure continues to spark considerable debate on proper tissue processing techniques, acceptable indications, methods of implantation, and potential long-term outcomes. PMID:27135295

  3. Musculoskeletal manifestations of endocrine disorders.

    PubMed

    Boswell, Stephanie B; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J; Forrester, Deborah M; Masih, Sulabha; Matcuk, George R

    2014-01-01

    Endocrine disorders can lead to disturbances in numerous systems within the body, including the musculoskeletal system. Radiological evaluation of these conditions can demonstrate typical appearances of the bones and soft tissues. Knowledge of these patterns can allow the radiologist to suggest a diagnosis that may not be clinically apparent. This review will highlight the typical musculoskeletal findings of acromegaly, hypercortisolism, hyperthyroidism, hypothyroidism, hyperparathyroidism, pseudo- and pseudopseudohypoparathyroidism, and diabetes mellitus. The radiological manifestations of each of these endocrine disorders, along with a brief discussion of the pathophysiology and clinical implications, will be discussed. PMID:24642251

  4. PTH promotes allograft integration in a calvarial bone defect

    PubMed Central

    Sheyn, Dmitriy; Yakubovich, Doron Cohn; Kallai, Ilan; Su, Susan; Da, Xiaoyu; Pelled, Gadi; Tawackoli, Wafa; Cook-Weins, Galen; Schwarz, Edward M.; Gazit, Dan; Gazit, Zulma

    2013-01-01

    Allografts may be useful in craniofacial bone repair, although they often fail to integrate with the host bone. We hypothesized that intermittent administration of parathyroid hormone (PTH) would enhance mesenchymal stem cell recruitment and differentiation, resulting in allograft osseointegration in cranial membranous bones. Calvarial bone defects were created in transgenic mice, in which luciferase is expressed under the control of the osteocalcin promoter. The mice were given implants of allografts with or without daily PTH treatment. Bioluminescence imaging (BLI) was performed to monitor host osteprogenitor differentiation at the implantation site. Bone formation was evaluated with the aid of fluorescence imaging (FLI) and micro–computed tomography (μCT) as well as histological analyses. Reverse transcription polymerase chain reaction (RT-PCR) was performed to evaluate the expression of key osteogenic and angiogenic genes. Osteoprogenitor differentiation, as detected by BLI, in mice treated with an allograft implant and PTH was over 2-fold higher than those in mice treated with an allograft implant without PTH. FLI also demonstrated that the bone mineralization process in PTH-treated allografts was significantly higher than that in untreated allografts. The μCT scans revealed a significant increase in bone formation in Allograft + PTH–treated mice comparing to Allograft + PBS treated mice. The osteogenic genes osteocalcin (Oc/Bglap) and integrin binding sialoprotein (Ibsp) were upregulated in the Allograft + PTH–treated animals. In summary, PTH treatment enhances osteoprogenitor differentiation and augments bone formation around structural allografts. The precise mechanism is not clear, but we show that infiltration pattern of mast cells, associated with the formation of fibrotic tissue, in the defect site is significantly affected by the PTH treatment. PMID:24131143

  5. A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease

    PubMed Central

    Moncayo, Roy; Moncayo, Helga

    2007-01-01

    Background Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters. Methods 13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca2+, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation. Results Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca2+, Mg, and Fe were found in TAO. Conclusion This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side

  6. Banking of massive osteoarticular and intercalary bone allografts--12 years' experience.

    PubMed

    Malinin, T I; Martinez, O V; Brown, M D

    1985-01-01

    Preparation and banking of massive osteoarticular allografts and intercalary bone allografts have been performed for the past 12 years. Careful selection of donors as well as extensive laboratory studies of the donor and the allograft have virtually eliminated the danger of transmitting disease from the donor to the recipient. The availability of a variety of allografts in the Tissue Bank allows for the selection, on an anatomic basis, of an allograft best suited for a particular recipient. The authors have supplied several hundred allografts to recipients in many institutions on the premise that excision, preparation, banking, and implantation of bone allografts constitute a clinical service. Thus, the surgeon who excises and prepares the allograft assumes a joint responsibility for the care of the recipient with the surgeon who implants the allograft. This establishes a close working relationship, which encourages frequent consultation between the parties concerned. This relationship is of particular importance in the initial evaluation of the patient and in determining which particular allograft will best serve a given patient. The experience at the authors' institution provides a model for a multiinstitutional facility that may serve as a base for discussion of the methodology involved in the excision, preparation, and storage of bone allografts. The costs associated with the operation of such a facility are not inconsiderable, but the cost of individual osteoarticular and intercalary allografts can be brought down by an increase in the efficiency of operation inherent in the processing of allografts from over 100 donors per year. During the past several years, the cost of excising and preparing intercalary allografts has been $600 per implant, while the cost for osteochondral allografts varied between $900 and $1,200. Such a large multiinstitutional facility offers the advantages of readily available allografts and quality control. However, because of the

  7. Design and characterization of an injectable tendon hydrogel: a novel scaffold for guided tissue regeneration in the musculoskeletal system.

    PubMed

    Farnebo, Simon; Woon, Colin Y L; Schmitt, Taliah; Joubert, Lydia-Marie; Kim, Maxwell; Pham, Hung; Chang, James

    2014-05-01

    A biocompatible hydrogel consisting of extracellular matrix (ECM) from human tendons is described as a potential scaffold for guided tissue regeneration and tissue engineering purposes. Lyophilized decellularized tendons were milled and enzymatically digested to form an ECM solution. The ECM solution properties are assessed by proteome analysis with mass spectrometry, and the material's rheological properties are determined as a function of frequency, temperature, and time. In vivo application of the gel in a rat model is assessed for remodeling and host cell repopulation. Histology for macrophage invasion, fibroblast repopulation, and nanoscale properties of the gel is assessed. Gel interaction with multipotent adipoderived stem cells (ASCs) is also addressed in vitro to assess possible cytotoxicity and its ability to act as a delivery vehicle for cells. Proteome analysis of the ECM-solution and gel mass spectroscopy identified the most abundant 150 proteins, of which two isoforms of collagen I represented more than 55% of the sample. Rheology showed that storage (G') and loss (G″) of the ECM solution were stable at room temperature but displayed sigmoidal increases after ∼15 min at 37°C, matching macroscopic observations of its thermo responsiveness. G' and G″ of the gel at 1 rad/s were 213.1±19.9 and 27.1±2.4 Pa, respectively. Electron microscopy revealed fiber alignment and good structural porosity in the gel, as well as invasion of cells in vivo. Histology also showed early CD68(+) macrophage invasion throughout the gel, followed by increasing numbers of fibroblast cells. ASCs mixed with the gel in vitro proliferated, indicating good biocompatibility. This ECM solution can be delivered percutaneously into a zone of tendon injury. After injection, the thermoresponsive behavior of the ECM solution allows it to polymerize and form a porous gel at body temperature. A supportive nanostructure of collagen fibers is established that conforms to the three

  8. Radiation sterilization of skin allograft

    NASA Astrophysics Data System (ADS)

    Kairiyama, E.; Horak, C.; Spinosa, M.; Pachado, J.; Schwint, O.

    2009-07-01

    In the treatment of burns or accidental loss of skin, cadaveric skin allografts provide an alternative to temporarily cover a wounded area. The skin bank facility is indispensable for burn care. The first human skin bank was established in Argentina in 1989; later, 3 more banks were established. A careful donor selection is carried out according to the national regulation in order to prevent transmissible diseases. As cadaveric human skin is naturally highly contaminated, a final sterilization is necessary to reach a sterility assurance level (SAL) of 10 -6. The sterilization dose for 106 batches of processed human skin was determined on the basis of the Code of Practice for the Radiation Sterilization of Tissue Allografts: Requirements for Validation and Routine Control (2004) and ISO 11137-2 (2006). They ranged from 17.6 to 33.4 kGy for bioburdens of >10-162.700 CFU/100 cm 2. The presence of Gram negative bacteria was checked for each produced batch. From the analysis of the experimental results, it was observed that the bioburden range was very wide and consequently the estimated sterilization doses too. If this is the case, the determination of a tissue-specific dose per production batch is necessary to achieve a specified requirement of SAL. Otherwise if the dose of 25 kGy is preselected, a standardized method for substantiation of this dose should be done to confirm the radiation sterilization process.

  9. Ageing, musculoskeletal health and work

    PubMed Central

    Palmer, Keith; Goodson, Nicola

    2016-01-01

    Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses, and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered. PMID:26612237

  10. Postoperative ultrasonography of the musculoskeletal system

    PubMed Central

    Chun, Kyung Ah; Cho, Kil-Ho

    2015-01-01

    Ultrasonography of the postoperative musculoskeletal system plays an important role in the Epub ahead of print accurate diagnosis of abnormal lesions in the bone and soft tissues. Ultrasonography is a fast and reliable method with no harmful irradiation for the evaluation of postoperative musculoskeletal complications. In particular, it is not affected by the excessive metal artifacts that appear on computed tomography or magnetic resonance imaging. Another benefit of ultrasonography is its capability to dynamically assess the pathologic movement in joints, muscles, or tendons. This article discusses the frequent applications of musculoskeletal ultrasonography in various postoperative situations including those involving the soft tissues around the metal hardware, arthroplasty, postoperative tendons, recurrent soft tissue tumors, bone unions, and amputation surgery. PMID:25971901

  11. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates. PMID:25844596

  12. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates.

  13. Fresh-frozen Complete Extensor Mechanism Allograft versus Autograft Reconstruction in Rabbits

    PubMed Central

    Chen, Guanyin; Zhang, Hongtao; Ma, Qiong; Zhao, Jian; Zhang, Yinglong; Fan, Qingyu; Ma, Baoan

    2016-01-01

    Different clinical results have been reported in the repair of extensor mechanism disruption using fresh-frozen complete extensor mechanism (CEM) allograft, creating a need for a better understanding of fresh-frozen CME allograft reconstruction. Here, we perform histological and biomechanical analyses of fresh-frozen CEM allograft or autograft reconstruction in an in vivo rabbit model. Our histological results show complete incorporation of the quadriceps tendon into the host tissues, patellar survival and total integration of the allograft tibia, with relatively fewer osteocytes, into the host tibia. Vascularity and cellularity are reduced and delayed in the allograft but exhibit similar distributions to those in the autograft. The infrapatellar fat pad provides the main blood supply, and the lowest cellularity is observed in the patellar tendon close to the tibia in both the allograft and autograft. The biomechanical properties of the junction of quadriceps tendon and host tissues and those of the allograft patellar tendon are completely and considerably restored, respectively. Therefore, fresh-frozen CEM allograft reconstruction is viable, but the distal patellar tendon and the tibial block may be the weak links of the reconstruction. These findings provide new insight into the use of allograft in repairing disruption of the extensor mechanism. PMID:26911538

  14. Artifacts in musculoskeletal ultrasonography.

    PubMed

    Taljanovic, Mihra S; Melville, David M; Scalcione, Luke R; Gimber, Lana H; Lorenz, Eileen J; Witte, Russell S

    2014-02-01

    During the past 2 decades, high-resolution ultrasonography (US) has been increasingly utilized in the diagnosis of musculoskeletal trauma and diseases with results comparable with MR imaging. US has an advantage over other cross-sectional modalities in many circumstances due to its superior spatial resolution and ability to allow dynamic assessment. When performing musculoskeletal US, the examiner has to be knowledgeable in the complex anatomy of the musculoskeletal system and US imaging technique. Additionally, he or she must be familiar with several common imaging artifacts in musculoskeletal US that may be mistaken for pathology, as well as several artifacts that frequently accompany pathologic conditions. These artifacts may occur with both B-mode gray-scale and Doppler imaging. In this article, we discuss common artifacts seen in musculoskeletal US and techniques to avoid or minimize these artifacts during clinical US examinations.

  15. Apoptotic tubular cell death during acute renal allograft rejection.

    PubMed

    Wever, P C; Aten, J; Rentenaar, R J; Hack, C E; Koopman, G; Weening, J J; ten Berge, I J

    1998-01-01

    Tubular cells are important targets during acute renal allograft rejection and induction of apoptosis might be a mechanism of tubular cell destruction. Susceptibility to induction of apoptosis is regulated by the homologous Bcl-2 and Bax proteins. Expression of Bcl-2 and Bax is regulated by p53, which down-regulates expression of Bcl-2, while simultaneously up-regulating expression of Bax. We studied apoptotic tubular cell death in 10 renal allograft biopsies from transplant recipients with acute rejection by in situ end-labelling and the DNA-binding fluorochrome propidium iodide. Tubular expression of p53, Bcl-2 and Bax was studies by immunohistochemistry. Five renal allograft biopsies from transplant recipients with uncomplicated clinical course and histologically normal renal tissue present in nephrectomy specimens from 4 patients with renal adenocarcinoma served as control specimens. Apoptotic cells and apoptotic bodies were detected in tubular epithelia and tubular lumina in 9 out of 10 acute rejection biopsies. In control renal tissue, apoptotic cells were detected in 1 biopsy only. Compared to control renal tissue, acute renal allograft rejection was, furthermore, associated with a shift in the ratio of Bcl-2 to Bax in favour of Bax in tubular epithelia and increased expression of p53 in tubular nuclei. These observations demonstrate that apoptosis contributes in part to tubular cell destruction during acute renal allograft rejection. In accordance, the shift in the ratio of Bcl-2 to Bax in favour of Bax indicates increased susceptibility of tubular epithelia to induction of apoptosis. The expression of p53 in tubular nuclei during acute renal allograft rejection indicates the presence of damaged DNA, which can be important in initiation of part of the observed apoptosis. These findings elucidate part of the mechanisms controlling apoptotic tubular cell death during acute renal allograft rejection.

  16. Bone Cysts After Osteochondral Allograft Repair of Cartilage Defects in Goats Suggest Abnormal Interaction Between Subchondral Bone and Overlying Synovial Joint Tissues

    PubMed Central

    Pallante-Kichura, Andrea L.; Cory, Esther; Bugbee, William D.; Sah, Robert L.

    2013-01-01

    The efficacy of osteochondral allografts (OCA) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12 months in vivo. The objectives of this study were to further analyze OCA and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral (ScB) and trabecular (TB) bone structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCA was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCA was lower than Non-Op and other OCA. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCA did not vary compared to Non-Op, but BS/TV was lower. (2) OCA contained “basal” cysts, localized to deeper regions, some “subchondral” cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal μCT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These

  17. Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues.

    PubMed

    Pallante-Kichura, Andrea L; Cory, Esther; Bugbee, William D; Sah, Robert L

    2013-11-01

    The efficacy of osteochondral allografts (OCAs) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12months in vivo. The objectives of this study were to further analyze OCAs and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral bone (ScB) and trabecular bone (TB) structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCAs was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCAs was lower than Non-Op and other OCAs. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCAs did not vary compared to Non-Op, but BS/TV was lower. (2) OCAs contained "basal" cysts, localized to deeper regions, some "subchondral" cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal μCT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These

  18. Severe adult burn survivors. What information about skin allografts?

    PubMed Central

    Gaucher, Sonia; Duchange, Nathalie; Jarraya, Mohamed; Magne, Jocelyne; Rochet, Jean-Michel; Stéphanazzi, Jean; Hervé, Christian; Moutel, Grégoire

    2013-01-01

    Background and objective During the acute phase of a severe burn, surgery is an emergency. In this situation, human skin allografts constitute an effective temporary skin substitute. However, information about the use of human tissue can not be given to the patients because most of the allografted patients are unconscious due to their injury. Objective This study explored the restitution of information on skin donation to patients who have been skin allografted and who have survived their injury. Method A qualitative study was conducted due to the limited number of patients in ability to be interviewed according to our medical and psychological criteria. Results and discussion Twelve patients who had been treated between 2002 and 2008 were interviewed. Our results show that 10 of them ignored that they had received skin allografts. One of the two patients who knew that they had received allografts knew that skin had been harvested from deceased donor. All patients expressed that there is no information that should not be delivered. They also expressed their relief to have had the opportunity to discuss their case and at being informed during their interview. Their own experience impacted their view in favor of organ and tissue donation. PMID:23229877

  19. Thoracoabdominal musculoskeletal injuries in racquet sports.

    PubMed

    Lehman, R C

    1988-04-01

    Thoracoabdominal musculoskeletal injuries are separated into rectus abdominus injuries and lower thoracic muscular injuries. Localized rectus injuries may be treated by steroid injection. Diffuse rectus injuries and thoracic injuries are treated by aggressive rehabilitation. The mechanisms of injury are different in each case, and prevention of these forces is necessary to allow soft-tissue healing.

  20. The genetic pleiotropy of musculoskeletal aging.

    PubMed

    Karasik, David; Cohen-Zinder, Miri

    2012-01-01

    Musculoskeletal aging is detrimental to multiple bodily functions and starts early, probably in the fourth decade of an individual's life. Sarcopenia is a health problem that is expected to only increase as a greater portion of the population lives longer; prevalence of the related musculoskeletal diseases is similarly expected to increase. Unraveling the biological and biomechanical associations and molecular mechanisms underlying these diseases represents a formidable challenge. There are two major problems making disentangling the biological complexity of musculoskeletal aging difficult: (a) it is a systemic, rather than "compartmental," problem, which should be approached accordingly, and (b) the aging per se is neither well defined nor reliably measurable. A unique challenge of studying any age-related condition is a need of distinguishing between the "norm" and "pathology," which are interwoven throughout the aging organism. We argue that detecting genes with pleiotropic functions in musculoskeletal aging is needed to provide insights into the potential biological mechanisms underlying inter-individual differences insusceptibility to the musculoskeletal diseases. However, exploring pleiotropic relationships among the system's components is challenging both methodologically and conceptually. We aimed to focus on genetic aspects of the cross-talk between muscle and its "neighboring" tissues and organs (tendon, bone, and cartilage), and to explore the role of genetics to find the new molecular links between skeletal muscle and other parts of the "musculoskeleton." Identification of significant genetic variants underlying the musculoskeletal system's aging is now possible more than ever due to the currently available advanced genomic technologies. In summary, a "holistic" genetic approach is needed to study the systems's normal functioning and the disease predisposition in order to improve musculoskeletal health.

  1. Use of animal models in musculoskeletal research.

    PubMed Central

    Neyt, J. G.; Buckwalter, J. A.; Carroll, N. C.

    1998-01-01

    Understanding of the human musculoskeletal system and common clinical disorders of bones, joints and soft tissues has been enhanced by the use of experimental animal models. Articles reporting on the results of these biomedical experiments frequently include conclusions that are based on the assumption that the biology of the animal model is similar to that of a human being for the disease process under investigation. The purpose of this investigation was to study the criteria and the considerations for selection of an animal model in musculoskeletal research. Selected journals from the musculoskeletal literature published between January 1991 and November 1995 were scrutinized for the use of animal models, and several criteria used in the selection of the various animal models were investigated. The selection criteria analyzed in this study included the biologic characteristics of the model, budget issues, the reproducibility of a musculoskeletal disease, and animal handling factors. A computer-assisted search of the musculoskeletal literature published from 1965 to 1995 was also performed to screen for reports comparing mammals used as animal models in terms of these selection criteria. Our findings imply that the selection of animal models in research of the musculoskeletal system is based partly on non-standardized criteria that are not necessarily based on the biology of the disease process being studied. In addition, there are limited comparative data on the selection and use of different animals for musculoskeletal research. We believe the selection of models should be more standardized based on both biological and non-biological criteria. Researchers would then be able to put in a more meaningful perspective the results of research using animal models and their clinical implications. PMID:9807717

  2. The genetic pleiotropy of musculoskeletal aging

    PubMed Central

    Karasik, David; Cohen-Zinder, Miri

    2012-01-01

    Musculoskeletal aging is detrimental to multiple bodily functions and starts early, probably in the fourth decade of an individual's life. Sarcopenia is a health problem that is expected to only increase as a greater portion of the population lives longer; prevalence of the related musculoskeletal diseases is similarly expected to increase. Unraveling the biological and biomechanical associations and molecular mechanisms underlying these diseases represents a formidable challenge. There are two major problems making disentangling the biological complexity of musculoskeletal aging difficult: (a) it is a systemic, rather than “compartmental,” problem, which should be approached accordingly, and (b) the aging per se is neither well defined nor reliably measurable. A unique challenge of studying any age-related condition is a need of distinguishing between the “norm” and “pathology,” which are interwoven throughout the aging organism. We argue that detecting genes with pleiotropic functions in musculoskeletal aging is needed to provide insights into the potential biological mechanisms underlying inter-individual differences insusceptibility to the musculoskeletal diseases. However, exploring pleiotropic relationships among the system's components is challenging both methodologically and conceptually. We aimed to focus on genetic aspects of the cross-talk between muscle and its “neighboring” tissues and organs (tendon, bone, and cartilage), and to explore the role of genetics to find the new molecular links between skeletal muscle and other parts of the “musculoskeleton.” Identification of significant genetic variants underlying the musculoskeletal system's aging is now possible more than ever due to the currently available advanced genomic technologies. In summary, a “holistic” genetic approach is needed to study the systems's normal functioning and the disease predisposition in order to improve musculoskeletal health. PMID:22934054

  3. Advances in Musculoskeletal MRI – Technical Considerations

    PubMed Central

    Shapiro, Lauren; Harish, Monica; Hargreaves, Brian; Staroswiecki, Ernesto; Gold, Garry

    2012-01-01

    The technology of musculoskeletal MRI imaging is advancing at a dramatic rate. MR imaging is now done at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and post processing techniques than ever before. These numerable technical advances are advantageous as they lead to an increased signal to noise ratio and increased variety of soft tissue contrast options. However, at the same time they potentially produce more imaging artifacts when compared with past techniques. Substantial technical advances have considerable clinical challenges in musculoskeletal radiology such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review, we consider technical advances in hardware and software of musculoskeletal MR imaging along with their clinical applications. PMID:22987756

  4. Rare presentations of cytomegalovirus infection in renal allograft recipients.

    PubMed

    Ardalan, Mohammadreza

    2012-01-01

    Cytomegalovirus is the most common viral infection after kidney transplantation. Clinical presentations of cytomegalovirus infection range from asymptomatic infection to organ-specific involvement. Most symptomatic infections manifest as fever and cytopenia. The gastrointestinal tract is the most common site of tissue-invasive infection, often presenting as diarrhea or gastrointestinal bleeding. Gastrointestinal obstruction, perforation, thrombosis of large gastrointestinal veins, splenic artery thrombosis, and pancreatitis are rare gastrointestinal presentations of cytomegalovirus infection. Renal-allograft ureteral stricture and skin involvement are other rare presentations of cytomegalovirus infection. hemophagocytic syndrome, thrombotic microangiopathy, adrenal insufficiency, and renal allograft artery stenosis are other rare symptoms of cytomegalovirus infection.

  5. A comparative evaluation of freeze-dried bone allograft with and without bioabsorbable guided tissue regeneration membrane Healiguide® in the treatment of Grade II furcation defects: A clinical study

    PubMed Central

    Jain, Deept; Deepa, Dhruvakumar

    2015-01-01

    Background: Furcation defects represent one of the most demanding therapeutic challenges for periodontal therapy. Various treatment modalities have been tried with different success rates. The present study was undertaken to evaluate the efficacy of freeze-dried bone allograft (FDBA) with and without bioabsorbable guided tissue regeneration (GTR) membrane Healiguide® in the treatment of Grade II furcation defects. Materials and Methods: Ten patients with bilateral Grade II furcation defects were selected for the study. After phase I therapy, subjects were divided into two arms and treated in a split-mouth design. Ten defects were treated with FDBA alone in the control arm. Ten defects were treated with FDBA in conjunction with bioabsorbable GTR membrane Healiguide® in test arm. Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, and relative attachment level (RAL) were assessed at baseline, 3 months, and 6 months postoperatively. Results: At 6 months, clinical improvement was seen in both the arms with mean pocket depth reduction of 1.2 ± 1.032 mm and 1.7 ± 0.948 mm and mean horizontal probing depth reduction being 2.1 ± 1.969 mm and 1.6 ± 1.264 mm in control and test arm, respectively. Both surgical procedures resulted in a statistically significant reduction in vertical and horizontal probing depths. Conclusion: Both the arms demonstrated a significant improvement in the probing depth, horizontal furcation depth, and RAL at 6 months postsurgery in the treatment of Grade II furcation defects. However, on the intergroup comparison, there was no statistically significant difference in the results achieved between two arms. PMID:26941515

  6. [Research of the durability of connective tissue complexes formed in the implantation area of various types of allograft during the experiment].

    PubMed

    Ioffe, O Iu; Shvets', I M; Stetsenko, O P; Tsiura, Iu P; Tarasiuk, T V; Lamashevs'kyĭ, V P; Makovets'kyĭ, I V; Furmanov, Iu O

    2014-01-01

    The aim of the study is to examine in the experiment on the animals the mechanical properties of connective tissue complexes formed in alloplasty area using the intraperitoneal on lay mesh and sublay methodologies with further comparison of them. The experiment has been conducted on 12 rabbits of Russian chinchilla breed. Animals were distributed in the following way: the first group--operated by intraperitoneal on lay mesh methodology (n = 6) through implantation of composite grid Proceed with one-side celullose coating produced by "Ethicon" company. The second group--performed modeling of preperitoneal plastic using two-component composite grid with large-pores Ultrapro produced by "Ethicon" company (n = 6). For the tensometric evaluation of the strength of implant integration into the red wall was used entire area of anterior red wall together with the implanted transplant. According to the deflection diagrams and dynamometer rates defined the maximum burden rates which is equivalent of muscular tissue budge against polymeric matrix. Statistically significant distinctions during 14 days were not detected; however strength during 30 days in the first group was 3 times higher than in the second group. We consider that the methodology of intraperitoneal on lay mesh can be considered as operation of choice of surgery treatment of the umbilical hernias. PMID:25906664

  7. An audit of consent for allograft use in elective orthopaedic surgery.

    PubMed

    Mullan, C J; Pagoti, R; Davison, H; McAlinden, M G

    2016-04-01

    Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.

  8. Artifacts in musculoskeletal MR imaging.

    PubMed

    Singh, Dinesh R; Chin, Michael S M; Peh, Wilfred C G

    2014-02-01

    MR imaging has become an important diagnostic tool in the evaluation of a vast number of pathologies and is of foremost importance in the evaluation of spine, joints, and soft tissue structures of the musculoskeletal system. MR imaging is susceptible to various artifacts that may affect the image quality or even simulate pathologies. Some of these artifacts have gained special importance with the use of higher field strength magnets and with the increasing need for MR imaging in postoperative patients, especially those with previous joint replacements or metallic implants. Artifacts may arise from patient motion or could be due to periodic motion, such as vascular and cardiac pulsation. Artifacts could also arise from various protocol errors including saturation, wraparound, truncation, shading, partial volume averaging, and radiofrequency interference artifacts. Susceptibility artifact occurs at interfaces with different magnetic susceptibilities and is of special importance with increasing use of metallic joint replacement prostheses. Magic angle phenomenon is a special type of artifact that occurs in musculoskeletal MR imaging. It is essential to recognize these artifacts and to correct them because they may produce pitfalls in image interpretation.

  9. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    PubMed

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients. PMID:25950536

  10. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    PubMed

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

  11. Musculoskeletal disorders and work.

    PubMed

    Grimstone, D

    1991-11-01

    Musculoskeletal problems are an only too regular daily feature of patients attending family practices, OH departments or indeed confronting the first aider. Derek Grimstone, senior employment nursing adviser of the HSE warns that only too frequently the job of the patient is not considered in association with the complaint and gives practical steps to avoid unnecessary suffering by employees in the workplace. PMID:1775280

  12. Musculoskeletal trauma: the baseball bat.

    PubMed

    Bryant, D D; Greenfield, R; Martin, E

    1992-11-01

    Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat.

  13. Musculoskeletal trauma: the baseball bat.

    PubMed Central

    Bryant, D. D.; Greenfield, R.; Martin, E.

    1992-01-01

    Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat. Images Figure 1 Figure 2 Figure 3 PMID:1460683

  14. Musculoskeletal applications of nuclear magnetic resonance

    SciTech Connect

    Moon, K.L. Jr.; Genant, H.K.; Helms, C.A.; Chafetz, N.I.; Crooks, L.E.; Kaufman, L.

    1983-04-01

    Thirty healthy subjects and 15 patients with a variety of musculoskeletal disorders were examined by conventional radiography, computed tomography (CT), and nuclear magnetic resonance (NMR). NMR proved capable of demonstrating important anatomic structures in the region of the lumbosacral spine. Lumbar disk protrusion was demonstrated in three patients with CT evidence of the disease. NMR appeared to differentiate annulus fibrosus from nucleus pulposus in intervertebral disk material. Avascular necrosis of the femoral head was demonstrated in two patients. The cruciate ligaments of the knee were well defined by NMR. Musceles, tendons and ligaments, and blood vessels could be reliably differentiated, and the excellent soft-tissue contrast of NMR proved useful in the evaluation of bony and soft-tissue tumors. NMR holds promise in the evaluation of musculoskeletal disorders.

  15. Freeze-dried microarterial allografts

    SciTech Connect

    Raman, J.; Hargrave, J.C.

    1990-02-01

    Rehydrated freeze-dried microarterial allografts were implanted to bridge arterial defects using New Zealand White rabbits as the experimental model. Segments of artery from the rabbit ear and thigh were harvested and preserved for a minimum of 2 weeks after freeze-drying. These allografts, approximately 1 mm in diameter and ranging from 1.5 to 2.5 cm in length, were rehydrated and then implanted in low-pressure and high-pressure arterial systems. Poor patency was noted in low-pressure systems in both allografts and autografts, tested in 12 rabbits. In the high-pressure arterial systems, allografts that were freeze-dried and reconstituted failed in a group of 10 rabbits with an 8-week patency rate of 30 percent. Gamma irradiation in an effort to reduce infection and antigenicity of grafts after freeze-drying was associated with a patency rate of 10 percent at 8 weeks in this system in another group of 10 rabbits. Postoperative cyclosporin A therapy was associated with a patency rate of 22.2 percent in the high-pressure arterial system in a 9-rabbit group. Control autografts in this system in a group of 10 rabbits showed a 100 percent patency at 8 weeks. Microarterial grafts depend on perfusion pressure of the vascular bed for long-term patency. Rehydrated freeze-dried microarterial allografts do not seem to function well in lengths of 1 to 2.5 cm when implanted in a high-pressure arterial system. Freeze-dried arterial allografts are probably not antigenic.

  16. The impact of childhood obesity on musculoskeletal form.

    PubMed

    Wearing, S C; Hennig, E M; Byrne, N M; Steele, J R; Hills, A P

    2006-05-01

    Despite the greater prevalence of musculoskeletal disorders in obese adults, the consequences of childhood obesity on the development and function of the musculoskeletal system have received comparatively little attention within the literature. Of the limited number of studies performed to date, the majority have focused on the impact of childhood obesity on skeletal structure and alignment, and to a lesser extent its influence on clinical tests of motor performance including muscular strength, balance and locomotion. Although collectively these studies imply that the functional and structural limitations imposed by obesity may result in aberrant lower limb mechanics and the potential for musculoskeletal injury, empirical verification is currently lacking. The delineation of the effects of childhood obesity on musculoskeletal structure in terms of mass, adiposity, anthropometry, metabolic effects and physical inactivity, or their combination, has not been established. More specifically, there is a lack of research regarding the effect of childhood obesity on the properties of connective tissue structures, such as tendons and ligaments. Given the global increase in childhood obesity, there is a need to ascertain the consequences of persistent obesity on musculoskeletal structure and function. A better understanding of the implications of childhood obesity on the development and function of the musculoskeletal system would assist in the provision of more meaningful support in the prevention, treatment and management of the musculoskeletal consequences of the condition.

  17. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  18. Musculoskeletal Disorders among Cosmetologists

    PubMed Central

    Tsigonia, Alexandra; Tanagra, Dimitra; Linos, Athena; Merekoulias, Georgios; Alexopoulos, Evangelos C.

    2009-01-01

    A cross-sectional study was performed to investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of low back, neck, shoulder, hand/wrist and knee musculoskeletal complaints among cosmetologists in Athens, Greece. The study population consisted of 95 female and seven male beauty therapists (response rate 90%) with a mean age and duration of employment of 38 and 16 years, respectively. Neck pain was the most prevalent musculoskeletal complaint, reported by 58% of the subjects, while hand/wrist and low back complaints resulted more frequently in self-reported consequences (chronicity, care seeking and absenteeism). Significant relationships were found between self-reported physical risk factors like prolonged sitting, use of vibrating tools, reaching far and awkward body postures and the occurrence of musculoskeletal disorders at various body sites. Among psychosocial variables co-worker support and skill discretion seem to be the most important reflecting organizational problems and cognitive-behavioral aspects. The study results also suggest that effective intervention strategies most likely have to take into account both ergonomic improvements and organizational aspects. PMID:20049238

  19. Musculoskeletal disorders among cosmetologists.

    PubMed

    Tsigonia, Alexandra; Tanagra, Dimitra; Linos, Athena; Merekoulias, Georgios; Alexopoulos, Evangelos C

    2009-12-01

    A cross-sectional study was performed to investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of low back, neck, shoulder, hand/wrist and knee musculoskeletal complaints among cosmetologists in Athens, Greece. The study population consisted of 95 female and seven male beauty therapists (response rate 90%) with a mean age and duration of employment of 38 and 16 years, respectively. Neck pain was the most prevalent musculoskeletal complaint, reported by 58% of the subjects, while hand/wrist and low back complaints resulted more frequently in self-reported consequences (chronicity, care seeking and absenteeism). Significant relationships were found between self-reported physical risk factors like prolonged sitting, use of vibrating tools, reaching far and awkward body postures and the occurrence of musculoskeletal disorders at various body sites. Among psychosocial variables co-worker support and skill discretion seem to be the most important reflecting organizational problems and cognitive-behavioral aspects. The study results also suggest that effective intervention strategies most likely have to take into account both ergonomic improvements and organizational aspects.

  20. Mechanoreceptor Reinnervation of Autografts Versus Allografts After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Young, Simon W.; Valladares, Roberto D.; Loi, Florence; Dragoo, Jason L.

    2016-01-01

    Background: Loss of proprioceptive function occurs after anterior cruciate ligament (ACL) rupture. Clinical, motor, and proprioceptive function is known to improve after ACL reconstruction but does not return to normal. While histological studies of human ACL allografts have been unable to demonstrate mechanoreceptor reinnervation, animal data suggest that reinnervation may occur when an autograft is used. Purpose: To compare the presence or absence of mechanoreceptors between allograft versus autograft after ACL reconstruction in humans. Study Design: Cohort study; Level of evidence, 3. Methods: Ten patients with previous ACL reconstruction presenting for either revision ACL surgery or knee arthroscopy for other reasons were enrolled in a prospective, comparative study. Five patients had a previous autograft ACL and 5 patients had an allograft. Biopsies, either from intact or ruptured grafts, were taken from identical locations as close to the femoral and tibial insertions as possible. Specimens were stained with hematoxylin-eosin (H-E) and monoclonal antibodies against neurofilament protein (NFP), known to be present in mechanoreceptor tissue. Immunohistochemical examination was carried out, and the number of NFP+ neural tissue analogs was counted and compared with that of native ACL tissue. Results: The mean time between original graft and biopsy was 6.9 years (range, 0.5-15 years). Histological examination showed significantly less NFP+ neural analogs in allograft and autograft patients than control tissue (mean number of NFP+ analogs per high-power field, 0.7 ± 0.9 [allograft] and 0.5 ± 0.8 [autograft] vs 4.7 ± 0.9 [controls]; P < .0001). There was no significant difference in NFP analogs between autograft and allograft tissue. Conclusion: We found a reduced concentration of NFP+ neural analogs in ACL grafts compared with native ACL tissue. This deficit exists irrespective of whether allograft or autograft is used. These findings may explain the continued

  1. Inhibition of the immune response to experimental fresh osteoarticular allografts

    SciTech Connect

    Rodrigo, J.J.; Schnaser, A.M.; Reynolds, H.M. Jr.; Biggart, J.M. 3d.; Leathers, M.W.; Chism, S.E.; Thorson, E.; Grotz, T.; Yang, Q.M. )

    1989-06-01

    The immune response to osteoarticular allografts is capable of destroying the cartilage--a tissue that has antigens on its cells identical to those on the bone and marrow cells. Osteoarticular allografts of the distal femur were performed in rats using various methods to attempt to temporarily inhibit the antibody response. The temporary systemic immunosuppressant regimens investigated were cyclophosphamide, azathioprine and prednisolone, cyclosporine A, and total lymphoid irradiation. The most successful appeared to be cyclosporine A, but significant side effects were observed. To specifically inhibit the immune response in the allograft antigens without systemically inhibiting the entire immune system, passive enhancement and preadministration of donor blood were tried. Neither was as effective as coating the donor bone with biodegradable cements, a method previously found to be successful. Cyclosporine A was investigated in dogs in a preliminary study of medial compartmental knee allografts and was found to be successful in inhibiting the antibody response and in producing a more successful graft; however, some significant side effects were similarly observed.

  2. A multiple-dose, open-label, safety, compliance, and usage evaluation study of epicutaneously applied Diractin (ketoprofen in Transfersome) in joint/musculoskeletal pain or soft tissue inflammation.

    PubMed

    Kneer, Werner; Rother, Ilka; Rother, Matthias; Seidel, Egbert

    2009-01-01

    The risk of oral NSAID including Cox-2 inhibitors to cause gastrointestinal, renal or cardiovascular adverse events related to systemic drug exposure could be reduced by local application. But only few long-term studies have been published to show safety and efficacy for long-term use of topical NSAID s. Diractin (formerly IDEA-033) is a viscous, aqueous formulation for epicutaneous application of ketoprofen based on ultra-deformable, self-regulating carrier (Transfersome). This multiple-dose, open label study with treatment periods up to 18 months included 402 patients with joint pain, musculoskeletal pain, stiffness or soft tissue inflammation (age of 61.4+/-11.5 years). Most of the patients suffered from osteoarthritis (OA) of the knee (68.9%). Diractin was applied epicutaneously up to twice daily with a maximum dose of 220 mg ketoprofen per a maximum of 2 application sites. The mean pain score at baseline was 5.4+/-.4 on a 10 point categorical scale. During the study the pain score progressively improved up to week 36 (3.5+/-1.9) without a substantial further change during the rest of observation period of up to 18 months. The reduction of pain scores between week 0 (baseline) and at all later visits was statistically significant (P<0.0001). Patients also reported an improvement of quality of life on the EUROQoL. The majority of treatment related adverse events were skin and subcutaneous tissue disorders with the highest frequency reported for erythema (16.7%) and pruritus (2.0%). Systemic ketoprofen exposure remained low throughout the study period with plasma concentrations of less than 1% of what was reported for a single, standard oral dose of 200 mg ketoprofen. There were no occurrences of treatment related serious adverse events and no remarkable changes in laboratory values or vital signs. In summary, Diractin provided adequate pain relief with a good safety and tolerability profile when used for up to 18 months (72 weeks).

  3. Allograft pretreatment for the repair of sciatic nerve defects: green tea polyphenols versus radiation

    PubMed Central

    Zhou, Sheng-hu; Zhen, Ping; Li, Shen-song; Liang, Xiao-yan; Gao, Ming-xuan; Tian, Qi; Li, Xu-sheng

    2015-01-01

    Pretreatment of nerve allografts by exposure to irradiation or green tea polyphenols can eliminate neuroimmunogenicity, inhibit early immunological rejection, encourage nerve regeneration and functional recovery, improve tissue preservation, and minimize postoperative infection. In the present study, we investigate which intervention achieves better results. We produced a 1.0 cm sciatic nerve defect in rats, and divided the rats into four treatment groups: autograft, fresh nerve allograft, green tea polyphenol-pretreated (1 mg/mL, 4°C) nerve allograft, and irradiation-pretreated nerve allograft (26.39 Gy/min for 12 hours; total 19 kGy). The animals were observed, and sciatic nerve electrophysiology, histology, and transmission electron microscopy were carried out at 6 and 12 weeks after grafting. The circumference and structure of the transplanted nerve in rats that received autografts or green tea polyphenol-pretreated nerve allografts were similar to those of the host sciatic nerve. Compared with the groups that received fresh or irradiation-pretreated nerve allografts, motor nerve conduction velocity in the autograft and fresh nerve allograft groups was greater, more neurites grew into the allografts, Schwann cell proliferation was evident, and a large number of new blood vessels was observed; in addition, massive myelinated nerve fibers formed, and abundant microfilaments and microtubules were present in the axoplasm. Our findings indicate that nerve allografts pretreated by green tea polyphenols are equivalent to transplanting autologous nerves in the repair of sciatic nerve defects, and promote nerve regeneration. Pretreatment using green tea polyphenols is better than pretreatment with irradiation. PMID:25788934

  4. Basic aspects of musculoskeletal pain: from acute to chronic pain

    PubMed Central

    Arendt-Nielsen, Lars; Fernández-de-las-Peñas, César; Graven-Nielsen, Thomas

    2011-01-01

    The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain. PMID:23115471

  5. Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study.

    PubMed

    Sun, Kang; Tian, Shaoqi; Zhang, Jihua; Xia, Changsuo; Zhang, Cailong; Yu, Tengbo

    2009-05-01

    The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24-47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and

  6. Emphysema in the renal allograft

    SciTech Connect

    Potter, J.L.; Sullivan, B.M.; Fluornoy, J.G.; Gerza, C.

    1985-04-01

    Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.

  7. Fresh-frozen human bone allograft in vertical ridge augmentation: clinical and tomographic evaluation of bone formation and resorption.

    PubMed

    Macedo, Luis Guilherme Scavone; Mazzucchelli-Cosmo, Luiz Antonio; Macedo, Nelson Luiz; Monteiro, Adriana Socorro Ferreira; Sendyk, Wilson Roberto

    2012-12-01

    The aim of the current study is to evaluate fresh-frozen human bone allografts (FHBAs) used in vertical ridge augmentation clinically and by computed tomography, and to analyze the resulting bone formation and graft resorption. Sixteen FHBAs were grafted in the maxillae and mandibles of 9 patients. The FHBAs, which were provided by the Musculoskeletal Tissue Bank of Marilia Hospital (Unioss), were frozen at -80°C. After 7 months, dental implants were placed and bone parameters were evaluated. Vertical bone formation was measured by computerized tomography before (T0) and at 7 months (T1) after the surgical procedure. Bone graft resorption was measured clinically from a landmark screw head using a periodontal probe. The results were analyzed by Student's t-test. Significant differences existed in the bone formation values at T0 and T1, with an average change of 4.03 ± 1.69 mm. Bone graft resorption values were 1.0 ± 0.82 mm (20%). Implants were placed with varying insertion torque values (35-45 Ncm), and achieved primary stability. This study demonstrates that FHBAs promote satisfactory vertical bone formation with a low resorption rates, good density, and primary implant stability. PMID:21811779

  8. Functional imaging of the musculoskeletal system.

    PubMed

    Griffith, James F

    2015-06-01

    Functional imaging, which provides information of how tissues function rather than structural information, is well established in neuro- and cardiac imaging. Many musculoskeletal structures, such as ligaments, fascia and mineralized bone, have by definition a mainly structural role and clearly don't have the same functional capacity as the brain, heart, liver or kidney. The main functionally responsive musculoskeletal tissues are the bone marrow, muscle and nerve and, as such, magnetic resonance (MR) functional imaging has primarily addressed these areas. Proton or phosphorus spectroscopy, other fat quantification techniques, perfusion imaging, BOLD imaging, diffusion and diffusion tensor imaging (DTI) are the main functional techniques applied. The application of these techniques in the musculoskeletal system has mainly been research orientated where they have already greatly enhanced our understanding of marrow physiology, muscle physiology and neural function. Going forwards, they will have a greater clinical impact helping to bridge the disconnect often seen between structural appearances and clinical symptoms, allowing a greater understanding of disease processes and earlier recognition of disease, improving prognostic prediction and optimizing the monitoring of treatment effect. PMID:26029633

  9. Regulatory oversight in the United States of vascularized composite allografts.

    PubMed

    Glazier, Alexandra K

    2016-06-01

    Vascularized composite allograft (VCA) transplantation is a medically acceptable treatment for the reconstruction of major tissue loss. The advent of VCA transplantation has spurred regulatory and policy development in the United States to address the multiple clinical, ethical and legal issues that must be considered for the practice of VCA donation and transplantation to develop within the existing framework of public trust and transparency vital to the success of donation and transplantation. PMID:26284312

  10. The clinical outcome of pazopanib treatment in Japanese patients with relapsed soft tissue sarcoma: A Japanese Musculoskeletal Oncology Group (JMOG) study

    PubMed Central

    Nakamura, Tomoki; Kawai, Akira; Araki, Nobuhito; Goto, Takahiro; Yonemoto, Tsukasa; Sugiura, Hideshi; Nishida, Yoshihiro; Hiraga, Hiroaki; Honoki, Kanya; Yasuda, Taketoshi; Boku, Shogen; Sudo, Akihiro; Ueda, Takafumi

    2016-01-01

    BACKGROUND Because the efficacy and safety of pazopanib in Japanese patients with soft tissue sarcoma (STS) had not been evaluated previously in a large‐scale cohort, the authors investigated the efficacy and safety of pazopanib in 156 Japanese patients with relapsed STS. This was a retrospective study based on the collection of real‐life, postmarketing surveillance data. METHODS Patients received pazopanib with the objective of treating local recurrence (n = 20), metastasis (n = 104), and both (n = 32). The patient median age was 53.8 years. The primary objective of this study was to clarify the efficacy of pazopanib for patients with STS. RESULTS The median treatment duration was 28.7 weeks, and the average dose intensity of pazopanib was 609 mg. Adverse events occurred in 127 patients (81.4%). In addition to the main common toxicities, such as hypertension and liver disorder, pneumothorax (n = 11) and thrombocytopenia (n = 16) also were observed. The median progression‐free survival for all patients was 15.4 weeks. The median progression‐free survival for patients with leiomyosarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, and liposarcoma was 18.6 weeks, 16.4 weeks, 15.3 weeks, and 8 weeks, respectively. The median survival for all patients was 11.2 months. The median survival for patients with leiomyosarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, and liposarcoma was 20.1 months, 10.6 months, 9.5 months, and 7.3 months, respectively. CONCLUSIONS There were apparent differences in the efficacy of pazopanib treatment among histologic types of STS. Pazopanib treatment is a new treatment option; however, adverse events like pneumothorax and thrombocytopenia, which did not occur frequently in the PALETTE study (pazopanib for metastatic soft‐tissue sarcoma), should be taken into consideration. Cancer 2016;122:1408‐16. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society

  11. Photochemical tissue bonding

    DOEpatents

    Redmond, Robert W.; Kochevar, Irene E.

    2012-01-10

    Photochemical tissue bonding methods include the application of a photosensitizer to a tissue and/or tissue graft, followed by irradiation with electromagnetic energy to produce a tissue seal. The methods are useful for tissue adhesion, such as in wound closure, tissue grafting, skin grafting, musculoskeletal tissue repair, ligament or tendon repair and corneal repair.

  12. Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

    PubMed Central

    Forsythe, Brian; Haro, Marc S.; Bogunovic, Ljiljana; Collins, Michael J.; Arns, Thomas A.; Trella, Katie J.; Shewman, Elizabeth F.; Verma, Nikhil N.; Bach, Bernard R.

    2016-01-01

    Background: Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft. Study Design: Controlled laboratory study. Methods: Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure. Results: Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43

  13. Microwave sterilization of femoral head allograft.

    PubMed

    Dunsmuir, Robert A; Gallacher, Grace

    2003-10-01

    The potential shortage of allograft bone has led to the need to investigate other sources of bone for allografts. Some allograft bone donated from primary total hip arthroplasty recipients must be discarded or treated to become usable as a result of bacterial contamination. Femoral head allografts were contaminated with Staphylococcus aureus and Bacillus subtilis. A domestic microwave oven was used. The contaminated bone was exposed to microwave irradiation for different time periods. The samples were then cultured to attempt to grow the two bacterial species. The contaminated bone samples failed to grow any organisms after 2 min of exposure to microwave irradiation. This study shows that sterilization of femoral head allografts contaminated with S. aureus and B. subtilis can be achieved with microwave irradiation in a domestic microwave oven. This method of sterilization of bone allografts is cheap, easily used, and an effective way to process contaminated bone. PMID:14532216

  14. Musculoskeletal involvement in sarcoidosis*, **

    PubMed Central

    Nessrine, Akasbi; Zahra, Abourazzak Fatima; Taoufik, Harzy

    2014-01-01

    Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management. PMID:24831403

  15. 77 FR 51544 - National Institute of Arthritis and Musculoskeletal and Skin Diseases; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-24

    ... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases Special Emphasis Panel: Tissue Engineering and Regenerative Medicine. Date... of Federal Domestic Assistance Program Nos. 93.846, Arthritis, Musculoskeletal and Skin...

  16. Mucormycosis (zygomycosis) of renal allograft.

    PubMed

    Gupta, Krishan L; Joshi, Kusum; Kohli, Harbir S; Jha, Vivekanand; Sakhuja, Vinay

    2012-12-01

    Fungal infection is relatively common among renal transplant recipients from developing countries. Mucormycosis, also known as zygomycosis, is one of the most serious fungal infections in these patients. The most common of presentation is rhino-cerebral. Isolated involvement of a renal allograft is very rare. A thorough search of literature and our medical records yielded a total of 24 cases with mucormycosis of the transplanted kidney. There was an association with cytomegalovirus (CMV) infection and anti-rejection treatment in these patients and most of these transplants were performed in the developing countries from unrelated donors. The outcome was very poor with an early mortality in 13 (54.5%) patients. Renal allograft mucormycosis is a relatively rare and potentially fatal complication following renal transplantation. Early diagnosis, graft nephrectomy and appropriate antifungal therapy may result in an improved prognosis for these patients.

  17. ENDOTHELIAL CELLS IN ALLOGRAFT REJECTION

    PubMed Central

    Al-Lamki, Rafia S.; Bradley, John R.; Pober, Jordan S.

    2008-01-01

    In organ transplantation, blood borne cells and macromolecules (e.g. antibodies) of the host immune system are brought into direct contact with the endothelial cell (EC) lining of graft vessels. In this location, graft ECs play several roles in allograft rejection, including the initiation of rejection responses by presentation of alloantigen to circulating T cells; the development of inflammation and thrombosis; and as targets of injury and agents of repair. PMID:19034000

  18. The effect of mesenchymal stem cell sheets on structural allograft healing of critical-sized femoral defects in mice

    PubMed Central

    Long, Teng; Zhu, Zhenan; Awad, Hani A.; Schwarz, Edward M.; Hilton, Matthew J.; Dong, Yufeng

    2014-01-01

    Structural bone allografts are widely used in the clinic to treat critical sized bone defects, despite lacking the osteoinductive characteristics of live autografts. To address this, we generated revitalized structural allografts wrapped with mesenchymal stem/progenitor cell (MSC) sheets, which were produced by expanding primary syngenic bone marrow derived cells on temperature-responsive plates, as a tissue engineered periosteum. In vitro assays demonstrated maintenance of the MSC phenotype in the sheets, suggesting that short-term culturing of MSC sheets is not detrimental. To test their efficacy in vivo, allografts wrapped with MSC sheets were transplanted into 4-mm murine femoral defects and compared to allografts with direct seeding of MSCs and allografts without cells. Evaluations consisted of x-ray plain radiography, 3D microCT, histology, and biomechanical testing at 4- and 6-weeks post-surgery. Our findings demonstrate that MSC sheets induce prolonged cartilage formation at the graft-host junction and enhanced bone callus formation, as well as graft-host osteointegration. Moreover, a large periosteal callus was observed spanning the allografts with MSC sheets, which partially mimics live autograft healing. Finally, biomechanical testing showed a significant increase in the structural and functional properties of MSC sheet grafted femurs. Taken together, MSC sheets exhibit enhanced osteogenicity during critical sized bone defect repair, demonstrating the feasibility of this tissue engineering solution for massive allograft healing. PMID:24393269

  19. The effect of mesenchymal stem cell sheets on structural allograft healing of critical sized femoral defects in mice.

    PubMed

    Long, Teng; Zhu, Zhenan; Awad, Hani A; Schwarz, Edward M; Hilton, Matthew J; Dong, Yufeng

    2014-03-01

    Structural bone allografts are widely used in the clinic to treat critical sized bone defects, despite lacking the osteoinductive characteristics of live autografts. To address this, we generated revitalized structural allografts wrapped with mesenchymal stem/progenitor cell (MSC) sheets, which were produced by expanding primary syngenic bone marrow derived cells on temperature-responsive plates, as a tissue-engineered periosteum. In vitro assays demonstrated maintenance of the MSC phenotype in the sheets, suggesting that short-term culturing of MSC sheets is not detrimental. To test their efficacy in vivo, allografts wrapped with MSC sheets were transplanted into 4-mm murine femoral defects and compared to allografts with direct seeding of MSCs and allografts without cells. Evaluations consisted of X-ray plain radiography, 3D microCT, histology, and biomechanical testing at 4- and 6-weeks post-surgery. Our findings demonstrate that MSC sheets induce prolonged cartilage formation at the graft-host junction and enhanced bone callus formation, as well as graft-host osteointegration. Moreover, a large periosteal callus was observed spanning the allografts with MSC sheets, which partially mimics live autograft healing. Finally, biomechanical testing showed a significant increase in the structural and functional properties of MSC sheet grafted femurs. Taken together, MSC sheets exhibit enhanced osteogenicity during critical sized bone defect repair, demonstrating the feasibility of this tissue engineering solution for massive allograft healing.

  20. Differential gene expression pattern in biopsies with renal allograft pyelonephritis and allograft rejection.

    PubMed

    Oghumu, Steve; Nori, Uday; Bracewell, Anna; Zhang, Jianying; Bott, Cherri; Nadasdy, Gyongyi M; Brodsky, Sergey V; Pelletier, Ronald; Satoskar, Abhay R; Nadasdy, Tibor; Satoskar, Anjali A

    2016-09-01

    Differentiating acute pyelonephritis (APN) from acute rejection (AR) in renal allograft biopsies can sometimes be difficult because of overlapping clinical and histologic features, lack of positive urine cultures,and variable response to antibiotics. We wanted to study differential gene expression between AR and APN using biopsy tissue. Thirty-three biopsies were analyzed using NanoString multiplex platform and PCR (6 transplant baseline biopsies, 8 AR, 15 APN [8 culture positive, 7 culture negative], and 4 native pyelonephritis [NP]). Additional 22 biopsies were tested by PCR to validate the results. CXCL9, CXCL10, CXCL11, and IDO1 were the top differentially expressed genes, upregulated in AR. Lactoferrin (LTF) and CXCL1 were higher in APN and NP. No statistically significant difference in transcript levels was seen between culture-positive and culture-negative APN biopsies. Comparing the overall mRNA signature using Ingenuity pathway analysis, interferon-gamma emerged as the dominant upstream regulator in AR and allograft APN, but not in NP (which clustered separately). Our study suggests that chemokine pathways in graft APN may differ from NP and in fact resemble AR, due to a component of alloreactivity, resulting in variable response to antibiotic treatment. Therefore, cautious addition of steroids might help in resistant cases of graft APN.

  1. New advances in musculoskeletal pain

    PubMed Central

    Bove, Susan E.; Flatters, Sarah J.L.; Inglis, Julia J.; Mantyh, Patrick W.

    2015-01-01

    Non-malignant musculoskeletal pain is the most common clinical symptom that causes patients to seek medical attention and is a major cause of disability in the world. Musculoskeletal pain can arise from a variety of common conditions including osteoarthritis, rheumatoid arthritis, osteoporosis, surgery, low back pain and bone fracture. A major problem in designing new therapies to treat musculoskeletal pain is that the underlying mechanisms driving musculoskeletal pain are not well understood. This lack of knowledge is largely due to the scarcity of animal models that closely mirror the human condition which would allow the development of a mechanistic understanding and novel therapies to treat this pain. To begin to develop a mechanism-based understanding of the factors involved in generating musculoskeletal pain, in this review we present recent advances in preclinical models of osteoarthritis, post-surgical pain and bone fracture pain. The models discussed appear to offer an attractive platform for understanding the factors that drive this pain and the preclinical screening of novel therapies to treat musculoskeletal pain. Developing both an understanding of the mechanisms that drive persistent musculoskeletal pain and novel mechanism-based therapies to treat these unique pain states would address a major unmet clinical need and have significant clinical, economic and societal benefits. PMID:19166876

  2. Understanding the biomechanical nature of musculoskeletal tissue.

    PubMed

    Karduna, Andrew R

    2012-01-01

    This article provides a general overview of the biomechanical principles associated with hand therapy. Specifically, it reviews the basic topics of material properties (including both theoretical principles and practical concepts), static analysis (including forces, moments, muscle forces, and Newton's laws), and ends with a clinical example involving analysis of the risk of damage to the A3 pulley.

  3. Rheumatology and musculoskeletal medicine

    PubMed Central

    Davenport, Graham

    2004-01-01

    MUSCULOSKELETAL disease accounts for a large proportion of a general practitioner's (GP's) workload. Proper management can not only improve quality of care, but also increase job satisfaction and reap rewards under the new contract. Osteoporosis creates a huge socioeconomic burden of disease and disability. Identifying high-risk groups in primary care and using preventative treatment can result in a substantial reduction in morbidity and mortality. GPs can help by presenting a unified lifestyle message, advising on fall prevention, and providing effective treatment; in particular, calcium and vitamin D for female nursing home residents. Osteoarthritis is eminently treatable in primary care with a number of management options for GPs, in addition to drug therapy. Glucosamine and chondroitin have few side effects and are worth recommending to patients with mild knee osteoarthritis. Rheumatoid arthritis can cause significant disability, which can be limited by early diagnosis, referral, and treatment. Severe refractory rheumatoid arthritis may warrant referral for consideration of biologic therapy. Assessment of the cardiovascular risk and possible use of statins in rheumatoid patients may reduce their cardiovascular mortality. GPs should aim to help patients to achieve optimum quality of life by using a holistic approach and by allowing maximum choice and control over their disease. PMID:15186570

  4. Paediatric musculoskeletal interventional radiology.

    PubMed

    Natali, Gian L; Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo

    2016-01-01

    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.

  5. Extracorporeal shockwave therapy in musculoskeletal disorders.

    PubMed

    Wang, Ching-Jen

    2012-01-01

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  6. Helpful tips for performing musculoskeletal injections.

    PubMed

    Metz, John P

    2010-01-01

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection. PMID:20052957

  7. Musculoskeletal injections: a review of the evidence.

    PubMed

    Stephens, Mark B; Beutler, Anthony I; O'Connor, Francis G

    2008-10-15

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection. PMID:18953975

  8. Musculoskeletal mnemonics: differentiating features.

    PubMed

    Currie, Jonathan W; Davis, Kirkland W; Lafita, Vaishali S; Blankenbaker, Donna G; De Smet, Arthur A; Rosas, Humberto; Lee, Kenneth S

    2011-01-01

    Mnemonics are often used in musculoskeletal radiology to help radiologists remember long differential diagnoses. However, unless the specific appearance of each entity on a differential is also recalled, mnemonics become useless. This article presents 8 mnemonics with their corresponding differential diagnoses and distinguishing features. Bubbly lucent lesions of bone are recalled with the FEGNOMASHIC mnemonic, but when only lucent lesions of the diaphysis are included, a more appropriate mnemonic is FEMALE. The lucent lesions of bone differentials often can be narrowed based on specific characteristics of the lesion but radiographic findings elsewhere and clinical information often help. Osseous metastases may present as lucent or sclerotic lesions; when sclerotic, the differential is best remembered with the mnemonic 5 "BEES" Like Pollen. The mnemonic for Wormian bones is PORKCHOPS. The Wormian bones in most of these entities are indistinguishable, so one must rely on radiographic findings outside the skull for diagnosis. By contrast, differentiating causes of acro-osteolysis is often possible with findings seen only on the hand radiographs; the mnemonic for acro-osteolysis is RADSHIP. In skeletally immature patients with frayed metaphyses, the mnemonic is CHARMS. Although the appearance of the fraying is seldom diagnostic, findings in the adjacent portions of the long bones may be characteristic. FETISH is the mnemonic used to remember the entities for the differential diagnosis of vertebra plana. Age of the patient, clinical history, and findings in the adjacent spine often help to provide the specific diagnosis. Nearly all the entities on the differential diagnosis for distal clavicle erosion (mnemonic: SHIRT Pocket) are included in other differentials in this article. PMID:21266270

  9. Repair of a Gingival Fenestration Using an Acellular Dermal Matrix Allograft.

    PubMed

    Breault, Lawrence G; Brentson, Raquel C; Fowler, Edward B; Bisch, Frederick C

    2016-01-01

    A case report illustrating the successful treatment of a gingival fenestration with an acellular dermal matrix (ADM) allograft. After 2½ months of healing, the ADM was completely integrated into the soft tissues of the mandibular anterior gingiva with complete resolution of the gingival fenestration, resulting in excellent gingival esthetics. PMID:26874103

  10. A retrospective study on annual evaluation of radiation processing for frozen bone allografts complying to quality system requirements.

    PubMed

    Ramalingam, Saravana; Mohd, Suhaili; Samsuddin, Sharifah Mazni; Min, N G Wuey; Yusof, Norimah; Mansor, Azura

    2015-12-01

    Bone allografts have been used widely to fill up essential void in orthopaedic surgeries. The benefit of using allografts to replace and reconstruct musculoskeletal injuries, fractures or disease has obtained overwhelming acceptance from orthopaedic surgeons worldwide. However, bacterial infection and disease transmission through bone allograft transplantation have always been a significant issue. Sterilization by radiation is an effective method to eliminate unwanted microorganisms thus assist in preventing life threatening allograft associated infections. Femoral heads procured from living donors and long bones (femur and tibia) procured from cadaveric donors were sterilized at 25 kGy in compliance with international standard ISO 11137. According to quality requirements, all records of bone banking were evaluated annually. This retrospective study was carried out on annual evaluation of radiation records from 1998 until 2012. The minimum doses absorbed by the bones were ranging from 25.3 to 38.2 kGy while the absorbed maximum doses were from 25.4 to 42.3 kGy. All the bones supplied by our UMMC Bone Bank were sterile at the required minimum dose of 25 kGy. Our analysis on dose variation showed that the dose uniformity ratios in 37 irradiated boxes of 31 radiation batches were in the range of 1.003-1.251, which indicated the doses were well distributed. PMID:25687771

  11. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.

    PubMed

    Valenti, J R; Sala, D; Schweitzer, D

    1994-01-01

    A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.

  12. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.

    PubMed

    Valenti, J R; Sala, D; Schweitzer, D

    1994-01-01

    A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction. PMID:8002109

  13. Predicting the development of cardiac allograft vasculopathy.

    PubMed

    Seki, Atsuko; Fishbein, Michael C

    2014-01-01

    Cardiac transplantation is a lifesaving therapy for patients with end-stage cardiovascular disease. There has been remarkable progress in controlling acute rejection, and the early survival rate after the heart transplantation has significantly improved. Cardiac allograft vasculopathy (CAV) is one of the common causes of death and a major limiting factor for long-term graft survival years after heart transplantation. CAV is a progressive occlusion of arteries and veins of the transplanted heart. CAV is often clinically silent because of the denervation of the transplanted heart. CAV tends to be found at an advanced stage of disease, including myocardial infarction (MI), congestive heart failure, arrhythmia, and/or sudden cardiac death. Because of the serious sequelae of CAV, risk factors, prevention, and prediction of CAV have been investigated. Despite the effort by many researchers, the pathogenesis is not yet completely understood. There are a number of both immune and nonimmune factors in the donor and recipient that are related to the development of CAV. In addition, several biomarkers in blood and tissue are found to correlate with the presence of CAV, and that may be able to predict CAV. Here, we review the pathology, pathogenesis, risk factors, diagnosis, and the potential for prediction of CAV. PMID:24972526

  14. Arthroscopic Anatomic Humeral Head Reconstruction With Osteochondral Allograft Transplantation for Large Hill-Sachs Lesions

    PubMed Central

    Snir, Nimrod; Wolfson, Theodore S.; Hamula, Mathew J.; Gyftopoulos, Soterios; Meislin, Robert J.

    2013-01-01

    Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation. PMID:24266001

  15. Management of chronic musculoskeletal pain.

    PubMed

    Uhl, Richard L; Roberts, Timothy T; Papaliodis, Dean N; Mulligan, Michael T; Dubin, Andrew H

    2014-02-01

    Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain.

  16. Musculoskeletal involvement in systemic sclerosis.

    PubMed

    Randone, Silvia Bellando; Guiducci, Serena; Cerinic, Marco Matucci

    2008-04-01

    Musculoskeletal involvement is more frequent than expected in patients with systemic sclerosis (SSc) and is a major cause of disability, even if the prognosis of the disease largely depends on visceral involvement. The most common clinical feature of musculoskeletal involvement is arthralgia; less frequent features are arthritis, flexion contractures, stiffness (affecting predominantly fingers, wrists and ankles), proximal muscle weakness (mainly of the shoulder and hip) and tendon sheath involvement. Tendon friction rubs are predictive of poor prognosis. If musculoskeletal involvement is suspected, serum creatinine phosphokinase, aldolase, lactate dehydrogenase, alkaline phosphate, rheumatoid factor and anticyclic citrullinated peptide autoantibodies should be checked routinely. Treatment for muscle involvement has not yet been considered adequately and, in the future, it is to be hoped that clinical trials will identify new drugs to control this aspect of SSc, which seriously compromises patients' quality of life. PMID:18455689

  17. Musculoskeletal ageing and primary prevention.

    PubMed

    Nedergaard, Anders; Henriksen, Kim; Karsdal, Morten A; Christiansen, Claus

    2013-10-01

    Loss of musculoskeletal mass and function is a natural ageing trait, reinforced by an unhealthy life style. Loss of bone (osteoporosis) and muscle (sarcopaenia) are conditions whose prevalence are increasing because of the change in population distribution in the western world towards an older mean age. Improvements in lifestyle factors, such as diet, smoking and exercise, are the most powerful tools to combat this decline efficiently; however, public health interventions aimed at tackling these problems have shown abysmal success at the population level, mostly due to failure in compliance. With these issues in mind, we believe that the primary prevention modality in coming decades will be pharmacological. We review the basic biology of musculoskeletal ageing and what measures can be taken to prevent ageing-associated loss of musculoskeletal mass and function, with particular emphasis on pharmacological means.

  18. Computational Biology: Modeling Chronic Renal Allograft Injury.

    PubMed

    Stegall, Mark D; Borrows, Richard

    2015-01-01

    New approaches are needed to develop more effective interventions to prevent long-term rejection of organ allografts. Computational biology provides a powerful tool to assess the large amount of complex data that is generated in longitudinal studies in this area. This manuscript outlines how our two groups are using mathematical modeling to analyze predictors of graft loss using both clinical and experimental data and how we plan to expand this approach to investigate specific mechanisms of chronic renal allograft injury.

  19. Treatment of lymphocele in renal allograft recipients.

    PubMed

    Greenberg, B M; Perloff, L J; Grossman, R A; Naji, A; Barker, C F

    1985-04-01

    Retroperitoneal lymphoceles developed in 12 renal allograft recipients during the last nine years. The interval between transplantation and the development of symptoms averaged seven months. The specific syndrome suggesting the presence of a lymphocele included lower abdominal swelling, weight gain, and, occasionally, fever without an obvious source of infection. Although these symptoms mimicked allograft rejection, diagnosis was easily made by ultrasound and intravenous pyelogram. Surgical marsupialization of the lymphocele with drainage into the peritoneal cavity proved to be an effective treatment.

  20. Kidney injury molecule-1 expression is closely associated with renal allograft damage.

    PubMed

    Song, Lianlian; Xue, Lijuan; Yu, Jinyu; Zhao, Jun; Zhang, Wenlan; Fu, Yaowen

    2013-08-01

    The aim of our study was to investigate the expression of kidney injury molecule-1 (KIM-1) in renal allograft biopsy samples and assess the clinical significance of its use as a biomarker for tissue damage. A total of 69 renal allograft biopsy samples from 17 patients with normal serum creatinine and 52 cases of increased serum creatinine were collected. They were divided into different groups according to the Banff 2007 diagnostic criteria. KIM-1 expression was detected by immunohistochemical methods and the association of KIM-1 and blood biochemical indexes was analyzed. KIM-1 expression increased as Banff 2007 classification grade increased and was positively correlated with tubular inflammation severity in the acute T-cell rejection group. Moreover, KIM-1 expression was strongly positive in the chronic active antibody-mediated rejection group. Interestingly, KIM-1 was weakly positive in the normal group without obvious acute rejection and injury of immunosuppressant toxicity. In this group, 27.3% (3/11) of the cases with normal serum creatinine level showed weakly positive KIM-1 expression in their renal tissues. KIM-1 expression level is positively correlated with renal allograft damage and tubular cell injury. KIM-1 is expressed in tubular epithelial cells before blood biochemical indexes become elevated and morphological changes occur. KIM-1 expression is an early, sensitive, and specific biomarker to determine renal tubular epithelial cell injury in renal allograft tissue.

  1. Rinsing of allograft bone does not improve implant fixation

    PubMed Central

    2013-01-01

    Background and purpose Impacted morselized allograft bone is a well-established method for reconstructing bone defects at revision surgery. However, the incorporation of bone graft is not always complete, and a substantial volume of fibrous tissue has been found around grafted implants. We hypothesized that rinsing the bone graft may improve graft incorporation by removing the majority of immunogenic factors present in blood, marrow, and fat. Methods We implanted a cylindrical (10- × 6-mm) porous-coated Ti implant into each proximal tibia of 12 dogs. The implants were surrounded by a 2.5-mm gap into which morselized fresh frozen allograft bone was impacted. The bone graft was either (1) untreated or (2) rinsed in 37°C saline for 3 × 1 min. After 4 weeks, the animals were killed and implant fixation was evaluated by mechanical push-out and histomorphometry. Results The groups (rinsed vs. control) were similar regarding mechanical implant fixation (mean (SD)): shear strength (MPa) 2.7 (1.0) vs. 2.9 (1.2), stiffness (MPa/mm) 15 (6.7) vs. 15 (5.6), and energy absorption (kJ/m2) 0.5 (0.2) vs. 0.6 (0.4), The same was evident for the new bone formation on the implant surface and around the implant: ongrowth (%) 6 vs. 7 and ingrowth (%) 9 vs. 9. Although not statistically significant, a 61% reduction in fibrous tissue ongrowth and 50% reduction in ingrowth were found in the rinsed group. Interpretation Within the limits of this experimental model, we did not detect any benefits of rinsing morselized allograft bone prior to impaction grafting. PMID:23621809

  2. Musculoskeletal Fitness and Risk of Mortality.

    ERIC Educational Resources Information Center

    Katzmarzyk, Peter T.; Craig, Cora L.

    2002-01-01

    Quantified the relationship between musculoskeletal fitness and all-cause mortality in Canada, using measures of musculoskeletal fitness (situps, pushups, grip strength, and sit- and-reach trunk flexibility) from adult male and female participants in the Canadian Fitness Survey. Results indicated that some components of musculoskeletal fitness,…

  3. Transplantation of cryopreserved canine venous allografts.

    PubMed

    Bank, H L; Schmehl, M K; Warner, R; Pratt, M F; Albernaz, M S; Metcalf, J S; Darcy, M

    1991-01-01

    Local vascular reconstructions frequently require the use of vein grafts to bridge arterial or venous defects. Most previous studies on the use of cryopreserved veins have used relatively large caliber vessels. There have been few studies on the effectiveness of cryopreserved micro- or small-venous allografts. Here, we tested two types of cryopreserved venous allografts: (1) 1.5- to 1.9-mm diameter microvenous grafts (MVG); and (2) 4- to 5-mm diameter small venous grafts (SVG). Cryopreserved MVG allografts were placed into saphenous arteries of six experimental dogs and SVG cryopreserved allografts were placed into femoral arteries of six experimental dogs for 3 to 6 weeks. Two fresh MVG autografts were also transplanted into experimental dogs as controls and autografts were transferred to the contralateral side in SVG dogs as controls. None of the six cryopreserved MVG grafts retained patency but three/six cryopreserved SVG allografts were patent at harvest. Histological examination of grfts revealed control autografts were undergoing arterialization with an intact intima. Experimental cryopreserved allografts showed extensive medial fibrosis, significant lymphocytic infiltrates, and sporadic areas of intact intima for both patent and nonpatent grafts.

  4. Electrical stimulation: Its role in growth, repair and remodeling of the musculoskeletal system

    SciTech Connect

    Black, J.

    1986-01-01

    This book examines the increasingly popular field of electrical stimulation of lesions of the musculoskeletal system, exploring its use in both research and treatment. The book describes clinical experience with electrical stimulation in orthopedic, neuro- and plastic surgery, biological sources of electrical signals, and electromechanical characterization of tissues. Contents include: growth; remodeling and repair; electricity and magnetism; electrical properties of tissues; natural electrical signals in the musculoskeletal system; methods for stimulating tissues; cell, tissue and organ culture; animal studies; clinical applications; overview and a glossary.

  5. Sickness absence due to musculoskeletal diagnoses and risk of diagnosis-specific disability pension: a nationwide Swedish prospective cohort study.

    PubMed

    Jansson, Catarina; Alexanderson, Kristina

    2013-06-01

    Musculoskeletal disorders constitute major public health problems. Few studies have, however, examined risk of disability pension among persons sickness absent due to musculoskeletal diagnoses. Thus, we constructed a prospective nationwide population-based cohort study based on Swedish registers, consisting of all 4,687,756 individuals living in Sweden December 31, 2004/2005, aged 20-64 years, who were not on disability or old-age pension. Those individuals who were sickness absent in 2005 due to musculoskeletal diagnoses were compared to those sickness absent due to non-musculoskeletal diagnoses and those with no sickness absence. Musculoskeletal diagnoses were categorized as follows: 1) artropathies/systemic connective tissue disorders, 2) dorsopathies, and 3) soft tissue disorders/osteopathies/chondropathies/other musculoskeletal disorders. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2009. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. In models adjusted for socio-demographic factors and morbidity, sickness absence due to all categories of musculoskeletal diagnoses was associated with 12- to 18-fold increased risks of all-cause disability pension (adjusted model, category 2 diagnoses, IRR = 18.57, 95% CI = 18.18-18.97). Similar associations were observed among both women and men sickness absent due to all 3 musculoskeletal diagnostic categories. Moreover, increased risks of disability pension because of cancer, mental, circulatory and musculoskeletal diagnoses were observed among individuals sickness absent because of any musculoskeletal diagnostic category (disability pension due to musculoskeletal diagnoses, adjusted model, category 2 diagnoses, IRR = 50.66, 95% CI = 49.06-52.32). In conclusion, this nationwide cohort study reveals strongly increased risks of all-cause and diagnosis-specific disability pension among those sickness absent due to

  6. Musculoskeletal problems in stroke survivors.

    PubMed

    Kendall, Richard

    2010-01-01

    Musculoskeletal problems in stoke survivors are common reasons for disability and pain. Shoulder pain is present in 24% of stroke survivors among all complications, second only to depression in 26%. Diagnosis and treatment of the various shoulder pain etiologies can significantly improve quality of life in these patients. This article reviews the common etiologies and treatments of shoulder and hip pain in stroke survivors.

  7. Noninvasive allograft imaging of acute rejection: evaluation of (131)I-anti-CXCL10 mAb.

    PubMed

    Cheng, Dayan; Sun, Hukui; Liang, Ting; Zhang, Chao; Song, Jing; Hou, Guihua

    2015-02-01

    The purpose of this study was to investigate the use of iodine-131-labeled anti-CXCL10 mAb as tracer targeted at CXCL10 to detect acute rejection (AR) with mice model. Expression of CXCL10 was proved by RT-PCR, ELISA, and immunochemistry staining. All groups were submitted to whole-body autoradioimaging and ex vivo biodistribution studies after tail vein injection of (131)I-anti-CXCL10 mAb. The highest concentration/expression of CXCL10 was detected in allograft tissue compared with allograft treated with tacrolimus and isograft control. Tacrolimus could obviously inhibit the rejection of allograft. Allograft could be obviously imaged at all checking points, much clearer than the other two groups. The biodistribution results showed the highest uptake of radiotracer in allograft. T/NT (target/nontarget) ratio was 4.15 ± 0.25 at 72 h, apparently different from allograft treated with tacrolimus (2.29 ± 0.10), P < 0.05. These data suggest that CXCL10 is a promising target for early stage AR imaging and (131)I-CXCL10 mAb can successfully image AR and monitor the effect of immunosuppressant.

  8. Musculoskeletal diseases—tendon

    PubMed Central

    Sakabe, Tomoya; Sakai, Takao

    2011-01-01

    Introduction Tendons establish specific connections between muscles and the skeleton by transferring contraction forces from skeletal muscle to bone thereby allowing body movement. Tendon physiology and pathology are heavily dependent on mechanical stimuli. Tendon injuries clinically represent a serious and still unresolved problem since damaged tendon tissues heal very slowly and no surgical treatment can restore a damaged tendon to its normal structural integrity and mechanical strength. Understanding how mechanical stimuli regulate tendon tissue homeostasis and regeneration will improve the treatment of adult tendon injuries that still pose a great challenge in today's medicine. Source of data This review summarizes the current status of tendon treatment and discusses new directions from the point of view of cell-based therapy and regenerative medicine approach. We searched the available literature using PubMed for relevant original articles and reviews. Growing points Identification of tendon cell markers has enabled us to study precisely tendon healing and homeostasis. Clinically, tissue engineering for tendon injuries is an emerging technology comprising elements from the fields of cellular source, scaffold materials, growth factors/cytokines and gene delivering systems. Areas timely for developing research The clinical settings to establish appropriate microenvironment for injured tendons with the combination of these novel cellular- and molecular-based scaffolds will be critical for the treatment. PMID:21729872

  9. Musculoskeletal disorders in farmers and farm workers.

    PubMed

    Walker-Bone, K; Palmer, K T

    2002-12-01

    Farming is a physically arduous occupation and this places farm workers at potential risk of musculoskeletal disorders such as osteoarthritis (OA) of the hip and knee, low back pain (LBP), neck and upper limb complaints, and hand-arm vibration syndrome (HAVS). This review considers the epidemiological evidence concerning such risks. The strongest evidence relates to OA of the hip, for which the public health impact is likely to be considerable. There is also weaker, but suggestive evidence that farmers more often have knee OA and LBP than workers in occupations with fewer physical demands. Tractor drivers, in particular, seem to have more LBP. Relatively little information exists on the risks of soft tissue rheumatism in the limbs and neck. For some outcomes, the link with occupational risk factors (such as heavy loading of joints and whole-body vibration) is sufficient to suggest the course that future prevention should take, but for several outcomes more research is first needed. PMID:12488514

  10. Musculoskeletal scintigraphy of the equine athlete.

    PubMed

    Dyson, Sue

    2014-01-01

    Nuclear scintigraphic examination of equine athletes has a potentially important role in the diagnosis of lameness or poor performance, but increased radiopharmaceutical uptake (IRU) is not necessarily synonymous with pain causing lameness. Nuclear scintigraphy is highly sensitive to changes in bone turnover that may be induced by loading and knowledge of normal patterns of RU is crucial for accurate diagnosis. Blood pool images can be useful for identification of some soft tissue injuries, although acute bone injuries may also have intense IRU in blood pool images. Some muscle injuries may be associated with IRU in bone phase images. The use of scintigraphy together with other diagnostic imaging modalities has helped us to better understand the mechanisms of some musculoskeletal injuries. In immature racehorses, stress-related bone injury is a common finding and may be multifocal, whereas in mature sport horses, a very different spectrum of injuries may be identified. False-negative results are common with some injuries.

  11. Usefulness of strain elastography of the musculoskeletal system

    PubMed Central

    2016-01-01

    Ultrasound elastography is a widely used technique for assessing the mechanical characteristics of tissues. Although there are several ultrasound elastography techniques, strain elastography (SE) is currently the most widely used technique for visualizing an elastographic map in real time. Among its various indications, SE is especially useful in evaluating the musculoskeletal system. In this article, we review the SE techniques for clinical practice and describe the images produced by these techniques in the context of the musculoskeletal system. SE provides information about tissue stiffness and allows real-time visualization of the image; however, SE cannot completely replace gray-scale, color, or power Doppler ultrasonography. SE can increase diagnostic accuracy and may be useful for the follow-up of benign lesions. PMID:26810195

  12. Current Safety of Renal Allograft Biopsy With Indication in Adult Recipients: An Observational Study.

    PubMed

    Tsai, Shang-Feng; Chen, Cheng-Hsu; Shu, Kuo-Hsiung; Cheng, Chi-Hung; Yu, Tung-Min; Chuang, Ya-Wen; Huang, Shih-Ting; Tsai, Jun-Li; Wu, Ming-Ju

    2016-02-01

    Renal biopsy remains the golden standard diagnosis of renal function deterioration. The safety in native kidney biopsy is well defined. However, it is a different story in allograft kidney biopsy. We conduct this retrospective study to clarify the safety of allograft kidney biopsy with indication.All variables were grouped by the year of biopsy and they were compared by Mann-Whitney U test (for continuous variables) or Chi-square test (for categorical variables). We collected possible factors associated with complications, including age, gender, body weight, renal function, cause of uremia, status of coagulation, hepatitis, size of needle, and immunosuppressants.We recruited all renal transplant recipients undergoing allograft biopsy between January of 2009 and December of 2014. This is the largest database for allograft kidney biopsy with indication. Of all the 269 biopsies, there was no difference in occurrence among the total 14 complications (5.2%) over these 6 years. There were only 3 cases of hematomas (1.11%), 6 gross hematuria (2.23%), 1 hydronephrosis (0.37%), and 2 hemoglobin decline (0.74%). The outcome of this cohort is the best compared to all other studies, and it is even better than the allograft protocol kidney biopsy. Among all possible factors, patients with pathological report containing "medullary tissue only" were susceptible to complications (P < 0.001, 1.8 of relative risk).In modern era, this study demonstrates the safety of allograft kidney biopsy with indication. Identifying the renal capsule before biopsy to avoid puncture into medulla is the most important element to prevent complications. PMID:26871853

  13. Radionuclide surveillance of the allografted pancreas

    SciTech Connect

    George, E.A.; Salimi, Z.; Carney, K.; Castaneda, M.; Garvin, P.J.

    1988-04-01

    To determine the value of scintigraphy to detect posttransplantation complications of the allografted pancreas, we retrospectively reviewed 209 scintigrams obtained with /sup 99m/Tc-sulfur colloid (/sup 99m/Tc-SC) and /sup 99m/Tc-glucoheptonate (/sup 99m/Tc-GH). The scintigraphic studies were performed in 37 recipients of simultaneous renal and pancreatic allografts harvested from the same donor. /sup 99m/Tc-SC was used as an indicator of thrombotic vasculitis; pancreatic perfusion and blood-pool parameters were monitored with /sup 99m/Tc-GH. In 11 of the 37 recipients, scintigraphic abnormalities suggested posttransplantation infarction. Recurrent episodes of acute rejection of the pancreatic allograft, which always coincided with acute rejection of the renal allograft, were monitored in 24 recipients. Rejection-induced ischemic pancreatitis was suggested in 12 of the 24 recipients and persisted in 10 recipients for several weeks after improvement of renal allograft rejection. Pancreatic atrophy was suggested scintigraphically in 16 of the 24 recipients with recurrent episodes of rejection. Spontaneous pancreatic-duct obstruction and obstructive pancreatitis were associated with a scintigraphic pattern similar to that of rejection-induced ischemic pancreatitis. We concluded that the specific radionuclides used in this series are useful for the surveillance and assessment of posttransplantation pancreatic infarction, acute rejection, pancreatitis, and atrophy

  14. Transient mixed chimerism for allograft tolerance.

    PubMed

    Oura, Tetsu; Hotta, Kiyohiko; Cosimi, A B; Kawai, Tatsuo

    2015-04-01

    Mixed chimerism discovered in Freemartin cattle by Ray Owen 70 years ago paved the way for research on immune tolerance. Since his discovery, significant progress has been made in the effort to induce allograft tolerance via mixed chimerism in various murine models. However, induction of persistent mixed chimerism has proved to be extremely difficult in major histocompatibility complex mismatched humans. Chimerism induced in humans tends to either disappear or convert to full donor chimerism, depending on the intensity of the conditioning regimen. Nevertheless, our studies in both NHPs and humans have clearly demonstrated that renal allograft tolerance can be induced by transient mixed chimerism. Our studies have shown that solid organ allograft tolerance via transient mixed chimerism 1) requires induction of multilineage hematologic chimerism, 2) depends on peripheral regulatory mechanisms, rather than thymic deletion, for long-term maintenance, 3) is organ specific (kidney and lung but not heart allograft tolerance are feasible). A major advantage of tolerance induction via transient mixed chimerism is exclusion of the risk of graft-versus-host disease. Our ongoing studies are directed toward improving the consistency of tolerance induction, reducing the morbidity of the conditioning regimen, substituting clinically available agents, such as Belatacept for the now unavailable anti-CD2 monoclonal antibody, and extending the protocol to recipients of deceased donor allografts.

  15. Thrombotic microangiopathy in renal allografts

    PubMed Central

    Radha, S.; Tameem, Afroz; Sridhar, G.; Aiyangar, A.; Rajaram, K. G.; Prasad, R.; Kiran, K.

    2014-01-01

    Thrombotic microangiopathy (TMA) is a serious complication of renal transplantation. It is a morphological expression of various etiological factors. In a renal allograft, TMA can occur de novo or be a recurrent disease. The aim of this study was to analyze the etiological factors and observe the changing trends of TMA with respect to emerging new etiological factors. We evaluated 131 graft biopsies over a period of 2½ years (2010-2012). All the renal biopsies were formalin fixed, paraffin embedded. Twenty serial sections were studied. Stains routinely used were Hematoxylin and Eosin, Periodic Acid Schiff, Massons Trichrome and Silver Methenamine stains. C4d by immunohistochemical method was done on all graft biopsies. Incidence of TMA in our series was 9.1%. Out of the 12 cases, five were associated with calcineurin inhibitor toxicity, three were diagnosed as acute antibody-mediated rejection, and two were recurrent haemolytic uremic syndrome. One patient developed haemolytic uremic syndrome on treatment with sirolimus and one patient was cytomegalovirus positive on treatment with ganciclovir, developed haemolytic uremic syndrome during treatment course. This study describes a spectrum of etiological factors for thrombotic mciroangiopathy ranging from common cause like calcineurin inhibitor toxicity to rare cause like ganciclovir induced TMA. PMID:24574627

  16. Thrombotic microangiopathy in renal allografts.

    PubMed

    Radha, S; Tameem, Afroz; Sridhar, G; Aiyangar, A; Rajaram, K G; Prasad, R; Kiran, K

    2014-01-01

    Thrombotic microangiopathy (TMA) is a serious complication of renal transplantation. It is a morphological expression of various etiological factors. In a renal allograft, TMA can occur de novo or be a recurrent disease. The aim of this study was to analyze the etiological factors and observe the changing trends of TMA with respect to emerging new etiological factors. We evaluated 131 graft biopsies over a period of 2½ years (2010-2012). All the renal biopsies were formalin fixed, paraffin embedded. Twenty serial sections were studied. Stains routinely used were Hematoxylin and Eosin, Periodic Acid Schiff, Massons Trichrome and Silver Methenamine stains. C4d by immunohistochemical method was done on all graft biopsies. Incidence of TMA in our series was 9.1%. Out of the 12 cases, five were associated with calcineurin inhibitor toxicity, three were diagnosed as acute antibody-mediated rejection, and two were recurrent haemolytic uremic syndrome. One patient developed haemolytic uremic syndrome on treatment with sirolimus and one patient was cytomegalovirus positive on treatment with ganciclovir, developed haemolytic uremic syndrome during treatment course. This study describes a spectrum of etiological factors for thrombotic mciroangiopathy ranging from common cause like calcineurin inhibitor toxicity to rare cause like ganciclovir induced TMA.

  17. The microextraction of RNA from archival cardiac allografts embedded in paraffin.

    PubMed

    Bledsoe, Brian; Groshart, Kenneth; Zhang, Quaing; Quasney, Michael; Dosanjh, Amrita

    2004-10-01

    One of the difficulties encountered in studying rejection in patients is the availability of tissue. The goal of our study was to isolate RNA from archival allograft tissue, and to demonstrate that it is of suitable quality for further molecular experimentation. Thirty-two paraffin embedded cardiac and five renal allograft archival samples were obtained after IRB approval, from a total of 18 transplant patients (13 cardiac/five renal transplant patients) from a search of the University of Tennessee's teaching hospitals. RNA was extracted from the paraffin blocks and amplified by reverse transcription-polymerase chain reaction (RT-PCR). Grade 3A and higher and non-rejection samples were tested. In addition, normal mouse liver tissue was isolated for comparison. Negative control samples were also included. RT-PCR amplification of 18s RNA, 324 bp target sequences, revealed readily detectable bands. Only one block that was 3 years old did not yield detectable RNA secondary to presumed degradation. The negative control showed no bands at 324 bp. We conclude that RNA from archived allograft tissue can be used for further experiments. The use of this tissue offers some distinct advantages when studying correlation of gene expression with clinical outcome and therapeutic response.

  18. Sterilization of allograft bone: is 25 kGy the gold standard for gamma irradiation?

    PubMed

    Nguyen, Huynh; Morgan, David A F; Forwood, Mark R

    2007-01-01

    For several decades, a dose of 25 kGy of gamma irradiation has been recommended for terminal sterilization of medical products, including bone allografts. Practically, the application of a given gamma dose varies from tissue bank to tissue bank. While many banks use 25 kGy, some have adopted a higher dose, while some choose lower doses, and others do not use irradiation for terminal sterilization. A revolution in quality control in the tissue banking industry has occurred in line with development of quality assurance standards. These have resulted in significant reductions in the risk of contamination by microorganisms of final graft products. In light of these developments, there is sufficient rationale to re-establish a new standard dose, sufficient enough to sterilize allograft bone, while minimizing the adverse effects of gamma radiation on tissue properties. Using valid modifications, several authors have applied ISO standards to establish a radiation dose for bone allografts that is specific to systems employed in bone banking. These standards, and their verification, suggest that the actual dose could be significantly reduced from 25 kGy, while maintaining a valid sterility assurance level (SAL) of 10(-6). The current paper reviews the methods that have been used to develop radiation doses for terminal sterilization of medical products, and the current trend for selection of a specific dose for tissue banks. PMID:16821106

  19. Palliative Care in Musculoskeletal Oncology.

    PubMed

    Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar

    2016-01-01

    Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251

  20. Theories of musculoskeletal injury causation.

    PubMed

    Kumar, S

    2001-01-15

    Based on the scientific evidence in published literature about precipitation of musculoskeletal injuries in the workplace, four theories have been proposed to explain these afflictions. Central to all theories is the presupposition that all occupational musculoskeletal injuries are biomechanical in nature. Disruption of mechanical order of a biological system is dependent on the individual components and their mechanical properties. These common denominators will be causally affected by the individual's genetic endowment, morphological characteristics and psychosocial makeup, and by the occupational biomechanical hazards. This phenomenon is explained by the Multivariate Interaction Theory. Differential Fatigue Theory accounts for unbalanced and asymmetric occupational activities creating differential fatigue and thereby a kinetic and kinematic imbalance resulting in injury precipitation. Cumulative Load Theory suggests a threshold range of load and repetition product beyond which injury precipitates, as all material substances have a finite life. Finally, Overexertion Theory claims that exertion exceeding the tolerance limit precipitates occupational musculoskeletal injury. It is also suggested that while these theories may explain the immediate mechanism of precipitation of injuries, they all operate simultaneously and interact to modulate injuries to varying degrees in different cases.

  1. Palliative Care in Musculoskeletal Oncology

    PubMed Central

    Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar

    2016-01-01

    Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251

  2. Decreasing latitude and increasing regulation in transplantable tissue programs.

    PubMed

    Humphries, Linda

    2005-11-01

    ADVANCED TECHNOLOGY and improved surgical techniques have led to new therapeutic uses for allografts. DISEASE TRANSMISSION via allograft tissue transplants has prompted federal intervention in the tissue banking industry and resulted in federal regulations. NEW STANDARDS from the Joint Commission on Accreditation of Healthcare Organizations became effective July 1, 2005, and apply to all hospitals that store or implant allograft tissues. These standards include mandatory policies on all aspects of hospital transplantation programs, including tissue ordering, receipt, storage, issuance, and record keeping. PMID:16355937

  3. Bone graft substitute: allograft and xenograft.

    PubMed

    Shibuya, Naohiro; Jupiter, Daniel C

    2015-01-01

    Rapid bone graft incorporation for structural rigidity is essential. Early range of motion, exercise, and weight-bearing are keys to rehabilitation. Structural and nonstructural bone grafts add length, height, and volume to alter alignment, function, and appearance. Bone graft types include: corticocancellous autograft, allograft, xenograft, and synthetic graft. Autogenic grafts are harvested from the patient, less likely to be rejected, and more likely to be incorporated; however, harvesting adds a procedure and donor site complication is common. Allografts, xenografts, and synthetic grafts eliminate secondary procedures and donor site complications; however, rejection and slower incorporation can occur.

  4. Sterilization effects on the mechanical properties of human bone-patellar tendon-bone allografts.

    PubMed

    Reid, James; Sikka, Robby; Tsoi, William; Narvy, Steven J; Hedman, Thomas; Lee, Thay Q; Vangsness, C Thomas

    2010-04-01

    Novel allograft processing methods are available from tissue banks to decrease disease transmission. This study evaluated the effects of 3 of these techniques on the initial mechanical properties of bone-patellar tendon-bone (BPTB) allografts: (1) aseptic harvest with low-dose radiation processing, (2) BioCleanse Tissue Processing System, and (3) Clearant Process. Ten-mm BPTB allografts were potted in an MTS 858 machine (MTS Systems Corp, Eden Prairie, Minnesota), cycled, and loaded to failure at a strain rate of 100%/s. Data were critically analyzed for graft dimensions and age and sex of donor. The 10th cycle and last cycle stiffness after 1000 cycles were measured at the toe region and at all points. The 2% yield stress (MPa), Young's modulus (MPa), elongation failure (mm), strain fracture (%), ultimate stress (MPa), and toughness (kJ) were measured. Forty-two tendons were tested (15 control, 11 BioCleanse, and 16 Clearant). No statistically significant differences were detected between the groups at their 10th cycle and last cycle stiffness (P>.05). Yield stress ranged from 19 to 28.8 MPa without a statistically significant difference (P>.05). Young's modulus ranged from 178.3 to 213.8 MPa without a statistically significant difference (P>.05). Similarly, elongation to failure, strain to failure, ultimate stress, and toughness showed no statistically significant differences among the 3 groups (P>.05). These processing techniques did not affect the time zero mechanical properties of the BPTB allograft tendons under these testing conditions. Clinical use of allografts should proceed with caution for selected patients.

  5. Renal medullary changes in renal allograft recipients with raised serum creatinine

    PubMed Central

    Sis, B; Sarioglu, S; Celik, A; Kasap, B; Yildiz, S; Kavukcu, S; Gulay, H; Camsari, T

    2006-01-01

    Objective To test the hypothesis that the renal medulla may reflect rejection related changes and thus have a predictive value in the assessment of acute renal allograft rejection or chronic graft damage. Methods 75 post‐transplant biopsies from 57 patients were scored according to the Banff 1997 scheme. The biopsies with adequate cortical and medullary tissue (n = 23) were selected and medullary tissues were reviewed for rejection related lesions except intimal arteritis. Chronic damage was determined by image analysis depending on periodic acid‐methenamine silver (PAMS)‐Masson trichrome (MT) staining. Medullary and cortical changes were compared. Results Interstitial inflammation and tubulitis were more frequent and severe in the cortex (p<0.001). Medullary tubulitis was associated with intimal arteritis (p = 0.003, r = 0.598). Medullary interstitial inflammation (n = 8) and tubulitis (n = 4) were associated with cortical borderline changes (n = 5) or allograft rejection (n = 3). The sensitivity, specificity, and positive and negative predictive values of medullary inflammatory changes in predicting cortical allograft rejection were 43%, 69%, 37%, and 73%, respectively. A significant association was observed between medullary MT‐SAP and cortical PAMS‐SAP values (p = 0.02, R2 = 0.23). Conclusions Acute rejection related lesions are more common and severe in the cortex, and the renal medulla does not sufficiently reflect cortical rejection. The positive and negative predictive values of medullary changes for allograft rejection are low, and medullary inflammation is not a reliable indicator of allograft rejection. Increased medullary fibrosis is correlated with chronic cortical damage. PMID:16461569

  6. Allograft rejection in cattle with bovine leukocyte adhesion deficiency.

    PubMed

    Müller, K E; Rutten, V P; Becker, C K; Hoek, A; Bernadina, W E; Wentink, G H; Figdor, C G

    1995-09-01

    In the present investigation cell-mediated immunity in animals with bovine leukocyte adhesion deficiency (BLAD) was studied by means of skin transplantation experiments. Autograft and allograft behaviour in animals with BLAD was compared with the behaviour of simultaneously transplanted autografts and allografts in healthy controls. Allograft survival time was prolonged in three BLAD cattle (28, 30, and 72 days) compared to six healthy controls (12-14 days). When transplantations were repeated on one animal with BLAD using skin grafts from the same donor, accelerated rejection was observed (allograft survival time decreased from 72 days at primary to 35 days at secondary and to 21 days at tertiary transplantation), suggesting the development of immunological memory. Graft-infiltrating lymphocytes that were obtained from allograft biopsies during the period of rejection, were shown to be from recipient origin (beta 2-integrin negative). Our findings demonstrate that, although prolonged allograft survival is observed in cattle with BLAD, skin allografts are ultimately rejected. PMID:8533316

  7. Ischemia-Reperfusion Injury Enhances Lymphatic Endothelial VEGFR3 and Rejection in Cardiac Allografts.

    PubMed

    Dashkevich, A; Raissadati, A; Syrjälä, S O; Zarkada, G; Keränen, M A I; Tuuminen, R; Krebs, R; Anisimov, A; Jeltsch, M; Leppänen, V-M; Alitalo, K; Nykänen, A I; Lemström, K B

    2016-04-01

    Organ damage and innate immunity during heart transplantation may evoke adaptive immunity with serious consequences. Because lymphatic vessels bridge innate and adaptive immunity, they are critical in immune surveillance; however, their role in ischemia-reperfusion injury (IRI) in allotransplantation remains unknown. We investigated whether the lymphangiogenic VEGF-C/VEGFR3 pathway during cardiac allograft IRI regulates organ damage and subsequent interplay between innate and adaptive immunity. We found that cardiac allograft IRI, within hours, increased graft VEGF-C expression and lymphatic vessel activation in the form of increased lymphatic VEGFR3 and adhesion protein expression. Pharmacological VEGF-C/VEGFR3 stimulation resulted in early lymphatic activation and later increase in allograft inflammation. In contrast, pharmacological VEGF-C/VEGFR3 inhibition during cardiac allograft IRI decreased early lymphatic vessel activation with subsequent dampening of acute and chronic rejection. Genetic deletion of VEGFR3 specifically in the lymphatics of the transplanted heart recapitulated the survival effect achieved by pharmacological VEGF-C/VEGFR3 inhibition. Our results suggest that tissue damage rapidly changes lymphatic vessel phenotype, which, in turn, may shape the interplay of innate and adaptive immunity. Importantly, VEGF-C/VEGFR3 inhibition during solid organ transplant IRI could be used as lymphatic-targeted immunomodulatory therapy to prevent acute and chronic rejection. PMID:26689983

  8. Musculoskeletal adaptations to weightlessness and development of effective countermeasures

    NASA Technical Reports Server (NTRS)

    Baldwin, K. M.; White, T. P.; Arnaud, S. B.; Edgerton, V. R.; Kraemer, W. J.; Kram, R.; Raab-Cullen, D.; Snow, C. M.

    1996-01-01

    A Research Roundtable, organized by the American College of Sports Medicine with sponsorship from the National Aeronautics and Space Administration, met in November 1995 to define research strategies for effective exercise countermeasures to weightlessness. Exercise was considered both independently of, and in conjunction with, other therapeutic modalities (e.g., pharmacological nutritional, hormonal, and growth-related factors) that could prevent or minimize the structural and functional deficits involving skeletal muscle and bone in response to chronic exposure to weightlessness, as well as return to Earth baseline function if a degree of loss is inevitable. Musculoskeletal deficits and countermeasures are described with respect to: 1) muscle and connective tissue atrophy and localized bone loss, 2) reductions in motor performance, 3) potential proneness to injury of hard and soft tissues, and 4) probable interaction between muscle atrophy and cardiovascular alterations that contribute to the postural hypotension observed immediately upon return from space flight. In spite of a variety of countermeasure protocols utilized previously involving largely endurance types of exercise, there is presently no activity-specific countermeasure(s) that adequately prevent or reduce musculoskeletal deficiencies. It seems apparent that countermeasure exercises that have a greater resistance element, as compared to endurance activities, may prove beneficial to the musculoskeletal system. Many questions remain for scientific investigation to identify efficacious countermeasure protocols, which will be imperative with the emerging era of long-term space flight.

  9. Graphic-based musculoskeletal model for biomechanical analyses and animation.

    PubMed

    Chao, Edmund Y S

    2003-04-01

    The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the 'Virtual Human' reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. This paper details the design, capabilities, and features of the VIMS development at Johns Hopkins University, an effort possible only through academic and commercial collaborations. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of this unique database and simulation technology. This integrated system will impact on medical education, basic research, device development and application, and clinical patient care related to musculoskeletal diseases, trauma, and rehabilitation.

  10. Renal allograft fibrosis: biology and therapeutic targets.

    PubMed

    Boor, P; Floege, J

    2015-04-01

    Renal tubulointerstitial fibrosis is the final common pathway of progressive renal diseases. In allografts, it is assessed with tubular atrophy as interstitial fibrosis/tubular atrophy (IF/TA). IF/TA occurs in about 40% of kidney allografts at 3-6 months after transplantation, increasing to 65% at 2 years. The origin of renal fibrosis in the allograft is complex and includes donor-related factors, in particular in case of expanded criteria donors, ischemia-reperfusion injury, immune-mediated damage, recurrence of underlying diseases, hypertensive damage, nephrotoxicity of immunosuppressants, recurrent graft infections, postrenal obstruction, etc. Based largely on studies in the non-transplant setting, there is a large body of literature on the role of different cell types, be it intrinsic to the kidney or bone marrow derived, in mediating renal fibrosis, and the number of mediator systems contributing to fibrotic changes is growing steadily. Here we review the most important cellular processes and mediators involved in the progress of renal fibrosis, with a focus on the allograft situation, and discuss some of the challenges in translating experimental insights into clinical trials, in particular fibrosis biomarkers or imaging modalities.

  11. Effects of complement activation on allograft injury

    PubMed Central

    Sheen, Joong Hyuk; Heeger, Peter S.

    2015-01-01

    Purpose of review To summarize the current knowledge regarding mechanisms linking the complement system to transplant injury, highlighting findings reported since 2013. Recent findings Building upon the documentation that complement activation is a pathogenic mediator of post-transplant ischemia-reperfusion (IR) injury, emerging evidence indicates blocking either the classical or lectin pathways attenuates IR injury in animal models. Immune cell-derived and locally activated complement, including intracellular C3 positively modulates allo-reactive T cell activation and expansion, while simultaneously inhibiting regulatory T cell induction and function, together promoting transplant rejection. While alloantibody-initiated complement activation directly injures target cells, complement-dependent signals activate endothelial cells to facilitate T cell dependent inflammation. Complement activation within allografts contributes to progressive chronic injury and fibrosis. Summary The complement cascade, traditionally considered relevant to transplantation only as an effector mechanism of antibody-initiated allograft injury, is now understood to damage the allograft through multiple mechanisms. Complement activation promotes post-transplant IR injury, formation and function of allo-antibody, differentiation and function of alloreactive T cells, and contributes to chronic progressive allograft failure. The recognition that complement impacts transplant injury at many levels provides a foundation for targeting complement as a therapy to prolong transplant survival and improve patient health. PMID:26132735

  12. Acute colitis in the renal allograft recipient.

    PubMed Central

    Perloff, L J; Chon, H; Petrella, E J; Grossman, R A; Barker, C F

    1976-01-01

    Four renal allograft recipients with evidence of ischemic damage to the colon are presented and compared with 11 cases from 5 major series. Similarities in the patients included: deterioration of renal function, multiple immunosuppressive and antibiotic regimens, the use of cadaver renal allografts, and diagnostic and therapeutic measures requiring frequent enemas with barium and ion-exchange resins. Two of our patients underwent surgery for the removal of segments of necrotic colon after several weeks of fever and abdominal pain initially attributed to either acute rejection, viral infection, or pancreatitis. One patient had three days of melena and responded to non-operative therapy. The fourth patient developed ischemic colonic changes 10 weeks after allograft nephrectomy and was receiving no immunosuppression at the time. Broad spectrum antibiotics were used at various times in all patients. Early aggressive evaluation of gastrointestinal complaints--including barium enema, upper gastrointestinal series with small bowel follow-through, proctosigmoidoscopy or colonoscopy, and arteriography--is indicated, in view of the lethality of the complication of colonic ulceration. The clinical pictures presented emphasize the fact that recipients of renal allografts are commonly heir to many complications which may be considered rare in the normal population. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4a. Fig. 4b. PMID:1108814

  13. Burden of major musculoskeletal conditions.

    PubMed Central

    Woolf, Anthony D.; Pfleger, Bruce

    2003-01-01

    Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain. PMID:14710506

  14. 'Getting under our skin': Introducing banked allograft skin to burn surgery in South Africa.

    PubMed

    Allorto, Nikki; Rogers, Alan David; Rode, Heinz

    2016-09-01

    Deceased donor skin possesses many of the properties of the ideal biological dressing, and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it, managing patients with extensive burns and wounds becomes far more challenging, and outcomes are significantly worse. With the recent establishment of such a bank in South Africa, the challenge facing the medical fraternity is to facilitate tissue donation so that allograft skin supply can match the enormous demand. PMID:27601105

  15. [The use of structural proximal tibial allografts coated with human albumin in treating extensive periprosthetic knee-joint bone deficiency and averting late complications. Case report].

    PubMed

    Klára, Tamás; Csönge, Lajos; Janositz, Gábor; Pap, Károly; Lacza, Zsombor

    2015-01-11

    The authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confirmed that treatment of lyophilised allografts with albumin improves the ability of bone marrow-derived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.

  16. Arthroscopic meniscal allograft transplantation without bone plugs.

    PubMed

    Alentorn-Geli, Eduard; Seijas Vázquez, Roberto; García Balletbó, Montserrat; Álvarez Díaz, Pedro; Steinbacher, Gilbert; Cuscó Segarra, Xavier; Rius Vilarrubia, Marta; Cugat Bertomeu, Ramón

    2011-02-01

    Partial or total meniscectomy are common procedures performed at Orthopedic Surgery departments. Despite providing a great relief of pain, it has been related to early onset knee osteoarthritis. Meniscal allograft transplantation has been proposed as an alternative to meniscectomy. The purposes of this study were to describe an arthroscopic meniscal allograft transplantation without bone plugs technique and to report the preliminary results. All meniscal allograft transplantations performed between 2001 and 2006 were approached for eligibility, and a total of 35 patients (involving 37 menisci) were finally engaged in the study. Patients were excluded if they had ipsilateral knee ligament reconstruction or cartilage repair surgery before meniscal transplantation or other knee surgeries after the meniscal transplantation. Scores on Lysholm, Subjective IKDC Form, and Visual Analogue Scale (VAS) scale for pain were obtained at a mean follow-up of 38.6 months and compared to pre-operative data. Data on chondral lesions were obtained during the arthroscopic procedure and through imaging (radiographs and MRI) studies pre-operatively. Two graft failures out of 59 transplants (3.4%) were found. Daily life accidents were responsible for all graft failures. Significant improvements for Lysholm, Subjective IKDC Form, and VAS for pain scores following the meniscal allograft transplantation were found (P < 0.0001). Controlling for chondral lesion, there was no significant interactions for Lysholm (n.s.), Subjective IKDC Form (n.s.), and VAS for pain scores (n.s.). This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. Improvements were observed independently of the degree of chondral lesion.

  17. Relationship between Comorbid Health Problems and Musculoskeletal Disorders Resulting in Musculoskeletal Complaints and Musculoskeletal Sickness Absence among Employees in Korea

    PubMed Central

    Baek, Ji Hye; Kim, Young Sun; Yi, Kwan Hyung

    2015-01-01

    Background To investigate the relationship between musculoskeletal disorders and comorbid health problems, including depression/anxiety disorder, insomnia/sleep disorder, fatigue, and injury by accident, and to determine whether certain physical and psychological factors reduce comorbid health problems. Methods In total, 29,711 employees were selected from respondents of the Third Korean Working Conditions Survey and categorized into two groups: Musculoskeletal Complaints or Musculoskeletal Sickness Absence. Four self-reported health indicators (overall fatigue, depression/anxiety, insomnia/sleep disorder, and injury by accident) were selected as outcomes, based on their high prevalence in Korea. We used multiple logistic regression analysis to determine the relationship between comorbid health problems, musculoskeletal complaints, and sickness absence. Results The prevalence of musculoskeletal complaints and musculoskeletal sickness absence due to muscular pain was 32.26% and 0.59%, respectively. Compared to the reference group, depression/anxiety disorder and overall fatigue were 5.2–6.1 times more prevalent in the Musculoskeletal Complaints Group and insomnia/sleep disorder and injury by accident were 7.6–11.0 times more prevalent in the Sickness Absence Group. When adjusted for individual and work-related physical factors, prevalence of all four comorbid health problems were slightly decreased in both groups. Conclusion Increases in overall fatigue and depression/anxiety disorder were observed in the Musculoskeletal Complaints Group, while increases in insomnia/sleep disorder and injury by accident were observed in the Sickness Absence Group. For management of musculoskeletal complaints and sickness absence in the workplace, differences in health problems between employees with musculoskeletal complaints and those with sickness absence as well as the physical and psychological risk factors should be considered. PMID:26106512

  18. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    PubMed

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.

  19. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    PubMed

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft. PMID:25973378

  20. Donor dendritic cell–derived exosomes promote allograft-targeting immune response

    PubMed Central

    Rojas-Canales, Darling M.; Divito, Sherrie J.; Shufesky, William J.; Stolz, Donna Beer; Erdos, Geza; Sullivan, Mara L.G.; Gibson, Gregory A.; Larregina, Adriana T.; Morelli, Adrian E.

    2016-01-01

    The immune response against transplanted allografts is one of the most potent reactions mounted by the immune system. The acute rejection response has been attributed to donor dendritic cells (DCs), which migrate to recipient lymphoid tissues and directly activate alloreactive T cells against donor MHC molecules. Here, using a murine heart transplant model, we determined that only a small number of donor DCs reach lymphoid tissues and investigated how this limited population of donor DCs efficiently initiates the alloreactive T cell response that causes acute rejection. In our mouse model, efficient passage of donor MHC molecules to recipient conventional DCs (cDCs) was dependent on the transfer of extracellular vesicles (EVs) from donor DCs that migrated from the graft to lymphoid tissues. These EVs shared characteristics with exosomes and were internalized or remained attached to the recipient cDCs. Recipient cDCs that acquired exosomes became activated and triggered full activation of alloreactive T cells. Depletion of recipient cDCs after cardiac transplantation drastically decreased presentation of donor MHC molecules to directly alloreactive T cells and delayed graft rejection in mice. These findings support a key role for transfer of donor EVs in the generation of allograft-targeting immune responses and suggest that interrupting this process has potential to dampen the immune response to allografts. PMID:27348586

  1. Inability of donor total body irradiation to prolong survival of vascularized bone allografts: Experimental study in the rat

    SciTech Connect

    Gonzalez del Pino, J.; Benito, M.; Randolph, M.A.; Weiland, A.J. )

    1990-07-01

    At the present time, the toxic side effects of recipient immunosuppression cannot be justified for human non-vital organ transplantation. Total body irradiation has proven effective in ablating various bone-marrow-derived and endothelial immunocompetent cellular populations, which are responsible for immune rejection against donor tissues. Irradiation at a dose of 10 Gy was given to donor rats six days prior to heterotopic transplantation of vascularized bone allografts to host animals. Another group of recipient rats also received a short-term (sixth to fourteenth day after grafting), low dose of cyclosporine. Total body irradiation was able merely to delay rejection of grafts across a strong histocompatibility barrier for one to two weeks, when compared to nonirradiated allografts. The combination of donor irradiation plus cyclosporine did not delay the immune response, and the rejection score was similar to that observed for control allografts. Consequently, allograft viability was quickly impaired, leading to irreversible bone damage. This study suggest that 10 Gy of donor total body irradiation delivered six days prior to grafting cannot circumvent the immune rejection in a vascularized allograft of bone across a strong histocompatibility barrier.

  2. Dynamometer Elbow Strength and Endurance Testing After Distal Biceps Reconstruction w/Allograft

    PubMed Central

    McGee, Alan; Strauss, Eric Jason; Jazrawi, Laith M.

    2015-01-01

    Objectives: The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue. Methods: Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis. Results: Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean follow-up for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5± 5.9 Nm) was 91.7% of that of the contralateral limb (41.8±4.9 Nm) in flexion and 93.4% (operative, 5.7±1.3 Nm; contralateral, 6.1± 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1±17.1%; contralateral, 30.8±17.1%; p = 0.29) or supination (operative, 38.2±16.5%; contralateral, 42.1±11.9%; p = 0.65). . The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported

  3. The role of the macrophage in cardiac allograft rejection in the rat.

    PubMed

    MacPherson, G G; Christmas, S E

    1984-01-01

    Macrophages (MO) are a well-recognized component of the cellular infiltrate in first-set (acute) allograft rejections. Definition of their actual role in the mediation of rejection depends on showing that they are present in sufficient numbers and at relevant sites in rejecting grafts, that they are capable of mediating damage to graft tissues, and that their absence interfere with rejection. We have used rat heart allografts to investigate these questions. Normal rejection takes 7 days. By this time the MO is the major infiltrating cell and large numbers are present close to myocardial cells. In some cases they appear to push pseudopodia into the cell. Neither they, or other cell types, appear to be interacting with endothelial cells. MO extracted from rejecting allografts are potent secretors of plasminogen activator but show poor glass adherence and phagocytic ability compared to resident peritoneal cells. Graft MO are able to damage beating heart cells in vitro; their activity is not immunologically specific. Peritoneal MO from rats immunised with allogeneic spleen cells and MO grown in vitro from bone marrow in the absence of allostimulators behave similarly. Manipulation of MO behaviour was attempted with rabbit anti-rat MO serum. This did not prolong allograft survival and did not significantly depress blood monocyte levels. 750 rads irradiation prolonged graft survival usually until the death of the animal. Rejection could be restored with small lymphocytes from a normal rat, and the addition of bone-marrow cells had no effect. However, hearts rejected by animals given irradiation and lymphocytes alone contained as many MO as those rejected by normal animals, despite a reduction in blood monocyte levels to less than 5% of normal. We conclude that MO are present in large numbers and at relevant sites in rejecting allografts, and that they show features of activation and have a cytotoxic capability against relevant target cells. However, present approaches

  4. Musculoskeletal manifestations of Lyme disease.

    PubMed

    Steere, A C

    1995-04-24

    Musculoskeletal involvement, particularly arthritis, is a common feature of Lyme disease. Early in the illness, patients may experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone in one or a few locations at a time, frequently lasting only hours or days in a given location. Weeks to months later, after the development of a marked cellular and humoral immune response to the spirochete, untreated patients often have intermittent or chronic monoarticular or oligoarticular arthritis-primarily in large joints, especially the knee-during a period of several years. The diagnosis of Lyme arthritis is usually based on the presence of this characteristic clinical picture, exposure in an endemic area, and an elevated immunoglobulin G antibody response to Borrelia burgdorferi. In addition, spirochetal DNA can often be detected in joint fluid by polymerase chain reaction. Lyme arthritis can usually be treated successfully with 1-month courses of oral doxycycline or amoxicillin or with 2- to 4-week courses of intravenous ceftriaxone. However, patients with certain genetic and immune markers may have persistent arthritis, despite treatment with oral or intravenous antibiotics. B. burgdorferi may occasionally trigger fibromyalgia, a chronic pain syndrome with diffuse joint and muscle symptoms. This syndrome does not appear to respond to antibiotic therapy.

  5. Rapid development of tissue bank achieved by International Atomic Energy Agency (IAEA) Tissue Banking Programme in China.

    PubMed

    Zhang, Yu-Min; Wang, Jian-Ru; Zhang, Nai-Li; Liu, Xiao-Ming; Zhou, Mo; Ma, Shao-Ying; Yang, Ting; Li, Bao-Xing

    2014-09-01

    Before 1986, the development of tissue banking in China has been slow and relatively uncoordinated. Under the support of International Atomic Energy Agency (IAEA), Tissue Banking in China experienced rapid development. In this period, China Institute for Radiation Protection tissue bank mastered systematic and modern tissue banking technique by IAEA training course and gradually developed the first regional tissue bank (Shanxi Provincial Tissue Bank, SPTB) to provide tissue allograft. Benefit from training course, SPTB promoted the development of tissue transplantation by ways of training, brochure, advertisement and meeting. Tissue allograft transplantation acquired recognition from clinic and supervision and administration from government. Quality system gradually is developing and perfecting. Tissue allograft transplantation and tissue bank are developing rapidly and healthy.

  6. Renal allograft rejection: examination of delayed differentiation of Treg and Th17 effector T cells.

    PubMed

    Pekalski, Marcin; Jenkinson, Sarah E; Willet, Joseph D P; Poyner, Elizabeth F M; Alhamidi, Abdulaziz H; Robertson, Helen; Ali, Simi; Kirby, John A

    2013-03-01

    Antigen presentation after kidney transplantation occurs in lymphoid tissues remote from the allograft, with activated T cells then migrating towards the graft. This study examined the possibility that these activated T cells can differentiate to acquire Th17 or Treg phenotypes after a time consistent with their arrival within renal allograft tissues. An immunocytochemical study was performed to demonstrate the response to intragraft TGF-β and the phenotype of lymphoid cells within rejecting human renal allograft tissue. A series of in vitro experiments was then performed to determine the potential to induce these phenotypes by addition of appropriate cytokines 3days after initial T cell activation. During renal allograft rejection there was a strong response to TGF-β, and both FOXP3 and IL-17A were expressed by separate lymphoid cells in the graft infiltrate. FOXP3 could be induced to high levels by the addition of TGF-β1 3days after the initiation of allogeneic mixed leukocyte culture. This Treg marker was enriched in the sub-population of T cells expressing the cell-surface αE(CD103)β7 integrin. The RORγt transcription factor and IL-17A were induced 3days after T cell activation by the addition of TGF-β1, IL-1β, IL-6 and IL-23; many of these Th17 cells also co-expressed CD103. T cells can develop an effector phenotype following cytokine stimulation 3days after initial activation. This suggests that the intragraft T cell phenotype may be indicative of the prevailing cytokine microenvironment.

  7. Resiniferatoxin (RTX) Causes a Uniquely Protracted Musculoskeletal Hyperalgesia in Mice by Activation of TRPV1 Receptors

    PubMed Central

    Abdelhamid, Ramy E.; Kovács, Katalin J.; Honda, Christopher N.; Nunez, Myra G.; Larson, Alice A.

    2013-01-01

    Inactivation of TRPV1 receptors is one approach to analgesic drug development. However, TRPV1 receptors exert different effects on each modality of pain. Because muscle pain is clinically important, we compared the effect of TRPV1 ligands on musculoskeletal nociception to that on thermal and tactile nociception. Injected parenterally, capsaicin had no effect on von Frey fiber responses (tactile) but induced a transient hypothermia and hyperalgesia in both the tail flick (thermal) and grip force (musculoskeletal) assays, presumably by its agonistic action at TRPV1 sites. In contrast, RTX produced a chronic (>58 days) thermal antinociception, consistent with its reported ability to desensitize TRPV1 sites. In the same mice, RTX produced a transient hypothermia (7 h) and a protracted (28 day) musculoskeletal hyperalgesia in spite of a 35.5% reduction in TRPV1 receptor-immunoreactivity in muscle afferents. Once musculoskeletal hyperalgesia subsided, mice were tolerant to the hyperalgesic effects of either capsaicin or RTX while tolerance to hypothermia did not develop until after three injections. Musculoskeletal hyperalgesia was prevented but not reversed by SB-366791, a TRPV1 antagonist, indicating that TRPV1 receptors initiate but do not maintain hyperalgesia. Injected intrathecally, RTX produced only a brief musculoskeletal hyperalgesia (2 days) after which mice were tolerant to this effect. Perspective The effect of TRPV1 receptors varies depending on modality and tissue type such that RTX causes thermal antinociception, musculoskeletal hyperalgesia, and no effect on tactile nociception in healthy mice. Spinal TRPV1 receptors are a potential target for pain relief as they induce only a short musculoskeletal hyperalgesia followed by desensitization. PMID:24188863

  8. Factors Predicting Meniscal Allograft Transplantation Failure

    PubMed Central

    Parkinson, Ben; Smith, Nicholas; Asplin, Laura; Thompson, Peter; Spalding, Tim

    2016-01-01

    Background: Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined. Purpose: To determine predictors of MAT failure in a large series to refine the indications for surgery and better inform future patients. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing MAT at a single institution between May 2005 and May 2014 with a minimum of 1-year follow-up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation, or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of the index surgery: group 1, intact or partial-thickness chondral loss; group 2, full-thickness chondral loss 1 condyle; and group 3, full-thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure, independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model. Results: There were 125 consecutive MATs performed, with 1 patient lost to follow-up. The median follow-up was 3 years (range, 1-10 years). The 5-year graft survival for the entire cohort was 82% (group 1, 97%; group 2, 82%; group 3, 62%). The probability of failure in group 1 was 85% lower (95% CI, 13%-97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% CI, 16%-89%) than medial allografts at

  9. Musculoskeletal Hydatid Cysts Resembling Tumors: A Report of Five Cases.

    PubMed

    Toğral, Güray; Arıkan, Şefik M; Ekiz, Timur; Kekeç, Ahmet F; Ekşioğlu, Mehmet F

    2016-05-01

    Although challenges in treatment of musculoskeletal hydatid cysts (HC) lesions have been documented, data regarding the musculoskeletal HC lesions resembling tumor is scarce. This paper presented 5 patients (3 males, 2 females) with a mean age of 41.6 years with tumor-like lesions of HC. Three of them had left ilium and acetabulum involvement, one involved left femur, and one involved left thigh muscle compartments. Pain was the main symptom and was seen in all patients. Clinical examination, radiologic evaluation, and histologic analysis were performed for diagnosis. Patients were treated through different surgical options, including simple debridement, bone cement filling with or without internal fixation, hip arthrodesis, reconstruction using hemipelvic replantation with femoral prosthesis and distal femur endoprosthetic replacement. After surgery, the operation region was washed by 20% hypertonic saline, and debridement was performed carefully without contamination. All patients received albendazole treatment. Cases were followed up 1 to 9 years for the recurrence. Walking difficulty and pain were the main symptoms during the follow-up. One patient was symptom-free. A reoccurrence in the perioperative soft tissue was detected in only one patient and control visits with antihelmintic treatment were recommended. We would like to emphasize that HC should be kept in mind for the differential diagnosis of the cystic or tumoral lesions of the musculoskeletal system, particularly in the endemic regions. Prompt diagnosis is of paramount importance for preventing destruction and complications. PMID:27384735

  10. Musculoskeletal injuries and pain in dancers: a systematic review update.

    PubMed

    Jacobs, Craig L; Hincapié, Cesar A; Cassidy, J David

    2012-01-01

    The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.

  11. Musculoskeletal imaging insight 2015: Kenya.

    PubMed

    Stevens, Kathryn J; Mutiso, Kavulani; Sconfienza, Luca Maria; Monu, Johnny

    2016-07-01

    Over the past 6 years the International Skeletal Society (ISS) outreach programs have become popular amongst the various radiology organizations in sub-Saharan Africa. So much so that that the ISS outreach is now routinely expected to participate in many of the international radiology conferences in that part of the world. The organizational planning for an outreach visit to Kenya took place over a 3-year period. Eventually a double-headed event; the seventh and eighth sub-Saharan outreach efforts were organized in Nairobi and in Mombasa, Kenya. The Nairobi outreach was an educational course on musculoskeletal imaging at the University of Nairobi and the Aga Khan University in Nairobi from 26 to 28 May 2015. The Mombasa outreach was organized in collaboration with the African Society of Radiology (ASR) at their annual meeting in Mombasa from 30 May to 2 June 2015. PMID:27115883

  12. Procurement of hand and arm allografts.

    PubMed

    Cetrulo, Curtis L; Kovach, Stephen J

    2013-12-01

    Upper extremity transplantation has been at the forefront of vascularized composite allotransplantation. There have been more hand and upper extremity transplants than any other kinds of vascularized composite allotransplantation. However, it is a new and evolving field. Reconstructive surgeons are relative newcomers to the field of transplantation, and the procurement of upper extremity allografts has many subtleties that will differ depending on the intended recipient. However, there are certain principles that can be adhered to that this review serves to elucidate. PMID:24310234

  13. Procurement of hand and arm allografts.

    PubMed

    Cetrulo, Curtis L; Kovach, Stephen J

    2013-12-01

    Upper extremity transplantation has been at the forefront of vascularized composite allotransplantation. There have been more hand and upper extremity transplants than any other kinds of vascularized composite allotransplantation. However, it is a new and evolving field. Reconstructive surgeons are relative newcomers to the field of transplantation, and the procurement of upper extremity allografts has many subtleties that will differ depending on the intended recipient. However, there are certain principles that can be adhered to that this review serves to elucidate.

  14. Running on time: the role of circadian clocks in the musculoskeletal system.

    PubMed

    Dudek, Michal; Meng, Qing-Jun

    2014-10-01

    The night and day cycle governs the circadian (24 hourly) rhythm of activity and rest in animals and humans. This is reflected in daily changes of the global gene expression pattern and metabolism, but also in the local physiology of various tissues. A central clock in the brain co-ordinates the rhythmic locomotion behaviour, as well as synchronizing various local oscillators, such as those found in the musculoskeletal system. It has become increasingly recognized that the internal molecular clocks in cells allow a tissue to anticipate the rhythmic changes in their local environment and the specific demands of that tissue. Consequently, the majority of the rhythmic clock controlled genes and pathways are tissue specific. The concept of the tissue-specific function of circadian clocks is further supported by the diverse musculoskeletal phenotypes in mice with deletions or mutations of various core clock components, ranging from increased bone mass, dwarfism, arthropathy, reduced muscle strength and tendon calcification. The present review summarizes the current understanding of the circadian clocks in muscle, bone, cartilage and tendon tissues, with particular focus on the evidence of circadian rhythms in tissue physiology, their entrainment mechanisms and disease links, and the tissue-specific clock target genes/pathways. Research in this area holds strong potential to advance our understanding of how circadian rhythms control the health and disease of the musculoskeletal tissues, which has major implications in diseases associated with advancing age. It could also have potential implications in sports performance and sports medicine. PMID:25195734

  15. Biomechanical analysis of patellar tendon allografts as a function of donor age.

    PubMed

    Flahiff, C M; Brooks, A T; Hollis, J M; Vander Schilden, J L; Nicholas, R W

    1995-01-01

    We evaluated the biomechanical properties of patellar tendon allografts from donors aged 18 to 55 years. Bone-patellar tendon-bone complexes were harvested from acceptable donors and processed. Fat and soft tissue were removed, and the tendons were sectioned lengthwise leaving the central third. Area measurements were taken, and mechanical testing was performed. Specimens were pulled to failure at a rate of 10% of the initial length per second. The force at failure, tensile stress, modulus of elasticity, and percent elongation were determined for each specimen. There was no significant correlation (P > 0.05) between age and any of the mechanical properties. Load at failure ranged from 2110 to 4650 N, with a mean of 3424 N. Regression analysis showed slightly decreasing tensile stress with increasing age, but the correlation was not significant. It appears that patellar tendon allografts from donors up to age 55 have similar mechanical properties.

  16. Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study

    PubMed Central

    Douloumpakas, I; Pyrpasopoulou, A; Triantafyllou, A; Sampanis, Ch; Aslanidis, S

    2007-01-01

    Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prevalence of connective tissue disorders in these patients has increased in the recent years affecting significantly their quality of life. Methods - Results: We conducted a pilot study including 208 sequentially selected patients with type 2 diabetes mellitus regularly followed-up at the Diabetes Center of the Hippokration University Hospital. Among the diabetic patients who were screened according to the Short Musculoskeletal Function Assessment Questionnaire for musculoskeletal symptoms and findings, 82.6% were found to exhibit musculoskeletal abnormalities, mainly of the degenerative, noninflammatory type. Conclusions: Musculoskeletal disorders are a common finding among patients with type 2 diabetes. Obesity and accumulation of abnormally glycosylated byproducts have been proposed as potential pathogenetic mediators of these connective tissue abnormalities. Of particular interest is, however, the common association of osteoarthritis, involving even non-weight bearing joints in patients with type 2 diabetes, indicating a common pathophysiologic mechanism connecting these two clinical conditions. PMID:19582198

  17. Mouse kidney transplantation: models of allograft rejection.

    PubMed

    Tse, George H; Hesketh, Emily E; Clay, Michael; Borthwick, Gary; Hughes, Jeremy; Marson, Lorna P

    2014-01-01

    Rejection of the transplanted kidney in humans is still a major cause of morbidity and mortality. The mouse model of renal transplantation closely replicates both the technical and pathological processes that occur in human renal transplantation. Although mouse models of allogeneic rejection in organs other than the kidney exist, and are more technically feasible, there is evidence that different organs elicit disparate rejection modes and dynamics, for instance the time course of rejection in cardiac and renal allograft differs significantly in certain strain combinations. This model is an attractive tool for many reasons despite its technical challenges. As inbred mouse strain haplotypes are well characterized it is possible to choose donor and recipient combinations to model acute allograft rejection by transplanting across MHC class I and II loci. Conversely by transplanting between strains with similar haplotypes a chronic process can be elicited were the allograft kidney develops interstitial fibrosis and tubular atrophy. We have modified the surgical technique to reduce operating time and improve ease of surgery, however a learning curve still needs to be overcome in order to faithfully replicate the model. This study will provide key points in the surgical procedure and aid the process of establishing this technique.

  18. Mouse Kidney Transplantation: Models of Allograft Rejection

    PubMed Central

    Clay, Michael; Borthwick, Gary; Hughes, Jeremy; Marson, Lorna P.

    2014-01-01

    Rejection of the transplanted kidney in humans is still a major cause of morbidity and mortality. The mouse model of renal transplantation closely replicates both the technical and pathological processes that occur in human renal transplantation. Although mouse models of allogeneic rejection in organs other than the kidney exist, and are more technically feasible, there is evidence that different organs elicit disparate rejection modes and dynamics, for instance the time course of rejection in cardiac and renal allograft differs significantly in certain strain combinations. This model is an attractive tool for many reasons despite its technical challenges. As inbred mouse strain haplotypes are well characterized it is possible to choose donor and recipient combinations to model acute allograft rejection by transplanting across MHC class I and II loci. Conversely by transplanting between strains with similar haplotypes a chronic process can be elicited were the allograft kidney develops interstitial fibrosis and tubular atrophy. We have modified the surgical technique to reduce operating time and improve ease of surgery, however a learning curve still needs to be overcome in order to faithfully replicate the model. This study will provide key points in the surgical procedure and aid the process of establishing this technique. PMID:25350513

  19. Perspectives in ultrasound-guided musculoskeletal interventions

    PubMed Central

    Daftary, Aditya Ravindra; Karnik, Alpana Sudhir

    2015-01-01

    Ultrasonography (USG) is a safe, easily available, and cost-effective modality, which has the additional advantage of being real time for imaging and image-guided interventions of the musculoskeletal system. Musculoskeletal interventions are gaining popularity in sports and rehabilitation for rapid healing of muscle and tendon injuries in professional athletes, healing of chronic tendinopathies, aspiration of joint effusions, periarticular bursae and ganglia, and perineural injections in acute and chronic pain syndromes. This article aims to provide an overview of the spectrum of musculoskeletal interventions that can be done under USG guidance both for diagnostic and therapeutic purposes. PMID:26288519

  20. Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL).

    PubMed

    Schmidt, Tanja; Hoburg, Arnd; Broziat, Christine; Smith, Mark D; Gohs, Uwe; Pruss, Axel; Scheffler, Sven

    2012-08-01

    Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.

  1. Digital subtraction angiography in musculoskeletal tumors and other conditions.

    PubMed

    Kolár, J; Zídková, H; Sprindrich, J; Matĕjovský, Z

    1990-01-01

    One hundred and forty consecutive DSA examinations of various musculoskeletal diseases were analyzed with respect to the contributions and/or limits of this modern diagnostic imaging modality. Angiography remains the imaging tool of choice for many benign and malignant orthopedic conditions of bones and soft tissues, mainly when MRI is still not generally available. It remains indispensable for embolization and/or local chemotherapy. DSA has the advantage of being less invasive and it also surpasses analog arteriography in better visualization of vascular patterns hidden in hyperostosis, sclerosis, and metallic shadows. Angiographic investigations, when necessary, should therefore start with DSA. PMID:2317132

  2. Platelet plasma rich products in musculoskeletal medicine: any evidence?

    PubMed

    Maffulli, Nicola; Del Buono, Angelo

    2012-06-01

    Platelet reach plasma (PRP) is considered to accelerate muscle and tendon healing and allow early return to elite competition, and it is often recommend as best practice for management of musculoskeletal injuries. Even though several growth factors abundant in PRPs have been extensively studied in tissue regeneration, the key factors are yet unknown. Given our rudimentary knowledge of the mechanism of action of the PRPs, it is challenging to use this technology to promote early healing, and produce improved and accelerated functional recovery. We prompt researchers to undertake appropriately powered level I studies with adequate and relevant outcome measures and clinically appropriate follow up.

  3. Musculoskeletal adaptation to mechanical forces on Earth and in space

    NASA Technical Reports Server (NTRS)

    Whalen, Robert

    1993-01-01

    A major concern of the US and Russian space programs is the health and safety of astronauts and cosmonauts. One of the areas receiving the most attention has been the effects of long duration space flight on the musculoskeletel system. After three decades of space flight and research, questions continue. Can exercise in space maintain musculoskeletal tissue mass and function in an adult? The objective of this paper is to address this question in a way that hopefully provides a rational basis for quantifying and evaluating the influnence of daily activities on muscle and bone on Earth and in space.

  4. The use of a biostatic fascia lata thigh allograft as a scaffold for autologous human culture of fibroblasts--An in vitro study.

    PubMed

    Żurek, Jarek; Dominiak, Marzena; Botzenhart, Ute; Bednarz, Wojciech

    2015-05-01

    The method for covering gingival recession defects and augmenting keratinized gingiva involves the use of autogenuous connective tissue grafts obtained from palatal mucosa in combination with various techniques of flap repositioning or tunnel techniques. In the case of multiple gingival recession defects the amount of connective tissue available for grafting is insufficient. Therefore, the use of substitutes is necessary. The most widely used material in recent years has been the acellular dermal matrix allograft. The disadvantage of its application lies in the absence of cells and blood vessels, which increases incorporation time. Primary cultured human autologic fibroblasts are commonly used to optimize the healing process. The aim of this study was to examine the in vitro biocompatibility of human fascia lata allograft as a new scaffold for primary cultured human autologic fibroblasts. For that, a fibroblast culture obtained from a fragment of gingival tissue taken from the hard palate mucosa of a subject was used. After 14 days the colony cells were inoculated on a fragment of human fascia lata allograft. After a further 7 days of incubation the material was frozen, cut and prepared for histochemical examination. After two weeks of incubation, and 7 days after inoculation on a fragment of fascia lata allograft numerous accumulations of the cultured fibroblast were found that had a typical structure and produced collagen fibres. A human fascia lata allograft can be used as a scaffold for primary cultured human autologic fibroblasts. Further studies should confirm the clinical efficacy of this solution.

  5. Transphyseal anterior cruciate ligament reconstruction in a skeletally immature knee using anterior tibialis allograft.

    PubMed

    Cho, Yool; Jang, Soo-Jin; Son, Jung-Hwan

    2011-05-18

    Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Nonoperative treatment of ACL injuries in skeletally immature patients have not been favorable. Surgical treatment options for complete ACL tears include primary ligament repair, extraarticular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physeal-sparing reconstruction. The advantage of transphyseal reconstruction is placement of the graft tissue in an isometric position, which provides better results, according to the literature. The potential disadvantage is angular or limb-length discrepancy caused by physeal violation. Controversy exists in allograft selection about whether bone or soft tissue passes into physes. The use of standard tunnels provides reliable results, but carries the risk of iatrogenic growth disturbance from physeal injury.This article presents 4 cases of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients that had satisfactory functional outcomes with no growth disturbances. This is the first report of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients in the English-speaking literature. All patients underwent transphyseal ACL reconstruction using anterior tibialis tendon allograft. None of the patients had angular deformities. No early physeal arrest was measured between the preoperative and postoperative radiographs. At last follow-up, the results of the Lachman test were normal for 3 patients and nearly normal for 1 patient. All patients demonstrated full range of knee motion (comparing the reconstructed knee to the contralateral knee). The results of the pivot-shift test were normal for 3 patients and nearly normal for 1 patient. No patients reported giving way.

  6. A target field design of open multi-purpose RF coil for musculoskeletal MR imaging at 3T.

    PubMed

    Gao, Fei; Zhang, Rui; Zhou, Diange; Wang, Xiaoying; Huang, Kefu; Zhang, Jue

    2016-10-01

    Musculoskeletal MR imaging under multi-angle situations plays an increasingly important role in assessing joint and muscle tissues system. However, there are still limitations due to the closed structures of most conventional RF coils. In this study, a time-harmonic target-field method was employed to design open multi-purpose coil (OMC) for multi-angle musculoskeletal MR imaging. The phantom imaging results suggested that the proposed OMC could achieve homogeneously distributed magnetic field and high signal-to-noise ratio (SNR) of 239.04±0.83 in the region of interest (ROI). The maximum temperature in the heating hazard test was 16°C lower than the standard regulation, which indicated the security of the designed OMC. Furthermore, to demonstrate the effectiveness of the proposed OMC for musculoskeletal MR imaging, especially for multi-angle imaging, a healthy volunteer was examined for MR imaging of elbow, ankle and knee using OMC. The in vivo imaging results showed that the proposed OMC is effective for MR imaging of musculoskeletal tissues at different body parts, with satisfied B1 field homogeneity and SNR. Moreover, the open structure of the OMC could provide a large joint movement region. The proposed open multi-purpose coil is feasible for musculoskeletal MR imaging, and potentially, it is more suitable for the evaluation of musculoskeletal tissues under multi-angle conditions.

  7. MRI of the Musculoskeletal System

    MedlinePlus

    ... a powerful magnetic field, radio waves and a computer to produce detailed pictures of joints, soft tissues ... powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, ...

  8. Complications in Musculoskeletal Intervention: Important Considerations

    PubMed Central

    Wang, David T.; Dubois, Melissa; Tutton, Sean M.

    2015-01-01

    Musculoskeletal (MSK) intervention has proliferated in recent years among various subspecialties in medicine. Despite advancements in image guidance and percutaneous technique, the risk of complication has not been fully eliminated. Overall, complications in MSK interventions are rare, with bleeding and infection the most common encountered. Other complications are even rarer. This article reviews various complications unique to musculoskeletal interventions, assists the reader in understanding where pitfalls lie, and highlights ways to avoid them. PMID:26038623

  9. The musculoskeletal effects of perioperative smoking.

    PubMed

    Argintar, Evan; Triantafillou, Kostas; Delahay, John; Wiesel, Brent

    2012-06-01

    Although the carcinogenic consequences of smoking are well known, further research is needed on the effects of smoking on musculoskeletal health and surgical outcomes. Orthopaedic perioperative complications of smoking include impaired healing, increased infection, delayed and/or impaired fracture union and arthrodesis, and inferior arthroplasty outcomes. The incorporation of smoking cessation protocols such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period may result in substantial benefits for patients' musculoskeletal and general health.

  10. Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study

    PubMed Central

    Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.

    2011-01-01

    Background Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist. Methods Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen® -processed nerve allografts) were compared to nerve isografts and silicone nerve guidance conduits in a 14 mm rat sciatic nerve defect. Results All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks post-operatively, while AxoGen®-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks post-operatively. All acellular allografts promoted greater amounts of motor recovery compared to silicone conduits. Conclusions These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo. PMID:21660979

  11. A Systematic Review of Failed Anterior Cruciate Ligament Reconstruction With Autograft Compared With Allograft in Young Patients

    PubMed Central

    Wasserstein, David; Sheth, Ujash; Cabrera, Alison; Spindler, Kurt P.

    2015-01-01

    Context: The advantages of allograft anterior cruciate ligament reconstruction (ACLR), which include shorter surgical time, less postoperative pain, and no donor site morbidity, may be offset by a higher risk of failure. Previous systematic reviews have inconsistently shown a difference in failure prevalence by graft type; however, such reviews have never been stratified for younger or more active patients. Objective: To determine whether there is a different ACLR failure prevalence of autograft compared with allograft in young, active patients. Data Sources: EMBASE, MEDLINE, Cochrane trials registry. Study Selection: Comparative studies of allograft versus autograft primary ACL reconstruction in patients <25 years of age or of high-activity level (military, Marx activity score >12 points, collegiate or semiprofessional athletes). Study Design: Systematic review with meta-analysis. Level of Evidence: Level 3. Data Extraction: Manual extraction of available data from eligible studies. Quantitative synthesis of failure prevalence and Lysholm score (outcomes in ≥3 studies) and I2 test for heterogeneity. Assessment of study quality using CLEAR NPT and Newcastle-Ottawa Scale (NOS). Results: Seven studies met inclusion criteria (1 level 1; 2 level 2, 4 level 3), including 788 patients treated with autograft tissue and 228 with various allografts. The mean age across studies was 21.7 years (64% male), and follow-up ranged between 24 and 51 months. The pooled failure prevalence was 9.6% (76/788) for autografts and 25.0% (57/228) for allografts (relative risk, 0.36; 95% CI, 0.24-0.53; P < 0.00001; I2 = 16%). The number needed to benefit to prevent 1 failure by using autograft was 7 patients (95% CI, 5-10). No difference between hamstrings autograft and patella tendon autograft was noted. Lysholm score was reported in 3 studies and did not differ between autograft and allograft. Conclusion: While systematic reviews comparing allograft and autograft ACLR have been equivocal

  12. Proximal humeral osteoarticular allografts: technique, pearls and pitfalls, outcomes.

    PubMed

    Farfalli, German L; Ayerza, Miguel A; Muscolo, D Luis; Aponte-Tinao, Luis A

    2015-12-01

    Allograft transplantation is a biologic reconstruction option for massive bone defects after resection of bone sarcomas. This type of reconstruction not only restores bone stock but it also allows us to reconstruct the joint anatomically. These factors are a major concern, especially in a young and active population.We are describing indications, surgical techniques, pearls and pitfalls, and outcomes of proximal humeral osteoarticular allografts, done at present time in our institution.We found that allograft fractures and articular complications, as epiphyseal resorption and subchondral fracture, are the main complications observed in proximal humerus osteoarticular allograft reconstructions. Nevertheless, only fractures need a reconstruction revision. Joint complications may adversely affect the limb function, but for this reason, an allograft revision is rarely performed.

  13. Surgical techniques and radiological findings of meniscus allograft transplantation.

    PubMed

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail.

  14. Mini Treadmill for Musculoskeletal Health

    NASA Technical Reports Server (NTRS)

    Humphreys, Bradley

    2015-01-01

    Because NASA's approach to space exploration calls for long-term extended missions, there is a pressing need to equip astronauts with effective exercise regimens that will maintain musculoskeletal and cardiovascular health. ZIN Technologies, Inc., has developed an innovative miniature treadmill for use in both zero-gravity and terrestrial environments. The treadmill offers excellent periodic impact exercise to stimulate cardiovascular activity and bone remodeling as well as resistive capability to encourage full-body muscle maintenance. A novel speed-control algorithm allows users to modulate treadmill speed by adjusting stride, and a new subject load device provides a more Earth-like gravity replacement load. This new and compact treadmill offers a unique approach to managing astronaut health while addressing the inherent and stringent challenges of space flight. The innovation also has the potential to offer numerous terrestrial applications, as a real-time daily load stimulus (DLS) measurement feature provides an effective mechanism to combat or manage osteoporosis, a major public health threat for 55 percent of Americans over the age of 50.

  15. Musculoskeletal Measures of Orofacial Pain

    PubMed Central

    Fricton, James R.

    1990-01-01

    Musculoskeletal disorders of the stomatognathic system comprise the majority of diagnoses responsible for chronic orofacial pain. The most common signs for these disorders include tenderness, limitation in range of motion, deviation in range of motion, and joint noise. Although these signs are used routinely for diagnosis, the reliability, validity, and accuracy of their use as diagnostic criteria or outcome measures has not been established. A series of clinical studies on a Craniomandibular Index (CMI) was completed to examine these issues. Interrater and intrarater reliability of the grouped items in the CMI ranged from 0.58-0.98, with an overall correlation coefficient of 0.95 and 0.96, respectively. Pressure algometry improved reliability of muscle and joint palpation for tenderness. Tenderness, but not dysfunction, was correlated with symptom severity. Both tenderness and dysfunction improved with treatment but did not become normal. The percent agreement of these signs as diagnostic criteria for the presence and stage of a temperomandibular joint (TMJ) internal derangement was about 80% compared with arthrotomography. These studies suggest that these clinical characteristics can be used with adequate reliability and validity to diagnose and measure severity if standardized methods are used. ImagesFigure 2 PMID:2085192

  16. Allograft Anterior Cruciate Ligament Reconstruction in Patients Younger than 25 Years.

    PubMed

    Carter, Thomas R; Rabago, Michael T

    2016-05-01

    Purpose The purpose of this study was to evaluate the outcomes for patients younger than 25 years who had anterior cruciate ligament (ACL) reconstructions with allograft tissue. Methods A total of 52 ACL reconstructions performed with fresh-frozen, nonirradiated tibialis or Achilles allografts in active patients younger than 25 years. Outcome evaluations included the International Knee Documentation Committee (IKDC) objective and subjective forms, KT-1000 arthrometry and Lysholm. Results Forty-two patients were available for follow-up at an average follow-up of 65 months (range, 33-99 months). The average age at surgery was 17 years and 7 months (range, 11 years 10 months-24 years 8 months). Objective and subjective data were obtained from 37 patients with 1 requiring revision, and 5 patients had only subjective data. IKDC objective results were 29-A and 5-B. KT-1000 differences were 0 mm for 4 patients, 1 mm for 23, 2 mm for 8, 3 mm for 1, and > 5 mm for 1 patient. The average IKDC subjective score was 90.2 ± 15.0 and average Lysholm score was 90.0 ± 11. Conclusion The result of our study found that using nonirradiated Achilles or tibialis tendon allografts for ACL reconstructions in active patients younger than 25 years can achieve good outcomes, with a low rate of failure. PMID:26227787

  17. Allograft Anterior Cruciate Ligament Reconstruction in Patients Younger than 25 Years.

    PubMed

    Carter, Thomas R; Rabago, Michael T

    2016-05-01

    Purpose The purpose of this study was to evaluate the outcomes for patients younger than 25 years who had anterior cruciate ligament (ACL) reconstructions with allograft tissue. Methods A total of 52 ACL reconstructions performed with fresh-frozen, nonirradiated tibialis or Achilles allografts in active patients younger than 25 years. Outcome evaluations included the International Knee Documentation Committee (IKDC) objective and subjective forms, KT-1000 arthrometry and Lysholm. Results Forty-two patients were available for follow-up at an average follow-up of 65 months (range, 33-99 months). The average age at surgery was 17 years and 7 months (range, 11 years 10 months-24 years 8 months). Objective and subjective data were obtained from 37 patients with 1 requiring revision, and 5 patients had only subjective data. IKDC objective results were 29-A and 5-B. KT-1000 differences were 0 mm for 4 patients, 1 mm for 23, 2 mm for 8, 3 mm for 1, and > 5 mm for 1 patient. The average IKDC subjective score was 90.2 ± 15.0 and average Lysholm score was 90.0 ± 11. Conclusion The result of our study found that using nonirradiated Achilles or tibialis tendon allografts for ACL reconstructions in active patients younger than 25 years can achieve good outcomes, with a low rate of failure.

  18. Frequent hepatocyte chimerism in long-term human liver allografts independent of graft outcome.

    PubMed

    Aini, Wulamujiang; Miyagawa-Hayashino, Aya; Ozeki, Munetaka; Tsuruyama, Tatsuaki; Tamaki, Keiji; Uemoto, Shinji; Haga, Hironori

    2013-03-01

    Microchimerism after liver transplantation is considered to promote graft tolerance or tissue repair, but its significance is controversial. By using multiplex polymerase chain reaction (PCR) of short tandem repeat (STR) loci after laser capture microdissection of hepatocyte nuclei, we compared the proportions of recipient-derived hepatocytes in long-term stable liver allografts and late dysfunctional allografts caused by chronic rejection or idiopathic post-transplantation hepatitis. Through fluorescence in situ hybridization (FISH), we also analyzed the presence of recipient-derived Y-positive hepatocytes in the biopsies of livers transplanted from female donors to male recipients. The study population comprised 24 pediatric liver transplant recipients who survived with the initial graft, whose 10-year protocol biopsy records were available, and who had normal liver function (stable graft, SG; n=13) or a late dysfunctional graft (LDG; n=11) with similar follow-up periods (mean 10.8years in the SG group and 11.2years in the LDG group). STR analysis revealed that hepatocyte chimerism occurred in 7 of 13 (54%) SGs and 5 of 11 (45%) LDGs (p=0.68). The proportion of hepatocyte chimerism was low, with a mean of 3% seen in 2 of 3 female-to-male transplanted livers (one each of SG and LDG). In conclusion, hepatocyte chimerism was a constant event. The extent of engraftment of recipient-derived hepatocytes does not seem to correlate with the degree of hepatic injury in long-term liver allografts.

  19. Therapies for Musculoskeletal Disease: Can we Treat Two Birds with One Stone?

    PubMed Central

    Girgis, Christian M.; Mokbel, Nancy; DiGirolamo, Douglas J.

    2014-01-01

    Musculoskeletal diseases are highly prevalent with staggering annual health care costs across the globe. The combined wasting of muscle (sarcopenia) and bone (osteoporosis)— both in normal aging and pathologic states—can lead to vastly compounded risk for fracture in patients. Until now, our therapeutic approach to the prevention of such fractures has focused solely on bone, but our increasing understanding of the interconnected biology of muscle and bone has begun to shift our treatment paradigm for musculoskeletal disease. Targeting pathways that centrally regulate both bone and muscle (eg, GH/IGF-1, sex steroids, etc.) and newly emerging pathways that might facilitate communication between these 2 tissues (eg, activin/myostatin) might allow a greater therapeutic benefit and/or previously unanticipated means by which to treat these frail patients and prevent fracture. In this review, we will discuss a number of therapies currently under development that aim to treat musculoskeletal disease in precisely such a holistic fashion. PMID:24633910

  20. Therapies for musculoskeletal disease: can we treat two birds with one stone?

    PubMed

    Girgis, Christian M; Mokbel, Nancy; Digirolamo, Douglas J

    2014-06-01

    Musculoskeletal diseases are highly prevalent with staggering annual health care costs across the globe. The combined wasting of muscle (sarcopenia) and bone (osteoporosis)-both in normal aging and pathologic states-can lead to vastly compounded risk for fracture in patients. Until now, our therapeutic approach to the prevention of such fractures has focused solely on bone, but our increasing understanding of the interconnected biology of muscle and bone has begun to shift our treatment paradigm for musculoskeletal disease. Targeting pathways that centrally regulate both bone and muscle (eg, GH/IGF-1, sex steroids, etc.) and newly emerging pathways that might facilitate communication between these 2 tissues (eg, activin/myostatin) might allow a greater therapeutic benefit and/or previously unanticipated means by which to treat these frail patients and prevent fracture. In this review, we will discuss a number of therapies currently under development that aim to treat musculoskeletal disease in precisely such a holistic fashion.

  1. Recognising neuroplasticity in musculoskeletal rehabilitation: a basis for greater collaboration between musculoskeletal and neurological physiotherapists.

    PubMed

    Snodgrass, Suzanne J; Heneghan, Nicola R; Tsao, Henry; Stanwell, Peter T; Rivett, Darren A; Van Vliet, Paulette M

    2014-12-01

    Evidence is emerging for central nervous system (CNS) changes in the presence of musculoskeletal dysfunction and pain. Motor control exercises, and potentially manual therapy, can induce changes in the CNS, yet the focus in musculoskeletal physiotherapy practice is conventionally on movement impairments with less consideration of intervention-induced neuroplastic changes. Studies in healthy individuals and those with neurological dysfunction provide examples of strategies that may also be used to enhance neuroplasticity during the rehabilitation of individuals with musculoskeletal dysfunction, improving the effectiveness of interventions. In this paper, the evidence for neuroplastic changes in patients with musculoskeletal conditions is discussed. The authors compare and contrast neurological and musculoskeletal physiotherapy clinical paradigms in the context of the motor learning principles of experience-dependent plasticity: part and whole practice, repetition, task-specificity and feedback that induces an external focus of attention in the learner. It is proposed that increased collaboration between neurological and musculoskeletal physiotherapists and researchers will facilitate new discoveries on the neurophysiological mechanisms underpinning sensorimotor changes in patients with musculoskeletal dysfunction. This may lead to greater integration of strategies to enhance neuroplasticity in patients treated in musculoskeletal physiotherapy practice.

  2. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature.

  3. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature. PMID:19039574

  4. Recirculation of indium-111-labeled lymphocytes in normal and allografted rats

    SciTech Connect

    Oluwole, S.; Satake, K.; Kuromoto, N.; Fawwaz, R.; Hardy, M.A.

    1983-11-01

    The kinetics of lymphocyte recirculation in normal and allografted rats with acute cardiac rejection was studied with indium-111 (In-111) labeled splenic lymphocytes in two groups of rats. Group 1 consisted of subgroups of normal Lewis rats infused with In-111 labeled unsensitized syngeneic cells (group 1a); ACI-sensitized syngeneic cells (group 1b); and ACI spleen cells (group 1c). Four rats from each subgroup were killed at 3, 6, 18, and 24 hr after cell infusion for blood, spleen, mesenteric lymph node (MLN), thymus, bone marrow (BM), liver, kidney, muscle, and heart scintillation counts. Group 2 consisted of Lewis recipients of ACI cardiac allografts infused with normal or with ACI-sensitized syngeneic splenic cells. Four rats from each subgroup were killed daily until rejection (day 7) for isotope counts of various organs. In ungrafted rats (group I), splenic accumulation of unsensitized syngeneic cells fell from 50% of the total injected dose/g tissue at 3 hr to 28% at 24 hr, whereas it rose from 12% at 3 hr to 39% at 24 hr in MLN. In contrast, the sensitized syngeneic and allogeneic cells homed preferentially to the spleen with insignificant accumulation in the MLN throughout the experiment. The BM and liver showed moderate accumulation while the thymus and nonlymphoid organs had low concentrations of labeled cells at all times. Splenic accumulation of unsensitized syngeneic cells in allografted rats (group II) showed a steep rise from day 1, reaching a peak at day 3, followed by a plateau--but sensitized cells demonstrated a peak on day 4 followed by a sharp decline until rejection. Accumulation of unsensitized cells in the MLN was significantly higher than that of sensitized cells throughout the study. There was a significant fall in radioactivity of BM, thymus, liver, and nonlymphoid organs from days 1-7, and the cardiac allograft demonstrated a reciprocal sharp rise in radioactivity.

  5. Perforin and granzyme B. Cytolytic proteins up-regulated during rejection of rat small intestine allografts.

    PubMed

    McDiarmid, S V; Farmer, D G; Kuniyoshi, J S; Robert, M; Khadavi, A; Shaked, A; Busuttil, R W

    1995-03-15

    Perforin and granzyme B are 2 cytolytic proteins specific to activated killer cells, particularly CTL. We have studied the mRNA expression of these 2 proteins by a reverse transcriptase polymerase chain reaction method in a unidirectional model of rat small intestine transplant rejection. The allograft group consisted of Lewis x Brown Norway F1 donors into Lewis recipients. The isograft controls were Lewis donors into Lewis recipients. Grafts were placed heterotopically and no immunosuppression was given. Five animals in each group were killed at postoperative days (POD) 3, 5, 7, 8, 9, 10, 12, and 14. mRNA was extracted and a semiquantitative reverse transcriptase polymerase chain reaction was performed. For the semiquantitative analysis, we compared scintillation counts from excised bands. Results were expressed as a percent activity compared with beta-actin. From the same tissue samples, a histologic evaluation was made and rejection was graded according to severity. The isograft controls showed no evidence of histologic rejection and a very low expression of mRNA for perforin and granzyme B from POD 3-14. In contrast, the allograft group began to show histologic evidence of mild rejection on POD 5. By day 7, rejection was moderately severe and associated with a significant up-regulation of perforin and granzyme B in the allografts compared with the controls (P < 0.01), which persisted through POD 14. Peak expression for perforin and granzyme B was on POD 10 and 8, respectively. We conclude that the up-regulation of perforin and granzyme B in rat small intestine transplant allografts is a useful marker of clinically important rejection. PMID:7886805

  6. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique.

    PubMed

    White, Brian J; Herzog, Mackenzie M

    2016-02-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue.

  7. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique

    PubMed Central

    White, Brian J.; Herzog, Mackenzie M.

    2016-01-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue. PMID:27073784

  8. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique.

    PubMed

    White, Brian J; Herzog, Mackenzie M

    2016-02-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue. PMID:27073784

  9. Sterilization of skin allografts by ionizing radiation.

    PubMed

    Bourroul, Selma Cecília; Herson, Marisa Roma; Pino, Eddy; Matho, Monica Beatriz

    2002-11-01

    The skin has a fundamental role in the viability of human body. In the case of extensive wounds, skin allografts provide an alternative to cover temporarily the damaged areas. After donor screening and preservation in glycerol 85%, the skin can be stored in a Skin Bank. Glycerol at this concentration has a bacteriostatic effect after certain time of preservation. On the other hand, skin sterilization by ionizing radiation may reduce the quarentine period for transplantation in patients. The objective of this work was to evaluate allograft sterilization using two sources of ionizing radiation. Through the analysis of stress-strain, it was intended to verify possible effects of the radiation on the structure of preserved grafts. Three groups of skin samples were selected. The first group was maintained in the initial conditions, not irradiated. The second was exposed to cobalt-60, while the third one was irradiated using an Dynamitron Accelerator JOB188 electron beam. The irradiation dose was 25 kGy for both tests. Both irradiation sources, and the Instron Universal Machine used for biomechanical experiments, are installed at the Centro de Tecnologia das Radiações/Instituto de Pesquisas Energéticas e Nucleares (São Paulo, Brazil). According to the preliminary results, biomechanical characteristics of the samples irradiated seem to be maintained with regard to the non irradiated group.

  10. Autograft versus allograft in anterior cruciate ligament reconstruction

    PubMed Central

    Kan, Shun-Li; Yuan, Zhi-Fang; Ning, Guang-Zhi; Yang, Bo; Li, Hai-Liang; Sun, Jing-Cheng; Feng, Shi-Qing

    2016-01-01

    Abstract Background: Anterior cruciate ligament (ACL) reconstruction is considered as the standard surgical procedure for the treatment of ACL tear. However, there is a crucial controversy in terms of whether to use autograft or allograft in ACL reconstruction. The purpose of this meta-analysis is to compare autograft with allograft for patients undergoing ACL reconstruction. Methods: PubMed, EMBASE, and the Cochrane Library were searched for randomized controlled trials that compared autograft with allograft in ACL reconstruction up to January 31, 2016. The relative risk or mean difference with 95% confidence interval was calculated using either a fixed- or random-effects model. The risk of bias for individual studies according to the Cochrane Handbook. The trial sequential analysis was used to test the robustness of our findings and get more conservative estimates. Results: Thirteen trials were included, involving 1636 participants. The results of this meta-analysis indicated that autograft brought about lower clinical failure, better overall International Knee Documentation Committee (IKDC) level, better pivot-shift test, better Lachman test, greater Tegner score, and better instrumented laxity test (P < 0.05) than allograft. Autograft was not statistically different from allograft in Lysholm score, subjective IKDC score, and Daniel 1-leg hop test (P > 0.05). Subgroup analyses demonstrated that autograft was superior to irradiated allograft for patients undergoing ACL reconstruction in clinical failure, Lysholm score, pivot-shift test, Lachman test, Tegner score, instrumented laxity test, and subjective IKDC score (P < 0.05). Moreover, there were no significant differences between autograft and nonirradiated allograft. Conclusions: Autograft is superior to irradiated allograft for patients undergoing ACL reconstruction concerning knee function and laxity, but there are no significant differences between autograft and nonirradiated allograft. However

  11. Orthopedic Health: Targeting Musculoskeletal Pain

    MedlinePlus

    ... is to grow a patient's own bone marrow stem cells, the ones that make connective tissues, outside ... problems. Using tiny, biodegradable fibers seeded with adult stem cells, we've made a prototype disc which ...

  12. Musculoskeletal infections associated with Citrobacter koseri.

    PubMed

    Kwaees, T A; Hakim, Z; Weerasinghe, C; Dunkow, P

    2016-09-01

    Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase(®) and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery. PMID:27412805

  13. Musicians' Medicine: Musculoskeletal Problems in String Players

    PubMed Central

    Lee, Han-Sung; Park, Ho Youn; Yoon, Jun O; Kim, Jin Sam; Chun, Jae Myeung; Aminata, Iman W.; Cho, Won-Joon

    2013-01-01

    There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed. PMID:24009899

  14. Musicians' medicine: musculoskeletal problems in string players.

    PubMed

    Lee, Han-Sung; Park, Ho Youn; Yoon, Jun O; Kim, Jin Sam; Chun, Jae Myeung; Aminata, Iman W; Cho, Won-Joon; Jeon, In-Ho

    2013-09-01

    There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed. PMID:24009899

  15. Musicians' medicine: musculoskeletal problems in string players.

    PubMed

    Lee, Han-Sung; Park, Ho Youn; Yoon, Jun O; Kim, Jin Sam; Chun, Jae Myeung; Aminata, Iman W; Cho, Won-Joon; Jeon, In-Ho

    2013-09-01

    There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed.

  16. Musculoskeletal infections associated with Citrobacter koseri.

    PubMed

    Kwaees, T A; Hakim, Z; Weerasinghe, C; Dunkow, P

    2016-09-01

    Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase(®) and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery.

  17. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery.

    PubMed

    Chiarello, Eugenio; Cadossi, Matteo; Tedesco, Giuseppe; Capra, Paola; Calamelli, Carlotta; Shehu, Alba; Giannini, Sandro

    2013-10-01

    Reconstruction of bone defects is a challenge for all orthopedic surgeons worldwide; to overcome this problem there are different options: the use of autografts, allografts and bone substitutes (BSs) to enhance and accelerate bone repair. Autografts have excellent biological properties but are associated with morbidity of the donor site and are restricted in volume. Allografts are available in adequate quantity but concerns still remain about the risk of infections, moreover they do not have osteogenetic properties. Bone substitutes have different indications and are very attractive for orthopedic surgeons. The present paper briefly reviews the advantages and disadvantages of autografts, allografts and BSs for bone reconstruction.

  18. Acute and Chronic Allograft Dysfunction in Kidney Transplant Recipients.

    PubMed

    Goldberg, Ryan J; Weng, Francis L; Kandula, Praveen

    2016-05-01

    Allograft dysfunction after a kidney transplant is often clinically asymptomatic and is usually detected as an increase in serum creatinine level with corresponding decrease in glomerular filtration rate. The diagnostic evaluation may include blood tests, urinalysis, transplant ultrasonography, radionuclide imaging, and allograft biopsy. Whether it occurs early or later after transplant, allograft dysfunction requires prompt evaluation to determine its cause and subsequent management. Acute rejection, medication toxicity from calcineurin inhibitors, and BK virus nephropathy can occur early or later. Other later causes include transplant glomerulopathy, recurrent glomerulonephritis, and renal artery stenosis.

  19. Design and optimization of a tissue-engineered bone graft substitute

    NASA Astrophysics Data System (ADS)

    Shimko, Daniel Andrew

    2004-12-01

    In 2000, 3.1 million surgical procedures on the musculoskeletal system were reported in the United States. For many of these cases, bone grafting was essential for successful fracture stabilization. Current techniques use intact bone obtained either from the patient (autograft) or a cadaver (allograft) to repair large defects, however, neither source is optimal. Allografts suffer integration problems, and for autografts, the tissue supply is limited. Because of these shortcomings, and the high demand for graft tissues, alternatives are being explored. To successfully engineer a bone graft replacement, one must employ a three pronged research approach, addressing (1) the cells that will inhabit the new tissue, (2) the culture environment that these cells will be exposed to, and (3) the scaffold in which these cells will reside. The work herein examines each of these three aspects in great detail. Both adult and embryonic stem cells (ESCs) were considered for the tissue-engineered bone graft. Both exhibited desirable qualities, however, neither were optimal in all categories examined. In the end, the possibility of teratoma formation and ethical issues surrounding ESCs, made the use of adult marrow-derived stem cells in the remaining experiments obligatory. In subsequent experiments, the adult stem cells' ability to form bone was optimized. Basic fibroblast growth factor, fetal bovine serum, and extracellular calcium supplementation studies were all performed. Ultimately, adult stem cells cultured in alpha-MEM supplemented with 10% fetal bovine serum, 10mM beta-glycerophosphate, 10nM dexamethasone, 50mug/ml ascorbic acid, 1%(v/v) antibiotic/antimycotic, and 10.4mM CaCl2 performed the best, producing nearly four times more mineral than any other medium formulation. Several scaffolds were then investigated including those fabricated from poly(alpha-hydroxy esters), tantalum, and poly-methylmethacrylate. In the final study, the most appealing cell type, medium

  20. Sex-specific effects of carotenoid intake on the immunological response to allografts in guppies (Poecilia reticulata).

    PubMed

    Grether, Gregory F; Kasahara, Shinji; Kolluru, Gita R; Cooper, Edwin L

    2004-01-01

    Rarely are the evolutionary origins of mate preferences known, but, recently, the preference of female guppies (Poecilia reticulata) for males with carotenoid-based sexual coloration has been linked to a sensory bias that may have originally evolved for detecting carotenoid-rich fruits. If carotenoids enhance the immune systems of these fishes, as has been suggested for other species, this could explain the origin of the attraction to orange fruits as well as the maintenance of the female preference for orange males. We used the classic immunological technique of tissue grafting to assay a component of the immune response of guppies raised on two different dietary levels of carotenoids. Individual scales were transplanted between pairs of unrelated fishes, creating reciprocal allografts. Transplanted scales were scored on a six-point rejection scale every day for 10 days. Five days later, the same pairs of fishes received a second set of allografts and were scored again. Compared with low-carotenoid-diet males, high-carotenoid-diet males mounted a significantly stronger rejection response to the second allograft but not to the first allograft. High-carotenoid-diet females, however, showed no improvement in graft rejection compared with low-carotenoid-diet females. To our knowledge, this is the first experimental evidence for sex-specific effects of carotenoid consumption on the immune system of a species with carotenoid-based sexual coloration. These results are consistent with the hypothesis that the mate preference for carotenoid coloration is maintained by the benefits to females of choosing healthy mates, but they cast doubt on the idea that the benefits of carotenoid consumption, per se, could account for the origin of the preference. The sex-specificity of carotenoid effects on allograft rejection in guppies provides indirect support for the general hypothesis that males pay an immunological cost for sexual ornamentation.

  1. Preliminary Results of Bioactive Amniotic Suspension with Allograft for Achieving One and Two-Level Lumbar Interbody Fusion

    PubMed Central

    Kerr, Eubulus J.; Utter, Philip A.; Cavanaugh, David A.; Frank, Kelly A.; Moody, Devan; McManus, Brian; Stone, Marcus B.

    2016-01-01

    Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In recent years alternatives such as allograft, demineralized bone matrix (DBM), ceramics, and bone morphogenetic protein (BMP) have gained favor, although the complications of these are not fully understood. Bioactive amniotic suspension (BAS) with allograft is a new class of material derived from human amniotic tissue. Methods Eligible patients receiving a one or two level lumbar interbody fusion with Nucel, a BAS with allograft, were contacted and scheduled for a mininmim 12 month follow-up visit. Patients were evaluated for fusion using CT's and plain radiographs. Clincal outcomes, including ODI, VAS back and leg were collected, as well as comorbidities including BMI, smoking status, diabetes and previous lumbar surgery. Results One-level patients (N=38) were 71.1% female with mean age of 58.4 ± 12.7 and mean BMI of 30.6 ± 6.08. Two-level patients (N=34) were 58.8% female with mean age of 49.3 ±10.9 and mean BMI of 30.1 ± 5.82. Kinematic fusion was achieved in 97.4% of one-level patients and 100% of two-level patients. Baseline comorbidities were present in 89.5% of one-level patients and 88.2% of two-level patients. No adverse events related to BAS were reported in this study. Conclusion Fusion status is evaluated with many different biologics and varying methods in the literature. BAS with allograft in this study demonstrated high fusion rates with no complications within a largely comorbid population. Although a small population, BAS with allograft results were encouraging for one and two-level lumbar interbody fusion in this study. Further prospective studies should be conducted to investigate safety and efficacy in a larger population. PMID:27162714

  2. Sex-specific effects of carotenoid intake on the immunological response to allografts in guppies (Poecilia reticulata).

    PubMed Central

    Grether, Gregory F.; Kasahara, Shinji; Kolluru, Gita R.; Cooper, Edwin L.

    2004-01-01

    Rarely are the evolutionary origins of mate preferences known, but, recently, the preference of female guppies (Poecilia reticulata) for males with carotenoid-based sexual coloration has been linked to a sensory bias that may have originally evolved for detecting carotenoid-rich fruits. If carotenoids enhance the immune systems of these fishes, as has been suggested for other species, this could explain the origin of the attraction to orange fruits as well as the maintenance of the female preference for orange males. We used the classic immunological technique of tissue grafting to assay a component of the immune response of guppies raised on two different dietary levels of carotenoids. Individual scales were transplanted between pairs of unrelated fishes, creating reciprocal allografts. Transplanted scales were scored on a six-point rejection scale every day for 10 days. Five days later, the same pairs of fishes received a second set of allografts and were scored again. Compared with low-carotenoid-diet males, high-carotenoid-diet males mounted a significantly stronger rejection response to the second allograft but not to the first allograft. High-carotenoid-diet females, however, showed no improvement in graft rejection compared with low-carotenoid-diet females. To our knowledge, this is the first experimental evidence for sex-specific effects of carotenoid consumption on the immune system of a species with carotenoid-based sexual coloration. These results are consistent with the hypothesis that the mate preference for carotenoid coloration is maintained by the benefits to females of choosing healthy mates, but they cast doubt on the idea that the benefits of carotenoid consumption, per se, could account for the origin of the preference. The sex-specificity of carotenoid effects on allograft rejection in guppies provides indirect support for the general hypothesis that males pay an immunological cost for sexual ornamentation. PMID:15002770

  3. The role of sensitization in musculoskeletal shoulder pain

    PubMed Central

    Borstad, John; Woeste, Christopher

    2015-01-01

    Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds. Discussion: It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain. PMID:26443971

  4. Effect of helium-neon laser on musculoskeletal trigger points

    SciTech Connect

    Snyder-Mackler, L.; Bork, C.; Bourbon, B.; Trumbore, D.

    1986-07-01

    Cold lasers have been proposed recently as a therapeutic tool for treating a wide variety of pathological conditions, including wounds, arthritis, orthopedic problems, and pain. These proposed therapeutic effects largely have been unsubstantiated by research. A randomized, double blind study was undertaken to ascertain the effect of a helium-neon (He-Ne) laser on the resistance of areas of skin overlying musculoskeletal trigger points. These areas usually demonstrate decreased skin resistance when compared with the surrounding tissue. Thirty patients with musculoskeletal trigger points were assigned randomly to either an experimental or a placebo group. In addition to standard physical therapy, each patient received three 15-second applications of a He-Ne laser or placebo stimulation from an identical unit that did not emit a laser. The results of a two-way analysis of covariance with one repeated measure showed a statistically significant increase (p less than .007) in skin resistance. This increase in an abnormal skin resistance pattern may accompany the resolution of pathological conditions.

  5. Musculoskeletal-induced Nucleation in Altitude Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. There are limited data available to evaluate cost-benefit relationships. Understanding the relationship is important to improve our understanding of the underlying mechanisms of nucleation in exercise prebreathe protocols and to quantify risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS.

  6. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor.

  7. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

  8. Dysplasia Epiphysealis Hemimelica Treated with Osteochondral Allograft: A Case Report

    PubMed Central

    Anthony, Chris A.; Wolf, Brian R.

    2015-01-01

    Background Dysplasia epiphysealis hemimelica (DEH), or Trevor's disease, is a developmental disorder of the pediatric skeleton characterized by asymmetric osteochondral overgrowth. Methods We present the case of a five year old boy with a two year history of right knee pain and evidence of DEH on imaging who underwent initial arthroscopic resection of his lesion with subsequent recurrence. The patient then underwent osteochondral allograft revision surgery and was asymptomatic at two year follow-up with a congruent joint surface. Results To our knowledge, this is the first reported case of a DEH lesion treated with osteochondral allograft and also the youngest reported case of osteochondral allograft placement in the literature. Conclusions Osteochondral allograft may be a viable option in DEH and other deformities of the pediatric knee. Level of Evidence Level V PMID:26361443

  9. Tissue engineering: orthopedic applications.

    PubMed

    Laurencin, C T; Ambrosio, A M; Borden, M D; Cooper, J A

    1999-01-01

    Because of an aging population and increased occurrence of sports-related injuries, musculoskeletal disorders have become one of the major health concerns in the United States. Current treatments, although fairly successful, do not provide the optimum therapy. These treatments typically rely on donor tissues obtained either from the patient or from another source. The former raises the issue of supply, whereas the latter poses the risk of rejection and disease transfer. This has prompted orthopedic surgeons and scientists to look for viable alternatives. In recent years, tissue engineering has gained increasing support as a method to treat orthopedic disorders. Because it uses principles of engineering, biology, and chemistry, tissue engineering may provide a more effective approach to the treatment of musculoskeletal disorders than traditional methods. This chapter presents a review of current methods and new tissue-engineering techniques for the treatment of disorders affecting bone, ligament, and cartilage.

  10. Deceased donor skin allograft banking: Response and utilization

    PubMed Central

    Gore, Madhuri A.; De, Anuradha S.

    2010-01-01

    Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country. PMID:21321645

  11. A Case of Intraparenchymal Pseudoaneurysms in Kidney Allograft.

    PubMed

    Lorentz, Liam Antony; Hlabangana, Linda Tebogo; Davies, Malcom

    2016-01-01

    BACKGROUND Percutaneous needle biopsy is routinely performed for renal allograft management. Vascular complications of the procedure include pseudoaneurysm and arterio-venous fistulae formation. Delayed diagnosis of these complications is due to their mostly asymptomatic and indolent nature. CASE REPORT We present a case of extensive intraparenchymal pseudoaneurysm formation within the inferior pole of the allograft, diagnosed two years following the most recent biopsy procedure. CONCLUSIONS Renal pseudoaneurysms may only be diagnosed years after their formation as they are typically asymptomatic. PMID:27510594

  12. The Spectrum of Renal Allograft Failure

    PubMed Central

    Chand, Sourabh; Atkinson, David; Collins, Clare; Briggs, David; Ball, Simon; Sharif, Adnan; Skordilis, Kassiani; Vydianath, Bindu; Neil, Desley; Borrows, Richard

    2016-01-01

    Background Causes of “true” late kidney allograft failure remain unclear as study selection bias and limited follow-up risk incomplete representation of the spectrum. Methods We evaluated all unselected graft failures from 2008–2014 (n = 171; 0–36 years post-transplantation) by contemporary classification of indication biopsies “proximate” to failure, DSA assessment, clinical and biochemical data. Results The spectrum of graft failure changed markedly depending on the timing of allograft failure. Failures within the first year were most commonly attributed to technical failure, acute rejection (with T-cell mediated rejection [TCMR] dominating antibody-mediated rejection [ABMR]). Failures beyond a year were increasingly dominated by ABMR and ‘interstitial fibrosis with tubular atrophy’ without rejection, infection or recurrent disease (“IFTA”). Cases of IFTA associated with inflammation in non-scarred areas (compared with no inflammation or inflammation solely within scarred regions) were more commonly associated with episodes of prior rejection, late rejection and nonadherence, pointing to an alloimmune aetiology. Nonadherence and late rejection were common in ABMR and TCMR, particularly Acute Active ABMR. Acute Active ABMR and nonadherence were associated with younger age, faster functional decline, and less hyalinosis on biopsy. Chronic and Chronic Active ABMR were more commonly associated with Class II DSA. C1q-binding DSA, detected in 33% of ABMR episodes, were associated with shorter time to graft failure. Most non-biopsied patients were DSA-negative (16/21; 76.1%). Finally, twelve losses to recurrent disease were seen (16%). Conclusion This data from an unselected population identifies IFTA alongside ABMR as a very important cause of true late graft failure, with nonadherence-associated TCMR as a phenomenon in some patients. It highlights clinical and immunological characteristics of ABMR subgroups, and should inform clinical practice and

  13. Biodegradable foam coating of cortical allografts.

    PubMed

    Bondre, S; Lewandrowski, K U; Hasirci, V; Cattaneo, M V; Gresser, J D; Wise, D L; Tomford, W W; Trantolo, D J

    2000-06-01

    Clinical outcomes of bone allograft procedures may be improved by modifying the surface of the graft with an osteoconductive biopolymeric coating. In this comparative in vitro study, we evaluated the dimensional stability, mechanical strength, hydrophilicity, and water uptake of biodegradable foams of poly(propylene fumarate) (PPF) and poly(d,l-lactic-co glycolic acid) (PLGA) when applied as surface coatings to cortical bone. Cortical bone samples were divided into four groups: Type I, untreated bone; Type II, laser-perforated bone; Type III, partially demineralized bone; and Type IV, laser-perforated and partially demineralized bone. Results show that PPF wets easily, achieving 12.5% wt/wt in 30 min. Compressive tests on the PPF foam material showed that the compressive strength was 6.8 MPa prior to in vitro incubation but then gradually reduced to 1.9 MPa at 8 weeks. Push-out and pulloff strength tests showed that initially both PPF and PLGA foam coatings had comparable adherence strengths to the cortical bone samples (100-150 N). When additional geometrical surface alteration by perforation and demineralization of the bony substrate was employed, in vitro adherence of the PPF foam coating was further increased to 120 N, demonstrating a statistically significant improvement of push-out strength throughout the entire 8-week observation period (p<0.0002 for all four data points). The pore geometry of PPF-foam coatings changed little over the 2-month evaluation period. In comparison, PLGA foam coating around the cortical bone samples rapidly lost structure with a decrease of 67% in strength seen after 1-week in vitro incubation. These new types of bone allografts may be particularly useful where the use of other replacement materials is not feasible or practical.

  14. Local long-term expression of lentivirally delivered IL-10 in the lung attenuates obliteration of intrapulmonary allograft airways.

    PubMed

    Hirayama, Shin; Sato, Masaaki; Liu, Mingyao; Loisel-Meyer, Severine; Yeung, Jonathan C; Wagnetz, Dirk; Cypel, Marcelo; Zehong, Guan; Medin, Jeffrey A; Keshavjee, Shaf

    2011-11-01

    Obliterative bronchiolitis (OB) is a form of chronic rejection after lung transplantation. Lentiviral vectors (LVs) facilitate long-term gene transduction in many tissues and organs. We hypothesized that lentiviral gene transfer of interleukin (IL)-10, a potent immune-modulating cytokine, to the lung could modulate the alloimmune responses in the lung after transplantation. C57BL6 mice received LVs encoding luciferase, enhanced green fluorescent protein (eGFP), or human IL-10 (huIL-10) through airways and underwent repeated bioluminescent imaging, immunofluorescence imaging, or ELISA of lung tissues, respectively. Luciferase activities peaked at day 7 and were stable after day 28 to over 15 months. eGFP staining demonstrated LV-mediated gene transduction mainly in alveolar macrophages. LV-huIL-10 delivery resulted in stable long-term expression of huIL-10 in the lung tissue (average 3.66 pg/mg at 1 year). Intrapulmonary allograft tracheal transplantation (BALBc→C57BL6) was used as a model of OB. LV-huIL-10 or LV-eGFP were delivered 7 days before transplantation and compared with no LV-transfection group. Allograft airways at day 28 were almost completely obliterated in all the groups. However, at day 42, allograft airways treated with LV-huIL-10 showed a spectrum of attenuation in airway fibrosis ranging from complete obliteration through bubble-like partial opening to complete patency with epithelial coverage in association with a significantly reduced obliteration ratio compared with the other groups (p<0.05). In conclusion, lentivirus-mediated gene transduction is useful in achieving long-term transgene expression in the lung. Long-term IL-10 expression has the potential to attenuate allograft airway obliteration. LV-mediated gene therapy could be a useful strategy to prevent or treat OB after lung transplantation. PMID:21568692

  15. Expression of granzyme A and B proteins by cytotoxic lymphocytes involved in acute renal allograft rejection.

    PubMed

    Kummer, J A; Wever, P C; Kamp, A M; ten Berge, I J; Hack, C E; Weening, J J

    1995-01-01

    Granzymes A and B are serine-proteinases stored in the granules of activated cytotoxic T-lymphocytes and natural killer (NK) cells. Expression of granzymes in tissues can be used as an activation marker for cytotoxic cells. Using mAbs specific for human granzyme A or B in immunohistochemical staining techniques we investigated expression of granzyme A and B by lymphocytes infiltrating acutely rejected renal allografts. Twelve core needle biopsies were taken from ten different patients during an episode of acute rejection. Eleven biopsies contained high numbers of granzyme A and B positive lymphocytes infiltrating tubular epithelium, and vascular and glomerular structures. In one patient infiltrating lymphocytes did not express granzyme A and only low amounts of granzyme B. No correlation was found between the number of granzyme positive cells and the severity of the rejection as classified by conventional histological criteria. In one tissue specimen from a patient with a renal allograft without signs of rejection, the number of granzyme positive cells was much lower compared to that of the transplant group. In spite of the presence of a marked inflammatory infiltrate, no granzyme positive cells were detected in renal biopsies from patients with various inflammatory, not transplant-related, renal diseases. Phenotypic analysis showed that granzymes A and B were expressed by CD56+ NK cells and CD3+ cells, representing cytotoxic T-lymphocytes. Thus, this study demonstrates that granzyme A and B protein-expressing lymphocytes infiltrate the kidney allografts during an acute cellular rejection but not in several other inflammatory renal diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Musculoskeletal pain in overweight and obese children

    PubMed Central

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  17. Musculoskeletal pain in overweight and obese children.

    PubMed

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  18. Pain and musculoskeletal pain syndromes in adolescents.

    PubMed

    Zapata, Aura Ligia; Moraes, Ana Julia Pantoja; Leone, Claudio; Doria-Filho, Ulysses; Silva, Clovis Artur Almeida

    2006-06-01

    The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.

  19. Role of anti-vimentin antibodies in allograft rejection.

    PubMed

    Rose, Marlene L

    2013-11-01

    Production of anti-vimentin antibodies (AVA) after solid organ transplantation are common. Although classically thought to be expressed mainly within the cytosol, recent evidence demonstrates that extracellular or cell surface expression of vimentin is not unusual. This review examines the evidence to assess whether AVA contribute to allograft pathology. Clinical studies suggest that AVA are associated with cardiac allograft vasculopathy in heart transplant recipients. Studies in non-human primates confirm that production of AVA after renal and heart transplantation are not inhibited by Cyclosporine. Experimental studies have demonstrated that mice pre-immunised with vimentin undergo accelerated acute rejection and vascular intimal occlusion of cardiac allografts. Adoptive transfer of hyperimmune sera containing AVA into B-cell-knock-out mice caused accelerated rejection of allografted hearts, this is clear evidence that antibodies to vimentin accelerate rejection. AVA act in concert with the alloimmune response and AVA do not damage syngeneic or native heart allografts. Confocal microscopy of allografted organs in vimentin immunised mice shows extensive expression of vimentin on endothelial cells, apoptotic leukocytes and platelet/leukocyte conjugates, co-localising with C4d. One explanation for the ability of AVA to accelerate rejection would be fixation of complement within the graft and subsequent pro-inflammatory effects; there may also be interactions with platelets within the vasculature.

  20. Musculoskeletal disorder (MSD) among agricultural workers.

    PubMed

    Basher, A; Nath, P; Siddique, Z S; Rahman, M H; Rubel, M A; Sayed, M S; Ahmad, S A; Mondol, G D; Bhuiyan, M R

    2015-01-01

    Farming is a large and main industry in Bangladesh. Large numbers of people are directly involved in farming and have very unique exposure compare to other sectors. Musculoskeletal problems among farmer population are not infrequent. This study was carried out among 200 farmers in one selected district. The study revealed that musculoskeletal problems were common among the farmers working in a traditional way. All the respondents were male. The age of all respondents lie between 20-60 years. Among them 22.5% farmers were illiterate, about 45.5% below Class V. About half (42%) of the respondents had reported pain in different parts of the body at least one or more times during working in land. And about two third (65.5%) of the farmers had history of joint pain and stiffness in last 12 month. Most of the farmers who suffered from musculoskeletal symptoms were 41-60 years. Specially who worked more then 20 years (82.6%) and average 6 hours per day (66.7%). The occurrence of musculoskeletal problems in various part of the body included Knee pain - 48.1%, Back pain (back ache) - 22.9%, Waist pain (low back ache) - 13.3%, Neck pain - 18.3% and shoulder pain - 10.7%. Length of work in year and daily average working hours were found significant association with musculoskeletal pain. It was found that musculoskeletal pain were more common among the farmers when they worked in squatting position (52%) and specially during weeding of plants (31%). Among them only 22% also engaged in other business. Most of the farmers complained dull aching pain (40.6%), only 2.3% noticed severe acute pain, but about 86% farmers' temporary stop their work for pain and 80% get relief after discontinue of work. About 75% respondents visited doctors for their pain which was statistically significant (p=0.001). It was found that the rates of musculoskeletal complaints are more among those individuals who worked relatively bad ergonomic condition, such as body position probably play an important

  1. Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation.

    PubMed

    Thompson, William R; Scott, Alexander; Loghmani, M Terry; Ward, Samuel R; Warden, Stuart J

    2016-04-01

    Achieving functional restoration of diseased or injured tissues is the ultimate goal of both regenerative medicine approaches and physical therapy interventions. Proper integration and healing of the surrogate cells, tissues, or organs introduced using regenerative medicine techniques are often dependent on the co-introduction of therapeutic physical stimuli. Thus, regenerative rehabilitation represents a collaborative approach whereby rehabilitation specialists, basic scientists, physicians, and surgeons work closely to enhance tissue restoration by creating tailored rehabilitation treatments. One of the primary treatment regimens that physical therapists use to promote tissue healing is the introduction of mechanical forces, or mechanotherapies. These mechanotherapies in regenerative rehabilitation activate specific biological responses in musculoskeletal tissues to enhance the integration, healing, and restorative capacity of implanted cells, tissues, or synthetic scaffolds. To become future leaders in the field of regenerative rehabilitation, physical therapists must understand the principles of mechanobiology and how mechanotherapies augment tissue responses. This perspective article provides an overview of mechanotherapy and discusses how mechanical signals are transmitted at the tissue, cellular, and molecular levels. The synergistic effects of physical interventions and pharmacological agents also are discussed. The goals are to highlight the critical importance of mechanical signals on biological tissue healing and to emphasize the need for collaboration within the field of regenerative rehabilitation. As this field continues to emerge, physical therapists are poised to provide a critical contribution by integrating mechanotherapies with regenerative medicine to restore musculoskeletal function. PMID:26637643

  2. Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation

    PubMed Central

    Thompson, William R.; Scott, Alexander; Loghmani, M. Terry; Ward, Samuel R.

    2016-01-01

    Achieving functional restoration of diseased or injured tissues is the ultimate goal of both regenerative medicine approaches and physical therapy interventions. Proper integration and healing of the surrogate cells, tissues, or organs introduced using regenerative medicine techniques are often dependent on the co-introduction of therapeutic physical stimuli. Thus, regenerative rehabilitation represents a collaborative approach whereby rehabilitation specialists, basic scientists, physicians, and surgeons work closely to enhance tissue restoration by creating tailored rehabilitation treatments. One of the primary treatment regimens that physical therapists use to promote tissue healing is the introduction of mechanical forces, or mechanotherapies. These mechanotherapies in regenerative rehabilitation activate specific biological responses in musculoskeletal tissues to enhance the integration, healing, and restorative capacity of implanted cells, tissues, or synthetic scaffolds. To become future leaders in the field of regenerative rehabilitation, physical therapists must understand the principles of mechanobiology and how mechanotherapies augment tissue responses. This perspective article provides an overview of mechanotherapy and discusses how mechanical signals are transmitted at the tissue, cellular, and molecular levels. The synergistic effects of physical interventions and pharmacological agents also are discussed. The goals are to highlight the critical importance of mechanical signals on biological tissue healing and to emphasize the need for collaboration within the field of regenerative rehabilitation. As this field continues to emerge, physical therapists are poised to provide a critical contribution by integrating mechanotherapies with regenerative medicine to restore musculoskeletal function. PMID:26637643

  3. Examining the Interaction of Force and Repetition on Musculoskeletal Disorder Risk: A Systematic Literature Review

    PubMed Central

    Gallagher, Sean; Heberger, John R.

    2015-01-01

    Objective Our aims were (a) to perform a systematic literature review of epidemiological studies that examined the interaction of force and repetition with respect to musculoskeletal disorder (MSD) risk, (b) to assess the relationship of force and repetition in fatigue failure studies of musculoskeletal tissues, and (c) to synthesize these findings. Background Many epidemiological studies have examined the effects of force and repetition on MSD risk; however, relatively few have examined the interaction between these risk factors. Method In a literature search, we identified 12 studies that allowed evaluation of a force−repetition interaction with respect to MSD risk. Identified studies were subjected to a methodological quality assessment and critical review. We evaluated laboratory studies of fatigue failure to examine tissue failure responses to force and repetition. Results Of the 12 epidemiological studies that tested a Force × Repetition interaction, 10 reported evidence of interaction. Based on these results, the suggestion is made that force and repetition may be interdependent in terms of their influence on MSD risk. Fatigue failure studies of musculoskeletal tissues show a pattern of failure that mirrors the MSD risk observed in epidemiological studies. Conclusions Evidence suggests that there may be interdependence between force and repetition with respect to MSD risk. Repetition seems to result in modest increases in risk for low−force tasks but rapid increases in risk for high−force tasks. This interaction may be representative of a fatigue failure process in affected tissues. PMID:23516797

  4. Cemented allograft-prosthesis composite reconstruction for the proximal femur tumor

    PubMed Central

    Min, Li; Tang, Fan; Duan, Hong; Zhou, Yong; Zhang, Wen-li; Shi, Rui; Tu, Chong-qi

    2015-01-01

    Introduction Cemented allograft-prosthesis composite (APC) reconstruction is one option following resection of the proximal femur tumor. However, rare studies have focused on the indications and complications. The goal of the present study was to (1) ascertain the indications for cemented APC arthroplasty in the proximal femur; (2) identify the detailed perioperative management; and (3) illustrate our experiences to avoid the complications of cemented APC. Materials and methods A total 28 patients who underwent cemented APC reconstruction of the proximal femur after tumor resection were retrospectively evaluated at a median follow-up of 56 months. Clinical records and radiographs were reviewed to evaluate patients’ outcome. Results In our series, excluding three cases of death that had a short follow-up period, union occurred in 22 (88.0%) patients (range 9–18 months). Nonunion of the greater trochanter was seen in six of the 12 patients (50.0%). Eight (32.0%) hips had resorption. There were two (8.0%) hips that were observed to have asymptomatic wear of the acetabulum. The average Musculoskeletal Tumor Society (MSTS) score was 26.5 points. The average Harris Hip Score (HHS) score was 80.6 points. There were no cases of recurrence, but metastasis was found in two hips. Conclusions Mastering indications, perioperative management, and complication prevention are all very important in the APC reconstruction after resection of the proximal femur. PMID:26345329

  5. Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update.

    PubMed

    Sweeney, Ashley; Hammer, Richard; Evenski, Andrea; Crim, Julia

    2016-11-01

    We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, "lace-like" lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual. We review the widely varying reported prevalence of imaging findings of bony sarcoidosis in the literature, and discuss reasons for this variability. We found that musculoskeletal findings at US and MRI were less specific than radiographic and CT findings, but were useful in quantifying extent of disease.

  6. Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update.

    PubMed

    Sweeney, Ashley; Hammer, Richard; Evenski, Andrea; Crim, Julia

    2016-11-01

    We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, "lace-like" lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual. We review the widely varying reported prevalence of imaging findings of bony sarcoidosis in the literature, and discuss reasons for this variability. We found that musculoskeletal findings at US and MRI were less specific than radiographic and CT findings, but were useful in quantifying extent of disease. PMID:27596753

  7. A single center's approach to discriminating donor versus host origin of renal neoplasia in the allograft kidney.

    PubMed

    Robin, Adam J; Cohen, Eric P; Chongkrairatanakul, Tepsiri; Saad, Ehad; Mackinnon, A Craig

    2016-08-01

    Renal cell carcinoma (RCC) in the allograft of kidney transplant recipient (KTR) patients is rare and may represent a de novo process arising from the transplanted organ or metastasis from a clinically undetectable host primary. Determination of host versus donor origin is important for staging and management. We report our experience utilizing Penta-C (PC) and Penta-D (PD) short-tandem repeat (STR) microsatellite analysis to discriminate between host and donor origin of RCC identified in renal allografts. We identified 5 KTR patients with RCC in the allograft kidney. The PC and PD microsatellite analysis was applied to tumor, host, and donor formalin-fixed, paraffin-embedded tissue sections and/or fresh blood leukocytes to identify the origin of the neoplastic cells. The PC and PD microsatellite alleles were robustly amplified in all samples. Each case showed one or more informative alleles indicating that the neoplastic cells originate from donor tissue. Allele frequency data indicate that by using both PC and PD markers, we will be able to discriminate between host and donor cell of origin in over 99% of cases. The PC and PD microsatellite analysis is a convenient, robust, and efficient strategy to determine donor versus host origin or RCC in transplant kidney specimens. PMID:27402221

  8. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years' minimum follow-up.

    PubMed

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

    A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction.

  9. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years' minimum follow-up.

    PubMed

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

    A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction. PMID:8961227

  10. Radiologic manifestations in the musculoskeletal system of miscellaneous endocrine disorders.

    PubMed

    Chew, F S

    1991-01-01

    The manifestations of endocrine derangements in the musculoskeletal system in infancy and childhood are disturbances in growth and maturation and in adulthood are disturbances in maintenance and metabolism. Hypercortisolism during skeletal immaturity suppresses growth. In the adult, hypercortisolism leads to osteoporosis, osteonecrosis, and muscle wasting. Deficiency of growth hormone during skeletal development results in short stature. An excess of growth hormone in a skeletally immature individual results in gigantism, an excess in a skeletally mature individual results in acromegaly. Patients with gigantism have extreme height with normal body proportions. Musculoskeletal manifestations of acromegaly include soft-tissue thickening, vertebral body enlargement, characteristic hand and foot changes, and enthesal bony proliferation. Hyperthyroidism causes catabolism of protein and loss of connective tissue, which manifest as muscle wasting. Deficient levels of thyroid hormone cause defects in growth and development. Severe growth retardation from congenital hypothyroidism is rare because neonatal screening recognizes the disorder and leads to early treatment. The skeletal manifestation of hypergonadism in children is precocious growth and early skeletal maturation. Although the initial precocious growth spurt results in a tall child, early closure of the growth plates results in a short adult. Hypogonadism in the prepubertal child results in delayed adolescence and delayed skeletal maturation. Diabetes mellitus in childhood results in decreased growth, a phenomenon presumed to be secondary to nutritional abnormalities. Generalized osteoporosis and short stature are common. In the adult, generalized osteoporosis may accompany insulin-dependent diabetes mellitus if obesity is absent. Calcification of interdigital arteries of the foot is common in diabetics and uncommon in other conditions. Additional skeletal manifestations relate to complications of diabetes such as

  11. Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.

    PubMed

    Than, P; Bálint, L; Domán, I; Szabó, G

    1999-01-01

    Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response.

  12. Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.

    PubMed

    Than, P; Bálint, L; Domán, I; Szabó, G

    1999-01-01

    Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response. PMID:10853785

  13. Successful liver allografts in mice by combination with allogeneic bone marrow transplantation

    SciTech Connect

    Nakamura, T.; Good, R.A.; Yasumizu, R.; Inoue, S.; Oo, M.M.; Hamashima, Y.; Ikehara, S.

    1986-06-01

    Successful liver allografts were established by combination with allogeneic bone marrow transplantation. When liver tissue of BALB/c (H-2d) or C57BL/6J (H-2b) mice was minced and grafted under the kidney capsules of C3H/HeN (H-2k) mice, it was rejected. However, when C3H/HeN mice were irradiated and reconstituted with T-cell-depleted BALB/c or BALB/c nu/nu bone marrow cells, or with fetal liver cells of BALB/c mice, they accepted both donor (stem-cell)-type (BALB/c) and host (thymus)-type (C3H/HeN) liver tissue. Assays for both mixed-lymphocyte reaction and induction of cytotoxic T lymphocytes revealed that the newly developed T cells were tolerant of both donor (stem-cell)-type and host (thymus)-type major histocompatibility complex determinants. We propose that liver allografts combined with bone marrow transplantation should be considered as a viable therapy for patients with liver disease such as liver cirrhosis and hepatoma.

  14. CLINICAL APPLICATION OF SHOCK WAVE THERAPY IN MUSCULOSKELETAL DISORDERS: PART I.

    PubMed

    Saggini, R; Di Stefano, A; Saggini, A; Bellomo, R G

    2015-01-01

    The shock wave has been widely recognized in literature as a biological regulator; therefore we carried out a review on the activity performed by shock waves on the bone-myofascial tissue system. To date, the application of Shock Wave Therapy (SWT) in musculoskeletal disorders has been primarily used in the treatment of tendinopathies (proximal plantar fasciopathy, lateral elbow tendinopathy, calcific tendinopathy of the shoulder, and patellar tendinopathy, etc.) and bone defects (delayed- and non-union of bone fractures, avascular necrosis of femoral head, etc.). Although the mechanism of their therapeutic effects is still unknown, the majority of published papers have shown positive and beneficial effects of using SWT as a treatment for musculoskeletal disorders, with a success rate ranging from 65 to 91%, while the complications are low or negligible. The purpose of this paper is to inform the reader about the published data on the clinical application of SWT in the treatment of musculoskeletal disorders. In this paper, with the help of a literature review, indications and success rates for SWT in the treatment of musculoskeletal disorders are outlined, while adequate SWT parameters (e.g., rate of impulses, energy flux density, etc.) are defined according to the present state of knowledge. Given the abundance of the argument, it seems appropriate to subdivide the review into two parts, the first concerning the evidence of Extracorporeal Shock Wave Therapy (ESWT) on bone disorders, the second concerning findings on tendon and muscle treatment.

  15. Reliability and validity of the Korean version of the Short Musculoskeletal Function Assessment questionnaire for patients with musculoskeletal disorder

    PubMed Central

    Jung, Kyoung-Sim; Jung, Jin-Hwa; In, Tae-Sung; Cho, Hwi-Young

    2016-01-01

    [Purpose] The purpose of this study was to establish the reliability and validity of the Short Musculoskeletal Function Assessment questionnaire, which was translated into Korean, for patients with musculoskeletal disorder. [Subjects and Methods] Fifty-five subjects (26 males and 29 females) with musculoskeletal diseases participated in the study. The Short Musculoskeletal Function Assessment questionnaire focuses on a limited range of physical functions and includes a dysfunction index and a bother index. Reliability was determined using the intraclass correlation coefficient, and validity was examined by correlating short musculoskeletal function assessment scores with the 36-item Short-Form Health Survey (SF-36) score. [Results] The reliability was 0.97 for the dysfunction index and 0.94 for the bother index. Validity was established by comparison with Korean version of the SF-36. [Conclusion] This study demonstrated that the Korean version of the Short Musculoskeletal Function Assessment questionnaire is a reliable and valid instrument for the assessment of musculoskeletal disorders. PMID:27799696

  16. Publications of the space physiology and countermeasures program, Musculoskeletal Discipline: 1980-1990

    NASA Technical Reports Server (NTRS)

    Hess, Elizabeth L.; Wallace-Robinson, Janice; Dickson, Katherine J.; Powers, Janet V.

    1992-01-01

    A 10-year cumulative bibliography of publications resulting from research supported by the musculoskeletal discipline of the space physiology and countermeasures program of NASA's Life Sciences Division is provided. Primary subjects are bone, mineral, and connective tissue, and muscle. General physiology references are also included. Principal investigators whose research tasks resulted in publication are identified by asterisk. Publications are identified by a record number corresponding with their entry in the life sciences bibliographic database, maintained by the George Washington University.

  17. Apoptosis and expression of cytotoxic T lymphocyte effector molecules in renal allografts.

    PubMed

    Olive, C; Cheung, C; Falk, M C

    1999-03-01

    Cytotoxic T lymphocyte (CTL) mediated apoptosis is thought to play a major role in the rejection of renal allografts following transplantation, however, the CTL effector mechanism that is primarily responsible for immunological rejection is unknown. The two major effector pathways of CTL killing which lead to apoptosis involve the Fas/Fas ligand (Fas L) lytic pathway, and the perforin/granzyme degranulation pathway. The expression of CTL effector molecules which influence these pathways include Fas, Fas L and TiA-1 (cytotoxic granule protein). This study has investigated apoptosis by in situ terminal deoxytransferase-catalysed DNA nick end labelling (TUNEL), and the expression of CTL effector molecules by immunohistochemistry, in renal allograft biopsies obtained from patients following kidney transplantation. Renal biopsies were classified into three histological groups; acute cellular rejection, chronic rejection, or no rejection. The extent of T-cell infiltration of renal tissues was assessed by immunohistochemical staining with an anti-CD3 monoclonal antibody. Numerous TUNEL positive cells were detected in all transplant biopsies examined; these consisted mainly of renal tubular cells and infiltrating cells, with some TUNEL positive cells also detected in the glomeruli. In the case of normal kidney tissue, renal cells also stained positive for TUNEL but there was no lymphocytic infiltration. There was significantly more T-cell infiltration observed in acute rejection biopsies compared to the no rejection biopsies. In the case of Fas L expression, there was little expression in all three biopsy groups, apart from one case of chronic rejection. Conversely, although there were no significant differences in TiA-1 expression between the three biopsy groups, TiA-1 expression was more prominent in acute rejection biopsies. Furthermore, Fas expression was significantly decreased in acute rejection biopsies when compared to those of chronic and no rejection in which Fas

  18. Amnion and Chorion Allografts in Combination with Coronally Advanced Flap in the Treatment of Gingival Recession: A Clinical Study

    PubMed Central

    Chakraborthy, Sonali; Sambashivaiah, Savita; Bilchodmath, Shivaprasad

    2015-01-01

    Background Guided tissue regeneration (GTR) based root coverage using different allograft membranes has been utilized to correct gingival recession defects with promising results. Amnion and chorion allograft membranes of alternative origin derived from human placental tissue has been advocated in the treatment of gingival recession. However, chorion membrane has been used in combination with amnion membrane no study has compared these allograft membranes in the treatment of gingival recession. Therefore, the purpose of this study was to clinically evaluate and compare the efficacy of amnion membrane and chorion membrane in combination with coronally advanced flap in the treatment of gingival recessions. Materials and Methods Twelve systemically healthy patients having at least 2 bilateral Miller’s Class I or Class II gingival recession were recruited and coronally advanced flap was performed with amnion membrane or chorion membrane. Clinical parameters such as gingival Index, plaque index, length of the recession, width of the recession, width of keratinized gingiva, relative attachment level were evaluated at baseline, 3 and 6 months post-surgery. Results The mean decrease in length of recession (LR) for Chorion site was 2.00±1.54mm and amnion site was 1.58±1.14mm. The gain in attachment level for amnion site was 2.17±1.53mm and for chorion site was 1.58±1.22mm. The total mean percentage of root coverage was 34% for chorion site and 22% for amnion site. Conclusion Both amnion membrane and chorion membrane has shown to be versatile allograft material to be used in the treatment of root coverage. PMID:26501023

  19. Biodistribution of an anti-interleukin 2 receptor monoclonal antibody in rat recipients of a heart allograft, and its use as a rejection marker in gamma scintigraphy

    SciTech Connect

    Thedrez, P.; Paineau, J.; Jacques, Y.; Chatal, J.F.; Pelegrin, A.; Bouchaud, C.; Soulillou, J.P. )

    1989-09-01

    Anti-interleukin-2 receptor monoclonal antibodies have been shown to prevent allograft rejection. This paper reports on the biodistribution of a mouse MoAb directed at the 55 Kd alpha chain of rat interleukin-2 receptor (IL2-R) during allograft rejection. Only a low percentage (approximately 1%) of intact 125I-labeled MoAb was detected in the rejected graft, and irrelevant control IgG1 was found at a similar level. This suggests that most of the injected intact MoAb bound to graft tissue via its monomorphic Fc segment. In contrast, OX39 F(ab')2 fragments showed a preferential localization in the rejected allograft and did not bind to the LEW-to-LEW syngeneic heart graft. Irrelevant F(ab')2 did not concentrate in the allogeneic graft. Accordingly, F(ab')2 fragments from OX39 or irrelevant MoAb were used for gamma-scintigraphy on allograft recipients together with biodistribution studies. Results show that scintigraphy was able to detect allograft accumulation of 131I OX39 F(ab')2, whereas no imaging was obtained when OX39 F(ab')2 was used in the syngeneic combination or when irrelevant 131-IgG1 F(ab')2 was given to allograft recipients. This method, applied to the clinical situation, could be of interest for detection of early graft rejection episodes by immunoscintigraphy using reagents specific for activation determinants on lymphocyte membranes, such as anti-interleukin-2 receptor MoAb.

  20. Creatine supplementation and aging musculoskeletal health.

    PubMed

    Candow, Darren G; Chilibeck, Philip D; Forbes, Scott C

    2014-04-01

    Sarcopenia refers to the progressive loss of muscle mass and muscle function and is a contributing factor for cachexia, bone loss, and frailty. Resistance training produces several physiological adaptations which improve aging musculoskeletal health, such as increased muscle and bone mass and strength. The combination of creatine supplementation and resistance training may further lead to greater physiological benefits. We performed meta-analyses which indicate creatine supplementation combined with resistance training has a positive effect on aging muscle mass and upper body strength compared to resistance training alone. Creatine also shows promise for improving bone mineral density and indices of bone biology. The combination of creatine supplementation and resistance training could be an effective intervention to improve aging musculoskeletal health. PMID:24190049

  1. Musculoskeletal manifestations of the antiphospholipid syndrome.

    PubMed

    Noureldine, M H A; Khamashta, M A; Merashli, M; Sabbouh, T; Hughes, G R V; Uthman, I

    2016-04-01

    The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports. PMID:26923284

  2. Operational and Research Musculoskeletal Summit: Summit Recommendations

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Walton, Marlei; Davis-Street, Janis; Smaka, Todd J.; Griffin, DeVon

    2006-01-01

    The Medical Informatics and Health Care Systems group in the Office of Space Medicine at NASA Johnson Space Center (JSC) has been tasked by NASA with improving overall medical care on the International Space Station (ISS) and providing insights for medical care for future exploration missions. To accomplish this task, a three day Operational and Research Musculoskeletal Summit was held on August 23-25th, 2005 at Space Center Houston. The purpose of the summit was to review NASA#s a) current strategy for preflight health maintenance and injury screening, b) current treatment methods in-flight, and c) risk mitigation strategy for musculoskeletal injuries or syndromes that could occur or impact the mission. Additionally, summit participants provided a list of research topics NASA should consider to mitigate risks to astronaut health. Prior to the summit, participants participated in a web-based pre-summit forum to review the NASA Space Medical Conditions List (SMCL) of musculoskeletal conditions that may occur on ISS as well as the resources currently available to treat them. Data from the participants were compiled and integrated with the summit proceedings. Summit participants included experts from the extramural physician and researcher communities, and representatives from NASA Headquarters, the astronaut corps, JSC Medical Operations and Human Adaptations and Countermeasures Offices, Glenn Research Center Human Research Office, and the Astronaut Strength, Conditioning, and Reconditioning (ASCR) group. The recommendations in this document are based on a summary of summit discussions and the best possible evidence-based recommendations for musculoskeletal care for astronauts while on the ISS, and include recommendati ons for exploration class missions.

  3. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores

  4. Stem cell derived endochondral cartilage stimulates bone healing by tissue transformation

    PubMed Central

    Bahney, Chelsea S; Hu, Diane P; Taylor, Aaron J; Ferro, Federico; Britz, Hayley M; Hallgrimsson, Benedikt; Johnstone, Brian; Miclau, Theodore; Marcucio, Ralph S

    2016-01-01

    Although bone has great capacity for repair, there are a number of clinical situations (fracture non-unions, spinal fusions, revision arthroplasty, segmental defects) in which auto- or allografts augment bone regeneration. Critical failures associated with current grafting treatments include osteonecrosis and limited integration between graft and host tissue. We speculated that the underlying problem with current bone grafting techniques is that they promote bone regeneration through direct osteogenesis. We hypothesized that using cartilage to promote endochondral bone regeneration would leverage normal developmental and repair sequences to produce a well-vascularized regenerate that integrates with the host tissue. In this study we use a translational murine model of a segmental tibia defect to test the clinical utility of bone regeneration from a cartilage graft. We further test the mechanism by which cartilage promotes bone regeneration using in vivo lineage tracing and in vitro culture experiments. Our data show that cartilage grafts support regeneration of a vascularized and integrated bone tissue in vivo, and subsequently propose a translational tissue engineering platform using chondrogenesis of MSCs. Interestingly, lineage tracing experiments show the regenerate was graft derived, suggesting transformation of the chondrocytes into bone. In vitro culture data shows that cartilage explants mineralize with the addition of BMP or by exposure to HUVEC conditioned medium, indicating that endothelial cells directly promote ossification. This study provides pre-clinical data for endochondral bone repair that has potential to significantly improve patient outcomes in a variety of musculoskeletal diseases and injuries. Further, in contrast to the dogmatic view that hypertrophic chondrocytes undergo apoptosis prior to bone formation, our data suggest cartilage can transform into bone by activating the pluripotent transcription factor Oct4A. Together these data

  5. Cirrhosis-related musculoskeletal disease: radiological review.

    PubMed

    Arora, Ankur; Rajesh, S; Bansal, Kalpana; Sureka, Binit; Patidar, Yashwant; Thapar, Shalini; Mukund, Amar

    2016-10-01

    Musculoskeletal problems in patients with liver disease are common; however, they are not so well described in the literature. Therefore, there is a need to collate information on these disorders, as their incidence is on a constant rise and some of these pathologies can severely debilitate the patient's quality of life. These disorders are parietal wall varices with or without bleeding, spontaneous intramuscular haematoma (e.g. rectus sheath), abdominal wall hernia, anasarca, hepatic osteodystrophy, septic arthritis, osteomyelitis, necrotizing fasciitis, osseous metastases from hepatocellular carcinoma etc. While portal hypertension plays a key role in disorders, in others, dysregulation of the coagulation system or a compromised immune system are responsible. Imaging plays an essential role in the assessment of these complications and awareness of these musculoskeletal manifestations is vital for establishing a timely diagnosis and planning of appropriate therapy, as these disorders can significantly impact the morbidity and mortality and also influence candidacy for liver transplantation. We herein comprehensively appraise various musculoskeletal complications associated with chronic liver disease/liver cirrhosis especially from an imaging perspective which, to the best of our knowledge, have not been collectively described in English literature. PMID:27356209

  6. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

  7. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    PubMed

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts.

  8. Significant prolongation of segmental pancreatic allograft survival in two species

    SciTech Connect

    Du Toit, D.F.; Heydenrych, J.J.

    1988-06-01

    A study was conducted to assess the suppression of segmental pancreatic allograft rejection by cyclosporine (CSA) alone in baboons and dogs, and subtotal marrow irradiation (TL1) alone and TL 1 in combination with CSA in baboons. Total pancreatectomy in the dog and primate provided a reliable diabetic model, induced an absolute deficiency of insulin and was uniformly lethal if not treated. Continuous administration of CSA in baboons resulted in modest allograft survival. As in baboons, dogs receiving CSA 25 mg/kg/d rendered moderate graft prolongation but a dose of 40 mg/kg/d resulted in significant graft survival (greater than 100 days) in 5 of 8 allograft recipients. Irradiation alone resulted in minimal baboon pancreatic allograft survival of 20 baboons receiving TL1 1,000 rad and CSA, 3 had graft survival greater than of 100 days. Of 15 baboons receiving TL1 800 rad and CSA, 6 had graft survival of greater than 100 days. In conclusion, CSA administration in dogs and TL1 in combination with CSA in baboons resulted in highly significant segmental pancreatic allograft survival.

  9. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    PubMed

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts. PMID:1389780

  10. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation. PMID:12827226

  11. Oral hydrogen water prevents chronic allograft nephropathy in rats.

    PubMed

    Cardinal, Jon S; Zhan, Jianghua; Wang, Yinna; Sugimoto, Ryujiro; Tsung, Allan; McCurry, Kenneth R; Billiar, Timothy R; Nakao, Atsunori

    2010-01-01

    Reactive oxygen species (ROS) contribute to the development of interstitial fibrosis and tubular atrophy seen in chronic allograft nephropathy (CAN). As molecular hydrogen gas can act as a scavenger of ROS, we tested the effect of treatment with hydrogen water (HW) in a model of kidney transplantation, in which allografts from Lewis rats were orthotopically transplanted into Brown Norway recipients that had undergone bilateral nephrectomy. Molecular hydrogen was dissolved in water and recipients were given HW from day 0 until day 150. Rats that were treated with regular water (RW) gradually developed proteinuria and their creatinine clearance declined, ultimately leading to graft failure secondary to CAN. In contrast, treatment with HW improved allograft function, slowed the progression of CAN, reduced oxidant injury and inflammatory mediator production, and improved overall survival. Inflammatory signaling pathways, such as mitogen-activated protein kinases, were less activated in renal allografts from HW-treated rats as compared with RW-treated rats. Hence, oral HW is an effective antioxidant and antiinflammatory agent that prevented CAN, improved survival of rat renal allografts, and may be of therapeutic value in the setting of transplantation. PMID:19907413

  12. Autophagy in allografts rejection: A new direction?

    PubMed

    Sun, Hukui; Cheng, Dayan; Ma, Yuanyuan; Wang, Huaiquan; Liang, Ting; Hou, Guihua

    2016-03-18

    Despite the introduction of new and effective immunosuppressive drugs, acute cellular graft rejection is still a major risk for graft survival. Modulating the dosage of immunosuppressive drugs is not a good choice for all patients, new rejection mechanisms discovery are crucial to limit the inflammatory process and preserve the function of the transplant. Autophagy, a fundamental cellular process, can be detected in all subsets of lymphocytes and freshly isolated naive T lymphocytes. It is required for the homeostasis and function of T lymphocytes, which lead to cell survival or cell death depending on the context. T cell receptor (TCR) stimulation and costimulator signals induce strong autophagy, and autophagy deficient T cells leads to rampant apoptosis upon TCR stimulation. Autophagy has been proved to be activated during ischemia-reperfusion (I/R) injury and associated with grafts dysfunction. Furthermore, Autophagy has also emerged as a key mechanism in orchestrating innate and adaptive immune response to self-antigens, which relates with negative selection and Foxp3(+) Treg induction. Although, the role of autophagy in allograft rejection is unknown, current data suggest that autophagy indeed sweeps across both in the graft organs and recipients lymphocytes after transplantation. This review presents the rationale for the hypothesis that targeting the autophagy pathway could be beneficial in promoting graft survival after transplantation. PMID:26876576

  13. Autophagy in allografts rejection: A new direction?

    PubMed

    Sun, Hukui; Cheng, Dayan; Ma, Yuanyuan; Wang, Huaiquan; Liang, Ting; Hou, Guihua

    2016-03-18

    Despite the introduction of new and effective immunosuppressive drugs, acute cellular graft rejection is still a major risk for graft survival. Modulating the dosage of immunosuppressive drugs is not a good choice for all patients, new rejection mechanisms discovery are crucial to limit the inflammatory process and preserve the function of the transplant. Autophagy, a fundamental cellular process, can be detected in all subsets of lymphocytes and freshly isolated naive T lymphocytes. It is required for the homeostasis and function of T lymphocytes, which lead to cell survival or cell death depending on the context. T cell receptor (TCR) stimulation and costimulator signals induce strong autophagy, and autophagy deficient T cells leads to rampant apoptosis upon TCR stimulation. Autophagy has been proved to be activated during ischemia-reperfusion (I/R) injury and associated with grafts dysfunction. Furthermore, Autophagy has also emerged as a key mechanism in orchestrating innate and adaptive immune response to self-antigens, which relates with negative selection and Foxp3(+) Treg induction. Although, the role of autophagy in allograft rejection is unknown, current data suggest that autophagy indeed sweeps across both in the graft organs and recipients lymphocytes after transplantation. This review presents the rationale for the hypothesis that targeting the autophagy pathway could be beneficial in promoting graft survival after transplantation.

  14. High-risk corneal allografts: A therapeutic challenge

    PubMed Central

    Yu, Tian; Rajendran, Vijayalakshmi; Griffith, May; Forrester, John V; Kuffová, Lucia

    2016-01-01

    Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privilege of the eye. However, mechanisms originally thought to promote immune privilege, such as the lack of antigen presenting cells and vessels in the cornea, are challenged by recent studies. Nevertheless, the immunological and physiological features of the cornea promoting a relatively weak alloimmune response is likely responsible for the high survival rate in “low-risk” settings. Furthermore, although corneal graft survival in “low-risk” recipients is favourable, the prognosis in “high-risk” recipients for corneal graft is poor. In “high-risk” grafts, the process of indirect allorecognition is accelerated by the enhanced innate and adaptive immune responses due to pre-existing inflammation and neovascularization of the host bed. This leads to the irreversible rejection of the allograft and ultimately graft failure. Many therapeutic measures are being tested in pre-clinical and clinical studies to counter the immunological challenge of “high-risk” recipients. Despite the prevailing dogma, recent data suggest that tissue matching together with use of systemic immunosuppression may increase the likelihood of graft acceptance in “high-risk” recipients. However, immunosuppressive drugs are accompanied with intolerance/side effects and toxicity, and therefore, novel cell-based therapies are in development which target host immune cells and restore immune homeostasis without significant side effect of treatment. In addition, developments in regenerative medicine may be able to solve both important short comings of allotransplantation: (1) graft rejection and ultimate graft failure; and (2) the lack of suitable donor corneas. The advances in technology and research indicate that wider therapeutic choices for patients may be available to

  15. Fractionated sublethal total body irradiation and donor bone marrow infusion for induction of specific allograft tolerance

    SciTech Connect

    Pierce, G.E.; Kimler, B.F.; Thomas, J.H.; Watts, L.M.; Kinnaman, M.L.

    1981-03-01

    Fractionated total lymphoid irradiation (FT-lymphoid-I) plus donor bone marrow (BM) can induce tolerance to skin allografts. In the present study, fractionated total body irradiation (FT-body-I) was studied as an alternative to FT-lymphoid-I. FT-body-I produces less pulmonary and gastrointestinal injury than does single exposure total body irradiation, but because of the decreased capacity of lymphoid tissues to recover from the effects of irradiation between fractions, the effect of FT-body-I on lymphoid cells, when delivered within 24 h, is approximately the same as an equivalent single exposure of total body irradiation. Therefore, FT-body-I, like FT-lymphoid-I, has some selectivity for lymphoid tissues and has the advantage that it can be delivered within the time constraints of ex vivo organ preservation.

  16. Long-term musculoskeletal morbidity after adult burn injury: a population-based cohort study

    PubMed Central

    Randall, Sean M; Fear, Mark W; Wood, Fiona M; Rea, Suzanne; Boyd, James H; Duke, Janine M

    2015-01-01

    Objective To investigate if adults who are hospitalised for a burn injury have increased long-term hospital use for musculoskeletal diseases. Design A population-based retrospective cohort study using linked administrative health data from the Western Australian Data Linkage System. Subjects Records of 17 753 persons aged at least 20 years when hospitalised for a first burn injury in Western Australia during the period 1980–2012, and 70 758 persons who were age and gender-frequency matched with no injury admissions randomly selected from Western Australia's electoral roll. Main outcome measures Admission rates and cumulative length of stay for musculoskeletal diseases. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and HRs with 95% CIs, respectively. Results After adjustment for pre-existing health status and demographic characteristics, the burn cohort had almost twice the hospitalisation rate for a musculoskeletal condition (IRR, 95% CI 1.98, 1.86 to 2.10), and spent 3.70 times as long in hospital with a musculoskeletal diagnosis (95% CI 3.10 to 4.42) over the 33-year period, than the uninjured comparison cohort. Adjusted survival analyses of incident post-burn musculoskeletal disease admissions found significant increases for the 15-year post burn discharge period (0–6 months: HR, 95% CI 2.51, 2.04 to 3.11; 6 months–2 years: HR, 95% CI 1.77, 1.53 to 2.05; 2–15 years: HR, 95% CI 1.32, 1.23 to 1.42). Incident admission rates were significantly elevated for 20 years post-burn for minor and severe burn injury for a range of musculoskeletal diseases that included arthropathies, dorsopathies, osteopathies and soft tissue disorders. Conclusions Minor and severe burn injuries were associated with significantly increased post-burn incident admission rates, long-term hospital use and prolonged length of stay for a range of musculoskeletal diseases. Further research is required

  17. Impact of joint laxity and hypermobility on the musculoskeletal system.

    PubMed

    Wolf, Jennifer Moriatis; Cameron, Kenneth L; Owens, Brett D

    2011-08-01

    Excessive joint laxity, or hypermobility, is a common finding of clinical importance in the management of musculoskeletal conditions. Hypermobility is common in young patients and in general is associated with an increased incidence of musculoskeletal injury. Hypermobility has been implicated in ankle sprains, anterior cruciate ligament injury, shoulder instability, and osteoarthritis of the hand. Patients with hypermobility and musculoskeletal injuries often seek care for diffuse musculoskeletal pain and injuries with no specific inciting event. Orthopaedic surgeons and other healthcare providers should be aware of the underlying relationship between hypermobility and musculoskeletal injury to avoid unnecessary diagnostic tests and inappropriate management. Prolonged therapy and general conditioning are typically required, with special emphasis on improving strength and proprioception to address symptoms and prevent future injury. Orthopaedic surgeons must recognize the implications of joint mobility syndromes in the management and rehabilitation of several musculoskeletal injuries and orthopaedic disorders. PMID:21807914

  18. Combining bisphosphonates with allograft bone for implant fixation.

    PubMed

    Mathijssen, N M C; Buma, P; Hannink, G

    2014-09-01

    The aim of this review was to discuss the current state of research of combining bisphosphonates with allograft bone for implant fixation. The allograft bone can only be reached by the bisphosphonate once it has been revascularized. However, this can be circumvented by local administration of bisphosphonates. Several animal studies showed that local application of bisphosphonates might protect the graft from resorption. There seems to be an optimum concentration for local application, however, this optimum varies for all different bisphosphonates. It can be concluded that local administration of bisphosphonates might play an important role in improving stability after surgery in which a prosthesis is combined with allograft bone to restore bony defects, however caution should be taken when extrapolating results of animal research to the human clinical situation. More research is needed to study the effect of local bisphophonate use in humans and to study possible side effects.

  19. BATF inhibition prevent acute allograft rejection after cardiac transplantation

    PubMed Central

    Yang, Bo; He, Fan; Dai, Chen; Tan, Rumeng; Ma, Dongxia; Wang, Zhimin; Zhang, Bo; Feng, Jincheng; Wei, Lai; Zhu, Hua; Chen, Zhishui

    2016-01-01

    Acute allograft rejection is a serious and life-threatening complication of organ transplantation. Th17 cells induced inflammation has been described to play an important role in allograft rejection. Since there is a plenty of evidence indicating that transcriptional factor BATF regulates the differentiation of Th17 and follicular T helper cells both in vitro and in vivo, we investigated whether is BATF involved in acute rejection and allograft survival by injecting lentivirus containing BATF shRNA through tail vein before the cardiac transplantation operation. We found that the allograft survival time of the mice treated with BATF shRNA was significantly prolonged compared with that of negative shRNA treated group and the control group. Further pathological analysis revealed that the BATF shRNA treatment group had significantly lower rejection degree than the negative shRNA group, while there was no significant difference between the negative shRNA group and the control group. Furthermore, flow cytometry analysis and quantitative polymerase chain reaction and enzyme-linked immuno sorbent assay were used to determine the proportion of T helper cells, the expression of specific transcription factor and the inflammatory cytokines respectively. Data showed that BATF regulated Th17 and Treg responses during allograft rejection. And BATF inhibition led to reduction of the expression level of Rorγ-t and enhancement of the Foxp-3. In addition, cytokines IL-17A and IL-4 were found decreased. This may indicate BATF as a novel therapy target for treatment of acute allograft rejection. PMID:27648151

  20. BATF inhibition prevent acute allograft rejection after cardiac transplantation.

    PubMed

    Yang, Bo; He, Fan; Dai, Chen; Tan, Rumeng; Ma, Dongxia; Wang, Zhimin; Zhang, Bo; Feng, Jincheng; Wei, Lai; Zhu, Hua; Chen, Zhishui

    2016-01-01

    Acute allograft rejection is a serious and life-threatening complication of organ transplantation. Th17 cells induced inflammation has been described to play an important role in allograft rejection. Since there is a plenty of evidence indicating that transcriptional factor BATF regulates the differentiation of Th17 and follicular T helper cells both in vitro and in vivo, we investigated whether is BATF involved in acute rejection and allograft survival by injecting lentivirus containing BATF shRNA through tail vein before the cardiac transplantation operation. We found that the allograft survival time of the mice treated with BATF shRNA was significantly prolonged compared with that of negative shRNA treated group and the control group. Further pathological analysis revealed that the BATF shRNA treatment group had significantly lower rejection degree than the negative shRNA group, while there was no significant difference between the negative shRNA group and the control group. Furthermore, flow cytometry analysis and quantitative polymerase chain reaction and enzyme-linked immuno sorbent assay were used to determine the proportion of T helper cells, the expression of specific transcription factor and the inflammatory cytokines respectively. Data showed that BATF regulated Th17 and Treg responses during allograft rejection. And BATF inhibition led to reduction of the expression level of Rorγ-t and enhancement of the Foxp-3. In addition, cytokines IL-17A and IL-4 were found decreased. This may indicate BATF as a novel therapy target for treatment of acute allograft rejection. PMID:27648151

  1. BATF inhibition prevent acute allograft rejection after cardiac transplantation

    PubMed Central

    Yang, Bo; He, Fan; Dai, Chen; Tan, Rumeng; Ma, Dongxia; Wang, Zhimin; Zhang, Bo; Feng, Jincheng; Wei, Lai; Zhu, Hua; Chen, Zhishui

    2016-01-01

    Acute allograft rejection is a serious and life-threatening complication of organ transplantation. Th17 cells induced inflammation has been described to play an important role in allograft rejection. Since there is a plenty of evidence indicating that transcriptional factor BATF regulates the differentiation of Th17 and follicular T helper cells both in vitro and in vivo, we investigated whether is BATF involved in acute rejection and allograft survival by injecting lentivirus containing BATF shRNA through tail vein before the cardiac transplantation operation. We found that the allograft survival time of the mice treated with BATF shRNA was significantly prolonged compared with that of negative shRNA treated group and the control group. Further pathological analysis revealed that the BATF shRNA treatment group had significantly lower rejection degree than the negative shRNA group, while there was no significant difference between the negative shRNA group and the control group. Furthermore, flow cytometry analysis and quantitative polymerase chain reaction and enzyme-linked immuno sorbent assay were used to determine the proportion of T helper cells, the expression of specific transcription factor and the inflammatory cytokines respectively. Data showed that BATF regulated Th17 and Treg responses during allograft rejection. And BATF inhibition led to reduction of the expression level of Rorγ-t and enhancement of the Foxp-3. In addition, cytokines IL-17A and IL-4 were found decreased. This may indicate BATF as a novel therapy target for treatment of acute allograft rejection.

  2. Effect of Neurocognition and Concussion on Musculoskeletal Injury Risk

    PubMed Central

    Herman, Daniel C.; Zaremski, Jason L.; Vincent, Heather K.; Vincent, Kevin R.

    2015-01-01

    Research regarding musculoskeletal injury risk has focused primarily on anatomical, neuromuscular, hormonal, and environmental risk factors; however, subsequent injury risk screening and intervention programs have been largely limited to neuromuscular factors and have faced challenges in both implementation and efficacy. Recent studies indicate that poor neurocognitive performance, either at baseline or in the aftermath of a concussion, is associated with elevated risk of musculoskeletal injury. Despite the relatively limited current understanding regarding the nature of the relationship between different aspects of neurocognitive performance and musculoskeletal injury risk, this is a promising area of research that may yield significant advances in musculoskeletal injury risk stratification, rehabilitation, and prevention. PMID:25968852

  3. Microvascular destruction identifies murine allografts that cannot be rescued from airway fibrosis

    PubMed Central

    Babu, Ashok N.; Murakawa, Tomohiro; Thurman, Joshua M.; Miller, Edmund J.; Henson, Peter M.; Zamora, Martin R.; Voelkel, Norbert F.; Nicolls, Mark R.

    2007-01-01

    Small airway fibrosis (bronchiolitis obliterans syndrome) is the primary obstacle to long-term survival following lung transplantation. Here, we show the importance of functional microvasculature in the prevention of epithelial loss and fibrosis due to rejection and for the first time, relate allograft microvascular injury and loss of tissue perfusion to immunotherapy-resistant rejection. To explore the role of alloimmune rejection and airway ischemia in the development of fibroproliferation, we used a murine orthotopic tracheal transplant model. We determined that transplants were reperfused by connection of recipient vessels to donor vessels at the surgical anastomosis site. Microcirculation through the newly formed vascular anastomoses appeared partially dependent on VEGFR2 and CXCR2 pathways. In the absence of immunosuppression, the microvasculature in rejecting allografts exhibited vascular complement deposition, diminished endothelial CD31 expression, and absent perfusion prior to the onset of fibroproliferation. Rejecting grafts with extensive endothelial cell injury were refractory to immunotherapy. After early microvascular loss, neovascularization was eventually observed in the membranous trachea, indicating a reestablishment of graft perfusion in established fibrosis. One implication of this study is that bronchial artery revascularization at the time of lung transplantation may decrease the risk of subsequent airway fibrosis. PMID:18060031

  4. Effects of Trypsinization and Mineralization on Intrasynovial Tendon Allograft Healing to Bone

    PubMed Central

    Qu, Jin; van Alphen, Nick A.; Thoreson, Andrew R.; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C.; Schmid, Thomas M.; Zhao, Chunfeng

    2014-01-01

    The purpose of the current study was to develop a novel technology to enhance tendon-to-bone interface healing by trypsinizing and mineralizing (TM) an intrasynovial tendon allograft in a rabbit bone tunnel model. Eight rabbit flexor digitorum profundus (FDP) tendons were used to optimize the trypsinization process. An additional 24 FDP tendons were stratified into control and TM groups; in each group, 4 tendons were used for in vitro evaluation of TM and 8 were transplanted into proximal tibial bone tunnels in rabbits. The samples were evaluated histologically and with mechanical testing at postoperative week 8. Maximum failure strength and linear stiffness were not significantly different between the control and TM tendons. A thin fibrous band of scar tissue formed at the graft-to-bone interface in the control group. However, only the TM group showed obvious new bone formation inside the tendon graft and a visible fibrocartilage layer at the bone tunnel entrance. This study is the first to explore effects of TM on the intrasynovial allograft healing to a bone tunnel. TM showed beneficial effects on chondrogenesis, osteogenesis, and integration of the intrasynovial tendon graft, but mechanical strength was the same as the control tendons in this short-term in vivo study. PMID:25611186

  5. Nitration and Inactivation of Manganese Superoxide Dismutase in Chronic Rejection of Human Renal Allografts

    NASA Astrophysics Data System (ADS)

    MacMillan-Crow, L. A.; Crow, John P.; Kerby, Jeffrey D.; Beckman, Joseph S.; Thompson, John A.

    1996-10-01

    Inflammatory processes in chronic rejection remain a serious clinical problem in organ transplantation. Activated cellular infiltrate produces high levels of both superoxide and nitric oxide. These reactive oxygen species interact to form peroxynitrite, a potent oxidant that can modify proteins to form 3-nitrotyrosine. We identified enhanced immunostaining for nitrotyrosine localized to tubular epithelium of chronically rejected human renal allografts. Western blot analysis of rejected tissue demonstrated that tyrosine nitration was restricted to a few specific polypeptides. Immunoprecipitation and amino acid sequencing techniques identified manganese superoxide dismutase, the major antioxidant enzyme in mitochondria, as one of the targets of tyrosine nitration. Total manganese superoxide dismutase protein was increased in rejected kidney, particularly in the tubular epithelium; however, enzymatic activity was significantly decreased. Exposure of recombinant human manganese superoxide dismutase to peroxynitrite resulted in a dose-dependent (IC50 = 10 μ M) decrease in enzymatic activity and concomitant increase in tyrosine nitration. Collectively, these observations suggest a role for peroxynitrite during development and progression of chronic rejection in human renal allografts. In addition, inactivation of manganese superoxide dismutase by peroxynitrite may represent a general mechanism that progressively increases the production of peroxynitrite, leading to irreversible oxidative injury to mitochondria.

  6. Obligatory role for interleukin-13 in obstructive lesion development in airway allografts.

    PubMed

    Lama, Vibha N; Harada, Hiroaki; Badri, Linda N; Flint, Andrew; Hogaboam, Cory M; McKenzie, Andrew; Martinez, Fernando J; Toews, Galen B; Moore, Bethany B; Pinsky, David J

    2006-07-01

    The pathogenesis of bronchiolitis obliterans (BO), a common and devastating obliterative disorder of small airways following lung transplantation, remains poorly understood. Lesions are characterized in their early stages by lymphocyte influx that evolves into dense fibrotic infiltrates. Airway specimens taken from patients with histological BO revealed infiltrating myofibroblasts, which strongly expressed the signaling chain of the high affinity interleukin-13 (IL-13) receptor IL-13Ralpha1. Because IL-13 has proinflammatory and profibrotic actions, a contributory role for IL-13 in BO development was examined using murine models of orthotopic and heterotopic tracheal transplantation. Compared with airway isografts, allografts exhibited a significant increase in relative IL-13 mRNA and protein levels. Allogeneic tracheas transplanted into IL-13-deficient mice were protected from BO in both transplant models. Flow cytometric analysis of orthotopic transplant tissue digests revealed markedly fewer infiltrating mononuclear phagocytes and CD3(+) T lymphocytes in IL-13-deficient recipients. Furthermore, protection from luminal obliteration, collagen deposition, and myofibroblast infiltration was observed in heterotopic airways transplanted into the IL-13(-/-) recipients. Transforming growth factor-beta1 expression was significantly decreased in tracheal allografts into IL-13(-/-) recipients, compared to wild-type counterparts. These human and murine data implicate IL-13 as a critical effector cytokine driving cellular recruitment and subsequent fibrosis in clinical and ex-perimental BO.

  7. Reconstruction of chronic abductor deficiency after revision hip arthroplasty using an extensor mechanism allograft.

    PubMed

    Drexler, M; Abolghasemian, M; Kuzyk, P R; Dwyer, T; Kosashvili, Y; Backstein, D; Gross, A E; Safir, O

    2015-08-01

    This study reports the clinical outcome of reconstruction of deficient abductor muscles following revision total hip arthroplasty (THA), using a fresh-frozen allograft of the extensor mechanism of the knee. A retrospective analysis was conducted of 11 consecutive patients with a severe limp because of abductor deficiency which was confirmed on MRI scans. The mean age of the patients (three men and eight women) was 66.7 years (52 to 84), with a mean follow-up of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild limp, and two had a persistent severe limp (p = 0.004). The mean power of the abductors improved on the Medical Research Council scale from 2.15 to 3.8 (p < 0.001). Pre-operatively, all patients required a stick or walking frame; post-operatively, four patients were able to walk without an aid. Overall, nine patients had severe or moderate pain pre-operatively; ten patients had no or mild pain post-operatively. At final review, the Harris hip score was good in five patients, fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively effective in the treatment of chronic abductor deficiency of the hip after THA when techniques such as local tissue transfer are not possible. Longer-term follow-up is necessary before the technique can be broadly applied. PMID:26224820

  8. Virtual interactive musculoskeletal system (VIMS) in orthopaedic research, education and clinical patient care

    PubMed Central

    Chao, Edmund YS; Armiger, Robert S; Yoshida, Hiroaki; Lim, Jonathan; Haraguchi, Naoki

    2007-01-01

    The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the "Virtual Human" reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of these unique database and simulation technology. This integrated system, model library and database will impact on orthopaedic education, basic research, device development and application, and clinical patient care related to musculoskeletal joint system reconstruction, trauma management, and rehabilitation. PMID:17343764

  9. A Case of Intraparenchymal Pseudoaneurysms in Kidney Allograft

    PubMed Central

    Lorentz, Liam Antony; Hlabangana, Linda Tebogo; Davies, Malcolm

    2016-01-01

    Patient: Male, 31 Final Diagnosis: Intraparenchymal pseudo-aneurysms in kidney transplant Symptoms: Asymptomatic Medication: — Clinical Procedure: Percutaneous renal biopsy Specialty: Transplantology Objective: Diagnostic/therapeutic accidents Background: Percutaneous needle biopsy is routinely performed for renal allograft management. Vascular complications of the procedure include pseudoaneurysm and arterio-venous fistulae formation. Delayed diagnosis of these complications is due to their mostly asymptomatic and indolent nature. Case Report: We present a case of extensive intraparenchymal pseudoaneurysm formation within the inferior pole of the allograft, diagnosed two years following the most recent biopsy procedure. Conclusions: Renal pseudoaneurysms may only be diagnosed years after their formation as they are typically asymptomatic. PMID:27510594

  10. Porous Allograft Bone Scaffolds: Doping with Strontium

    PubMed Central

    Zhao, Yantao; Guo, Dagang; Hou, Shuxun; Zhong, Hongbin; Yan, Jun; Zhang, Chunli; Zhou, Ying

    2013-01-01

    Strontium (Sr) can promote the process of bone formation. To improve bioactivity, porous allograft bone scaffolds (ABS) were doped with Sr and the mechanical strength and bioactivity of the scaffolds were evaluated. Sr-doped ABS were prepared using the ion exchange method. The density and distribution of Sr in bone scaffolds were investigated by inductively coupled plasma optical emission spectrometry (ICP-OES), X-ray photoelectron spectroscopy (XPS), and energy-dispersive X-ray spectroscopy (EDS). Controlled release of strontium ions was measured and mechanical strength was evaluated by a compressive strength test. The bioactivity of Sr-doped ABS was investigated by a simulated body fluid (SBF) assay, cytotoxicity testing, and an in vivo implantation experiment. The Sr molar concentration [Sr/(Sr+Ca)] in ABS surpassed 5% and Sr was distributed nearly evenly. XPS analyses suggest that Sr combined with oxygen and carbonate radicals. Released Sr ions were detected in the immersion solution at higher concentration than calcium ions until day 30. The compressive strength of the Sr-doped ABS did not change significantly. The bioactivity of Sr-doped material, as measured by the in vitro SBF immersion method, was superior to that of the Sr-free freeze-dried bone and the Sr-doped material did not show cytotoxicity compared with Sr-free culture medium. The rate of bone mineral deposition for Sr-doped ABS was faster than that of the control at 4 weeks (3.28±0.23 µm/day vs. 2.60±0.20 µm/day; p<0.05). Sr can be evenly doped into porous ABS at relevant concentrations to create highly active bone substitutes. PMID:23922703

  11. Porous allograft bone scaffolds: doping with strontium.

    PubMed

    Zhao, Yantao; Guo, Dagang; Hou, Shuxun; Zhong, Hongbin; Yan, Jun; Zhang, Chunli; Zhou, Ying

    2013-01-01

    Strontium (Sr) can promote the process of bone formation. To improve bioactivity, porous allograft bone scaffolds (ABS) were doped with Sr and the mechanical strength and bioactivity of the scaffolds were evaluated. Sr-doped ABS were prepared using the ion exchange method. The density and distribution of Sr in bone scaffolds were investigated by inductively coupled plasma optical emission spectrometry (ICP-OES), X-ray photoelectron spectroscopy (XPS), and energy-dispersive X-ray spectroscopy (EDS). Controlled release of strontium ions was measured and mechanical strength was evaluated by a compressive strength test. The bioactivity of Sr-doped ABS was investigated by a simulated body fluid (SBF) assay, cytotoxicity testing, and an in vivo implantation experiment. The Sr molar concentration [Sr/(Sr+Ca)] in ABS surpassed 5% and Sr was distributed nearly evenly. XPS analyses suggest that Sr combined with oxygen and carbonate radicals. Released Sr ions were detected in the immersion solution at higher concentration than calcium ions until day 30. The compressive strength of the Sr-doped ABS did not change significantly. The bioactivity of Sr-doped material, as measured by the in vitro SBF immersion method, was superior to that of the Sr-free freeze-dried bone and the Sr-doped material did not show cytotoxicity compared with Sr-free culture medium. The rate of bone mineral deposition for Sr-doped ABS was faster than that of the control at 4 weeks (3.28 ± 0.23 µm/day vs. 2.60 ± 0.20 µm/day; p<0.05). Sr can be evenly doped into porous ABS at relevant concentrations to create highly active bone substitutes. PMID:23922703

  12. Tissue banking in Bangladesh: 12 years of experience (2003-2014).

    PubMed

    Akhtar, Naznin; Rahman, Md Shaifur; Jamil, Hossen Mohammad; Arifuzzaman, Md; Miah, M M; Asaduzzaman, S M

    2016-06-01

    Tissue Banking and Biomaterial Research Unit (TBBRU), the only tissue bank of Bangladesh, has been established to create an available supply of human tissue allografts for transplantation in Bangladesh. Since its establishment in 2003, TBBRU strictly follows the guidelines of tissue banking setup by the International Atomic Energy Agency, the European Association of Tissue Banks and the American Association of Tissue Banks. Though started serving from earlier, regular supply of tissue allografts from this bank were documented at the end of 2006. From January 2007 to December 2014, 3747 bones and 5772 amniotic sacs were collected from live tissue donors. During this period, 59,489 cc bone allografts and 23,472 pieces of amniotic membrane allografts were processed. In the same period, 58,483 cc bone allografts and 20,786 pieces membrane were supplied to different hospitals throughout the country on the basis of demand. The outcomes of the concerted efforts of tissue banking professionals and physicians were the restoration of health and hope of 3662 patients during the last 8 years.

  13. Diffusion-weighted imaging in musculoskeletal radiology—clinical applications and future directions

    PubMed Central

    Bhojwani, Nicholas; Szpakowski, Peter; Partovi, Sasan; Maurer, Martin H.; Grosse, Ulrich; von Tengg-Kobligk, Hendrik; Zipp-Partovi, Lisa; Fergus, Nathan; Kosmas, Christos; Nikolaou, Konstantin

    2015-01-01

    Diffusion-weighted imaging (DWI) is an established diagnostic tool with regards to the central nervous system (CNS) and research into its application in the musculoskeletal system has been growing. It has been shown that DWI has utility in differentiating vertebral compression fractures from malignant ones, assessing partial and complete tears of the anterior cruciate ligament (ACL), monitoring tumor response to therapy, and characterization of soft-tissue and bone tumors. DWI is however less useful in differentiating malignant vs. infectious processes. As of yet, no definitive qualitative or quantitative properties have been established due to reasons ranging from variability in acquisition protocols to overlapping imaging characteristics. Even with these limitations, DWI can still provide clinically useful information, increasing diagnostic accuracy and improving patient management when magnetic resonance imaging (MRI) findings are inconclusive. The purpose of this article is to summarize recent research into DWI applications in the musculoskeletal system. PMID:26682143

  14. Bioactive lipid coating of bone allografts directs engraftment and fate determination of bone marrow-derived cells in rat GFP chimeras.

    PubMed

    Das, Anusuya; Segar, Claire E; Chu, Yihsuan; Wang, Tiffany W; Lin, Yong; Yang, Chunxi; Du, Xeujun; Ogle, Roy C; Cui, Quanjun; Botchwey, Edward A

    2015-09-01

    Bone grafting procedures are performed to treat wounds incurred during wartime trauma, accidents, and tumor resections. Endogenous mechanisms of repair are often insufficient to ensure integration between host and donor bone and subsequent restoration of function. We investigated the role that bone marrow-derived cells play in bone regeneration and sought to increase their contributions by functionalizing bone allografts with bioactive lipid coatings. Polymer-coated allografts were used to locally deliver the immunomodulatory small molecule FTY720 in tibial defects created in rat bone marrow chimeras containing genetically-labeled bone marrow for monitoring cell origin and fate. Donor bone marrow contributed significantly to both myeloid and osteogenic cells in remodeling tissue surrounding allografts. FTY720 coatings altered the phenotype of immune cells two weeks post-injury, which was associated with increased vascularization and bone formation surrounding allografts. Consequently, degradable polymer coating strategies that deliver small molecule growth factors such as FTY720 represent a novel therapeutic strategy for harnessing endogenous bone marrow-derived progenitors and enhancing healing in load-bearing bone defects.

  15. Bioactive lipid coating of bone allografts directs engraftment and fate determination of bone marrow-derived cells in rat GFP chimeras

    PubMed Central

    Das, Anusuya; Segar, Claire E.; Chu, Yihsuan; Wang, Tiffany W.; Lin, Yong; Yang, Chunxi; Du, Xeujun; Ogle, Roy C.; Cui, Quanjun; Botchwey, Edward A.

    2015-01-01

    Bone grafting procedures are performed to treat wounds incurred during wartime trauma, accidents, and tumor resections. Endogenous mechanisms of repair are often insufficient to ensure integration between host and donor bone and subsequent restoration of function. We investigated the role that bone marrow-derived cells play in bone regeneration and sought to increase their contributions by functionalizing bone allografts with bioactive lipid coatings. Polymer-coated allografts were used to locally deliver the immunomodulatory small molecule FTY720 in tibial defects created in rat bone marrow chimeras containing genetically-labeled bone marrow for monitoring cell origin and fate. Donor bone marrow contributed significantly to both myeloid and osteogenic cells in remodeling tissue surrounding allografts. FTY720 coatings altered the phenotype of immune cells two weeks post-injury, which was associated with increased vascularization and bone formation surrounding allografts. Consequently, degradable polymer coating strategies that deliver small molecule growth factors such as FTY720 represent a novel therapeutic strategy for harnessing endogenous bone marrow-derived progenitors and enhancing healing in load-bearing bone defects. PMID:26125501

  16. Bioactive lipid coating of bone allografts directs engraftment and fate determination of bone marrow-derived cells in rat GFP chimeras.

    PubMed

    Das, Anusuya; Segar, Claire E; Chu, Yihsuan; Wang, Tiffany W; Lin, Yong; Yang, Chunxi; Du, Xeujun; Ogle, Roy C; Cui, Quanjun; Botchwey, Edward A

    2015-09-01

    Bone grafting procedures are performed to treat wounds incurred during wartime trauma, accidents, and tumor resections. Endogenous mechanisms of repair are often insufficient to ensure integration between host and donor bone and subsequent restoration of function. We investigated the role that bone marrow-derived cells play in bone regeneration and sought to increase their contributions by functionalizing bone allografts with bioactive lipid coatings. Polymer-coated allografts were used to locally deliver the immunomodulatory small molecule FTY720 in tibial defects created in rat bone marrow chimeras containing genetically-labeled bone marrow for monitoring cell origin and fate. Donor bone marrow contributed significantly to both myeloid and osteogenic cells in remodeling tissue surrounding allografts. FTY720 coatings altered the phenotype of immune cells two weeks post-injury, which was associated with increased vascularization and bone formation surrounding allografts. Consequently, degradable polymer coating strategies that deliver small molecule growth factors such as FTY720 represent a novel therapeutic strategy for harnessing endogenous bone marrow-derived progenitors and enhancing healing in load-bearing bone defects. PMID:26125501

  17. Development of tissue bank

    PubMed Central

    Narayan, R. P.

    2012-01-01

    The history of tissue banking is as old as the use of skin grafting for resurfacing of burn wounds. Beneficial effects of tissue grafts led to wide spread use of auto and allograft for management of varied clinical conditions like skin wounds, bone defects following trauma or tumor ablation. Availability of adequate amount of tissues at the time of requirement was the biggest challenge that forced clinicians to find out techniques to preserve the living tissue for prolonged period of time for later use and thus the foundation of tissue banking was started in early twentieth century. Harvesting, processing, storage and transportation of human tissues for clinical use is the major activity of tissue banks. Low temperature storage of processed tissue is the best preservation technique at present. Tissue banking organization is a very complex system and needs high technical expertise and skilled personnel for proper functioning in a dedicated facility. A small lapse/deviation from the established protocol leads to loss of precious tissues and or harm to recipients as well as the risk of transmission of deadly diseases and tumors. Strict tissue transplant acts and stringent regulations help to streamline the whole process of tissue banking safe for recipients and to community as whole. PMID:23162240

  18. Use of botulinum toxin in musculoskeletal pain.

    PubMed

    Singh, Jasvinder A

    2013-01-01

    Chronic musculoskeletal pain is a common cause of chronic pain, which is associated with a total cost of $635 billion per year in the U.S. Emerging evidence suggests an anti-nociceptive action of botulinum toxin, independent of its muscle paralyzing action. This review provides a summary of data from both non-randomized and randomized clinical studies of botulinum toxin in back pain and various osteoarticular conditions, including osteoarthritis, tennis elbow, low back pain and hand pain. Three randomized controlled trials (RCTs) of small sizes provide evidence of short-term efficacy of a single intra-articular injection of 100 units of botulinum toxin A (BoNT/A) for the relief of pain and the improvement of both function and quality of life in patients with chronic joint pain due to arthritis. Three RCTs studied intramuscular BoNT/A for tennis elbow with one showing a significant improvement in pain relief compared with placebo, another one showing no difference from placebo, and the third finding that pain and function improvement with BoNT/A injection were similar to those obtained with surgical release. One RCT of intramuscular BoNT/A for low back pain found improvement in pain and function compared to placebo. Single RCTs using local injections of BoNT in patients with either temporomandibular joint (TMJ) pain or plantar fasciitis found superior efficacy compared to placebo. One RCT of intramuscular BoNT/B in patients with hand pain and carpal tunnel syndrome found improvement in pain in both BoNT/B and placebo groups, but no significant difference between groups. Most evidence is based on small studies, but the use of BoNT is supported by a single, and sometimes up to three, RCTs for several chronic musculoskeletal pain conditions. This indicates that botulinum toxin may be a promising potential new treatment for chronic refractory musculoskeletal pain. Well-designed large clinical trials are needed. PMID:24715952

  19. Use of botulinum toxin in musculoskeletal pain

    PubMed Central

    Singh, Jasvinder A

    2013-01-01

    Chronic musculoskeletal pain is a common cause of chronic pain, which is associated with a total cost of $635 billion per year in the U.S. Emerging evidence suggests an anti-nociceptive action of botulinum toxin, independent of its muscle paralyzing action. This review provides a summary of data from both non-randomized and randomized clinical studies of botulinum toxin in back pain and various osteoarticular conditions, including osteoarthritis, tennis elbow, low back pain and hand pain. Three randomized controlled trials (RCTs) of small sizes provide evidence of short-term efficacy of a single intra-articular injection of 100 units of botulinum toxin A (BoNT/A) for the relief of pain and the improvement of both function and quality of life in patients with chronic joint pain due to arthritis. Three RCTs studied intramuscular BoNT/A for tennis elbow with one showing a significant improvement in pain relief compared with placebo, another one showing no difference from placebo, and the third finding that pain and function improvement with BoNT/A injection were similar to those obtained with surgical release. One RCT of intramuscular BoNT/A for low back pain found improvement in pain and function compared to placebo. Single RCTs using local injections of BoNT in patients with either temporomandibular joint (TMJ) pain or plantar fasciitis found superior efficacy compared to placebo. One RCT of intramuscular BoNT/B in patients with hand pain and carpal tunnel syndrome found improvement in pain in both BoNT/B and placebo groups, but no significant difference between groups. Most evidence is based on small studies, but the use of BoNT is supported by a single, and sometimes up to three, RCTs for several chronic musculoskeletal pain conditions. This indicates that botulinum toxin may be a promising potential new treatment for chronic refractory musculoskeletal pain. Well-designed large clinical trials are needed. PMID:24715952

  20. Coronary Collaterals Predict Improved Survival and Allograft Function in Patients with Coronary Allograft Vasculopathy

    PubMed Central

    Lavine, Kory J.; Sintek, Marc; Novak, Eric; Ewald, Gregory; Geltman, Edward; Joseph, Susan; Pfeifer, John; Mann, Douglas

    2013-01-01

    Background Despite improvements in the care of patients who have received cardiac transplants, coronary allograft vasculopathy (CAV) remains the most prevalent cause of late allograft failure and cardiac mortality. Few proven therapies are available for this important disease. The presence of coronary collaterals imparts a favorable prognosis in patients with native ischemic heart disease; however, the impact of collaterals in CAV is unknown. Methods and results To determine whether the development of coronary collaterals is associated with improved outcomes in patients with CAV, we performed a retrospective analysis of patients followed in the heart transplant program at Barnes Jewish Hospital from 1994–2008. The primary endpoints included all cause mortality and the composite of all cause mortality, retransplantation, and inotrope dependence. We screened 493 patients and identified 59 (12%) subjects with moderate to severe CAV. Angiographically visible coronary collaterals were present in 34 (57%) subjects. Kaplan-Meier and Cox multivariable analyses revealed that patients with collaterals had reduced incidence of all cause mortality HR 0.20, p<0.001 and the composite endpoint HR 0.17, p<0.001. In addition, patients with collaterals had less severe heart failure symptoms as measured by NYHA class. Immunostaining of biopsy specimens revealed that among patients with CAV, the presence of coronary collaterals correlated with increased microvascular density, reduced fibrosis and lower LVEDP. Conclusions Together, these data demonstrate that the presence of coronary collaterals predicts a favorable prognosis in patients with CAV and suggests that interventions aimed at promoting collateral and microvascular growth may serve as effective therapies for this disease. PMID:23709657

  1. Management of musculoskeletal dysfunction in infants

    PubMed Central

    YAO, DAN; DENG, XINGQIANG; WANG, MINGGUANG

    2016-01-01

    Excessive crying (or infant colic) is a common pain syndrome of infancy without any specific known aetiology or effective management. Many cases result in long-term poor sleep, behavioral problems and parental stress. The biomechanical aspects of this condition lack adequate investigation despite its strong link with assisted and/or difficult births. The present review focused on the current trends in the management of this mal-musculoskeletal health of infants associated with the condition of excessive crying. In addition, the risk factors associated with therapeutic procedures used to manage the above conditions were also discussed. PMID:27284288

  2. [Musculoskeletal examination: from neonates to adolescents].

    PubMed

    Mary, Pierre

    2006-01-31

    A large number of medical consultations are related to musculoskeletal abnormalities. Less than 10 percent of patients are referred for surgery. In most cases, history taking and a mere clinical examination are sufficient to establish a diagnosis. Useful additional tests are usually limited to standard anteroposterior and lateral x-rays and laboratory analysis when an infection- or inflammation-induced abnormality is suspected. Any physician likely to deal with children should be able to conduct this clinical examination and include some of its elements given its essential role in screening (spinal deformities for instance).

  3. Functional Immune Anatomy of the Liver-As an Allograft.

    PubMed

    Demetris, A J; Bellamy, C O C; Gandhi, C R; Prost, S; Nakanuma, Y; Stolz, D B

    2016-06-01

    The liver is an immunoregulatory organ in which a tolerogenic microenvironment mitigates the relative "strength" of local immune responses. Paradoxically, necro-inflammatory diseases create the need for most liver transplants. Treatment of hepatitis B virus, hepatitis C virus, and acute T cell-mediated rejection have redirected focus on long-term allograft structural integrity. Understanding of insults should enable decades of morbidity-free survival after liver replacement because of these tolerogenic properties. Studies of long-term survivors show low-grade chronic inflammatory, fibrotic, and microvascular lesions, likely related to some combination of environment insults (i.e. abnormal physiology), donor-specific antibodies, and T cell-mediated immunity. The resultant conundrum is familiar in transplantation: adequate immunosuppression produces chronic toxicities, while lightened immunosuppression leads to sensitization, immunological injury, and structural deterioration. The "balance" is more favorable for liver than other solid organ allografts. This occurs because of unique hepatic immune physiology and provides unintended benefits for allografts by modulating various afferent and efferent limbs of allogenic immune responses. This review is intended to provide a better understanding of liver immune microanatomy and physiology and thereby (a) the potential structural consequences of low-level, including allo-antibody-mediated injury; and (b) how liver allografts modulate immune reactions. Special attention is given to the microvasculature and hepatic mononuclear phagocytic system.

  4. Urine Proteomics to Detect Biomarkers for Chronic Allograft Dysfunction

    PubMed Central

    Quintana, Luís F.; Solé-Gonzalez, Amanda; Kalko, Susana G.; Bañon-Maneus, Elisenda; Solé, Manel; Diekmann, Fritz; Gutierrez-Dalmau, Alex; Abian, Joaquin; Campistol, Josep M.

    2009-01-01

    Despite optimal immunosuppressive therapy, more than 50% of kidney transplants fail because of chronic allograft dysfunction. A noninvasive means to diagnose chronic allograft dysfunction may allow earlier interventions that could improve graft half-life. In this proof-of-concept study, we used mass spectrometry to analyze differences in the urinary polypeptide patterns of 32 patients with chronic allograft dysfunction (14 with pure interstitial fibrosis and tubular atrophy and 18 with chronic active antibody-mediated rejection) and 18 control subjects (eight stable recipients and 10 healthy control subjects). Unsupervised hierarchical clustering showed good segregation of samples in groups corresponding mainly to the four biomedical conditions. Moreover, the composition of the proteome of the pure interstitial fibrosis and tubular atrophy group differed from that of the chronic active antibody-mediated rejection group, and an independent validation set confirmed these results. The 14 protein ions that best discriminated between these two groups correctly identified 100% of the patients with pure interstitial fibrosis and tubular atrophy and 100% of the patients with chronic active antibody-mediated rejection. In summary, this study establishes a pattern for two histologic lesions associated with distinct graft outcomes and constitutes a first step to designing a specific, noninvasive diagnostic tool for chronic allograft dysfunction. PMID:19056874

  5. Tuberculosis in a renal allograft recipient presenting with intussusception.

    PubMed

    Mohapatra, A; Basu, G; Sen, I; Asirvatham, R; Michael, J S; Pulimood, A B; John, G T

    2012-01-01

    Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11(th) postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

  6. Recurrence of Acute Page Kidney in a Renal Transplant Allograft

    PubMed Central

    Zayas, Carlos; Mulloy, Laura; Jagadeesan, Muralidharan

    2016-01-01

    Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft. PMID:27725836

  7. Kidney allograft survival in dogs treated with total lymphoid irradiation

    SciTech Connect

    Howard, R.J.; Sutherland, D.E.R.; Lum, C.T.; Lewis, W.I.; Kim, T.H.; Slavin, S.; Najarian, J.S.

    1981-02-01

    Total lymphoid irradiation (TLI) is immunosuppressive and, in rodents, can induce a state where transplantation of allogenic bone marrow results in chimerism and permanent acceptance of organ allografts from the donor strain. Twelve splenectomized dogs were treated with TLI (150 rads per fraction, total dose 1950 to 3000 rads) before bilateral nephrectomy and renal allotransplantation. Eight dogs received bone marrow from the kidney donor. In 13 untreated control dogs renal allografts functioned for a mean +- (SE) of 4.7 +- 0.3 days. In the four TLI treated dogs who did not receive bone marrow the renal allografts functioned for 15 to 76 days (two dogs died with functioning grafts). In the eight TLI treated dogs who received donor bone marrow, two died immediately after transplantation, two rejected at 3 and 13 days, one died at 13 days with a functioning graft, and two have had the grafts function for longer than 500 days. Chimerism was not detected in the one dog tested. The response of peripheral blood lymphocytes to stimulation with phytohemaglutinin and in mixed lymphocyte culture was suppressed for at least one month after TLI. The results confirm the immunosuppressive effect of TLI. The absence of kidney rejection in two recipients of donor bone marrow show the potential of this approach to induce long-term immunologic unresponsiveness as to an organ allograft, but the outcome is unpredictable and further experiments are needed to define the optimal conditions for administration of TLI and bone marrow to the recipients.

  8. Identification and treatment of cyclosporine-associated allograft thrombosis

    SciTech Connect

    Schlanger, R.E.; Henry, M.L.; Sommer, B.G.; Ferguson, R.M.

    1986-08-01

    Endothelial injury associated with cyclosporine (CSA) therapy in the absence of rejection has resulted in irreversible intrarenal allograft thrombosis and transplant loss. Indium 111 (/sup 111/In)-labeled platelet scanning is an effective way to identify those transplants that are at risk for acute loss. Two hundred prospective /sup 111/In scans were obtained (100 on allografts with normal function and 100 with transplant dysfunction of all causes). /sup 111/In scans in patients with dose-dependent CSA nephrotoxicity (N = 58) and biopsy proved acute rejection (N = 22) were negative. Grossly abnormal scans (three to eight times greater than hepatic uptake) were noted in nine recipients identified as having a hemolytic uremic-like syndrome associated with CSA use. Accelerated allograft functional loss was irreversible in six patients despite stopping CSA, systemic anticoagulation, increased steroids and antilymphocyte globulin, and infusion of fresh-frozen plasma. Three patients with grossly positive /sup 111/In scans and clinical and laboratory parameters consistent with this syndrome were treated with cessation of CSA and intra-arterial infusion of streptokinase into the renal allograft followed by systemic heparinization. Normal transplant function was regained and continues at 1, 7, and 8 months after transplant. /sup 111/In-labeled platelet scanning can noninvasively identify this syndrome of CSA-associated arteriopathy and allow for early therapy to reverse it. Intrarenal arterial streptokinase therapy is a successful way to treat acute CSA-associated arteriopathy.

  9. Stress and musculoskeletal discomfort among hydrocarbon industry workers in Mexico.

    PubMed

    Avila-Chaurand, R; Prado-León, L R; González-Muñoz, E L

    2012-01-01

    This study of 114 workers in the hydrocarbon industry was conducted to identify the relationship between stress and musculoskeletal discomfort, and to view the roles played by such factors as age, schooling, obesity, workplace and job seniority. All factors except seniority were found to affect the presence of musculoskeletal discomfort in some area of the body.

  10. Epidemiology of Musculoskeletal Injuries among Sedentary and Physically Active Adults.

    ERIC Educational Resources Information Center

    Hootman, Jennifer M.; Macera, Carol A.; Ainsworth, Barbara E.; Addy, Cheryl L.; Martin, Malissa; Blair, Steven N.

    2002-01-01

    Examined types and frequencies of musculoskeletal injuries among adults with above average activity levels enrolled in the Dallas Aerobics Center Longitudinal Study. Participant surveys and examinations indicated that one-quarter of all respondents reported musculoskeletal injuries (most of which were activity- related). Sport participants had the…

  11. Musculoskeletal reported symptoms among aircraft assembly workers: a multifactorial approach.

    PubMed

    Menegon, Fabrício Augusto; Fischer, Frida Marina

    2012-01-01

    The aim of this study was to evaluate factors associated with reported work-related musculoskeletal symptoms among aircraft assembly workers. Population consisted of 552 (491 men/61 women) workers who performed tasks related to the work of aircraft assembly. Participants completed a comprehensive questionnaire, including socio-demographic information, habits/lifestyles, working conditions, and work organization. Workers also answered the Nordic Musculoskeletal Questionnaire to obtain data on musculoskeletal symptoms. Multivariate logistic regression was performed to analyze factors associated with musculoskeletal reported symptoms. Results showed that body regions with the highest prevalence of reported musculoskeletal symptoms were similar when referred the past twelve months and the past seven days. Significant factors associated with musculoskeletal symptoms included variables related to conflicts at work, sleep problems, mental fatigue, and lack of time for personal care and recovery. Working time in the industry was associated only with reports for the last seven days and regular physical activity off-work seems to be a positive factor in preventing musculoskeletal symptoms for the past twelve months. The results highlight the multi-factorial nature of the problem. Actions to prevent musculoskeletal diseases at the aircraft assembly work should consider multiple interventions that would promote better recovery between work shifts. PMID:22317290

  12. Coping with Musculoskeletal Pain: Implications for Office Workers

    ERIC Educational Resources Information Center

    Oztug, Ozhan; Cowie, Helen

    2011-01-01

    The aim of the present research was to understand how office workers cope with back, neck and upper limb musculoskeletal disorders at work (and their implications for work). A small (N = 120) questionnaire survey collected information about potential participants' background and history of musculoskeletal disorders. These data were used to inform…

  13. Dynamic Ultrasound Imaging Applications to Quantify Musculoskeletal Function

    PubMed Central

    Sikdar, Siddhartha; Wei, Qi; Cortes, Nelson

    2014-01-01

    Advances in imaging methods have led to new capability to study muscle and tendon motion in vivo. Direct measurements of muscle and tendon kinematics using imaging may lead to improved understanding of musculoskeletal function. This review presents quantitative ultrasound methods for muscle dynamics that can be used to assess in vivo musculoskeletal function when integrated with other conventional biomechanical measurements. PMID:24949846

  14. Bone allograft and implant fixation tested under influence of bio-burden reduction, periosteal augmentation and topical antibiotics. Animal experimental studies.

    PubMed

    Barckman, Jeppe

    2014-01-01

    Loosening of an artificial joint prosthesis is a painful and debilitating condition that can be treated only by re-operation. Re-operations accounted for approximately 15% of all hip replacement operations performed in Denmark between the year 1995 and 2010. The process of loosening is often accompanied by destructive inflammation and osteolysis, which leads to insufficient bone stock that often requires extensive bone grafting. Impacted morselized bone graft is a well-established method for improving the amount and quality of bone stock that ensures sufficient stability and anchorage of the revision implants. Among bone graft options, the autologous bone graft is considered the gold standard. It is naturally biocompatible, but its use in revision surgery is curtailed by its limited volume and by considerable donor site morbidity. Allograft bone is readily available and is the most commonly used graft material. However, it has been shown that the incorporation of allograft bone into the host bone is not always complete, and substantial fibrous tissue formation has been described. A reason for this may be that allograft bone is a foreign tissue, which, contrary to autogenic bone, may induce an immunogenic response that leads to increased fibrous tissue formation. Furthermore, the fresh-frozen allograft has minimal osteoinductive and no osteogenic capacity. The studies in this thesis have investigated ways of improving the incorporation of allograft bone by adding osteoinductive cells from the periosteum and reducing the immunogenic load of the allograft bone by rinsing. Furthermore, the impact of antibiotic protection of the bone graft has been evaluated. The same experimental implant model was used in all three studies. This model enables evaluation of early implant fixation and osseointegration of an uncemented implant surrounded by impacted morselized bone graft. Unloaded gap implants were inserted into the metaphysis of the proximal tibia (Study I) and distal

  15. Bone allograft and implant fixation tested under influence of bio-burden reduction, periosteal augmentation and topical antibiotics. Animal experimental studies.

    PubMed

    Barckman, Jeppe

    2014-01-01

    Loosening of an artificial joint prosthesis is a painful and debilitating condition that can be treated only by re-operation. Re-operations accounted for approximately 15% of all hip replacement operations performed in Denmark between the year 1995 and 2010. The process of loosening is often accompanied by destructive inflammation and osteolysis, which leads to insufficient bone stock that often requires extensive bone grafting. Impacted morselized bone graft is a well-established method for improving the amount and quality of bone stock that ensures sufficient stability and anchorage of the revision implants. Among bone graft options, the autologous bone graft is considered the gold standard. It is naturally biocompatible, but its use in revision surgery is curtailed by its limited volume and by considerable donor site morbidity. Allograft bone is readily available and is the most commonly used graft material. However, it has been shown that the incorporation of allograft bone into the host bone is not always complete, and substantial fibrous tissue formation has been described. A reason for this may be that allograft bone is a foreign tissue, which, contrary to autogenic bone, may induce an immunogenic response that leads to increased fibrous tissue formation. Furthermore, the fresh-frozen allograft has minimal osteoinductive and no osteogenic capacity. The studies in this thesis have investigated ways of improving the incorporation of allograft bone by adding osteoinductive cells from the periosteum and reducing the immunogenic load of the allograft bone by rinsing. Furthermore, the impact of antibiotic protection of the bone graft has been evaluated. The same experimental implant model was used in all three studies. This model enables evaluation of early implant fixation and osseointegration of an uncemented implant surrounded by impacted morselized bone graft. Unloaded gap implants were inserted into the metaphysis of the proximal tibia (Study I) and distal

  16. Predicting pain outcomes after traumatic musculoskeletal injury.

    PubMed

    Rosenbloom, Brittany N; Katz, Joel; Chin, Kelly Y W; Haslam, Lynn; Canzian, Sonya; Kreder, Hans J; McCartney, Colin J L

    2016-08-01

    Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches. PMID:27058677

  17. Standard reference values for musculoskeletal ultrasonography

    PubMed Central

    Schmidt, W; Schmidt, H; Schicke, B; Gromnica-Ihle, E

    2004-01-01

    Objectives: To determine standard reference values for musculoskeletal ultrasonography in healthy adults. Methods: Ultrasonography was performed on 204 shoulders, elbows, hands, hips, knees, and feet of 102 healthy volunteers (mean age 38.4 years; range 20–60; 54 women) with a linear probe (10–5 MHz; Esaote Technos MP). Diameters of tendons, bursae, cartilage, erosions, hypoechoic rims around tendons and at joints were measured with regard to established standard scans. Mean, minimum, and maximum values, as well as two standard deviations (2 SD) were determined. Mean values ±2 SD were defined as standard reference values. Results: Hypoechoic rims were normally present in joints and tendon sheaths owing to physiological synovial fluid and/or cartilage. Similarly, fluid was found in the subdeltoid bursa in 173/204 (85%), at the long biceps tendon in 56 (27%), in the suprapatellar recess in 158 (77%), in the popliteal bursae in 32 (16%), and in the retrocalcaneal bursa in 49 (24%). Erosions of >1 mm were seen at the humeral head in 47 (23%). Values for important intervals were determined. The correlation between two investigators was 0.96 (0.78–0.99). The reliability of follow up investigations was 0.83 (0.52–0.99). Conclusions: Fluid in bursae as well as hypoechoic rims within joints and around tendons are common findings in healthy people. This study defines standard reference values for musculoskeletal ultrasonography to prevent misinterpretation of normal fluid as an anatomical abnormality. PMID:15249327

  18. Musculoskeletal interventional radiology: ultrasound and CT.

    PubMed

    Martel Villagrán, J; Bueno Horcajadas, Á; Agrela Rojas, E

    2016-05-01

    We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment. PMID:27134018

  19. Radionuclide Imaging of Musculoskeletal Infection: A Review.

    PubMed

    Palestro, Christopher J

    2016-09-01

    There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. MRI is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. (67)Ga is used primarily for spondylodiskitis. Although in vitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiskitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. (111)In-biotin is useful for spondylodiskitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection-specific agents. (18)F-FDG is the radiopharmaceutical of choice for spondylodiskitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest (68)Ga may be useful in musculoskeletal infection. (124)I-fialuridine initially showed promise as an infection-specific radiopharmaceutical, but subsequent investigations were disappointing. The development of PET/CT and SPECT/CT imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management. PMID:27390160

  20. Common musculoskeletal problems in the performing artist.

    PubMed

    Hansen, Pamela A; Reed, Kristi

    2006-11-01

    In this chapter we touched on a wide variety of unique musculoskeletal conditions in the musician and dancer. We outlined generalized methods of evaluation that stress the importance of the interdisciplinary approach in this highly specialized patient population and stressed the importance of specific involvement of the music or dance instructor in evaluation and management. We sought to emphasize the need to refer to specialized care early when in doubt of diagnosis or when usual first-line treatments fail. We gave examples of specific injury patterns common in these subgroups and suggestions for early management. Finally, we described some general principals for prevention of musculoskeletal injury in this group. A physician treating the performing artist must always keep in mind that in this unique patient population, their occupation is not only a means of earning a living, it is their passion. Artists make great sacrifice both physically and mentally to bring the world such immeasurable beauty. It is our responsibility to care for them in the most comprehensive and compassionate manner possible while informing them as honestly as possible about their treatment options.

  1. Musculoskeletal symptoms, postural disorders and occupational risk factors: correlation analysis.

    PubMed

    Comper, Maria Luiza C; Macedo, Felipe; Padula, Rosimeire S

    2012-01-01

    Work-related musculoskeletal disorders (WRMSD) include a list of inflammatory and degenerative diseases characterized by the presence of musculoskeletal symptoms, compensatory posture changes and functional disabilities. The objective of this study was to evaluate the kinetic/functional characteristics of textile plant workers, their level of exposure to risk factors and the contribution these make to musculoskeletal symptoms. The sample of 42 workers answered the Nordic Questionnaire and the Job Factors Questionnaire. The kinetic/functional characteristics of each worker were verified by a blinded evaluator. Data were analyzed using descriptive statistics and Pearson's correlation. Musculoskeletal symptoms were more prevalent in the spinal region and upper limbs. The exposure levels to risk factors were identified as a serious problem. Postural disorders, musculoskeletal symptoms and risk factors were correlated (P ≤ 0.05).

  2. Reconstruction of compound loss of lateral malleolus and lateral ankle ligaments with double-bundle Achilles tendon-bone allograft.

    PubMed

    Ko, Dukhwan; Jung, Hong-Geun; Kim, Hyeung-June; Cha, Seung-Han; Nam, Kyoung-Mo

    2014-01-01

    Open ankle fracture, including compound loss of the lateral malleolus, lateral ankle ligaments, and overlying skin, is a severe injury and can result in ankle instability and permanent disability. Treatment of this injury is challenging and requires bone grafting and soft tissue reconstruction. In the present report, we describe a unique reconstruction technique for compound loss of the lateral malleolus, lateral ankle ligaments, and the overlying skin using a double-bundle Achilles tendon-bone allograft combined with a reverse sural fasciocutaneous flap. The patient obtained a stable ankle with nearly full range of motion and displayed satisfactory function during the follow-up period.

  3. Allograft reconstruction of peroneus longus and brevis tendons tears arising from a single muscular belly. Case report and surgical technique.

    PubMed

    Pellegrini, Manuel J; Adams, Samuel B; Parekh, Selene G

    2015-03-01

    Anatomic variants of the peroneal tendons may cause tendon disorders. Moreover, there is a lack of evidence on how to address chronic tendon pathology when a variant of the peroneal tendons is causing the patient's symptoms. We present a patient with an uncommon peroneal muscle presentation: a single muscular belly dividing into both the peroneus longus and brevis tendons. After extensive debridement of tendinopathic tissue, primary repair or tenodesis was not possible; therefore a unique solution for this problem was performed, reconstructing both peroneal tendons using a semitendinosus allograft.

  4. Meeting Physical Activity Guidelines and Musculoskeletal Injury: The WIN Study

    PubMed Central

    Morrow, James R.; DeFina, Laura F.; Leonard, David; Trudelle-Jackson, Elaine; Custodio, Michelle A.

    2012-01-01

    Introduction The United States Department of Health and Human Services disseminated physical activity guidelines for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic physical activity and resistance exercise associated with decreased morbidity and mortality risk and increased health benefits. However, increases in physical activity levels are associated with increased risk of musculoskeletal injuries. We related the amount and type of physical activity conducted on a weekly basis with the risk of musculoskeletal injury. Methods Prospective, observational study using weekly Internet tracking of moderate-to-vigorous physical activity and resistance exercise behaviors and musculoskeletal injuries in 909 community-dwelling women for up to 3 years. Primary outcome was self-reported musculoskeletal injuries (total, physical activity-related, and non physical activity-related) interrupting typical daily work and/or exercise behaviors for ≥2 days or necessitating health care provider visit. Results Meeting versus not meeting physical activity guidelines was associated with more musculoskeletal injuries during physical activity (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.05 – 1.85, P = 0.02), but was not associated with musculoskeletal injuries unrelated to physical activity (HR = 0.99, 95% CI = 0.75 – 1.29, P = 0.92), or with musculoskeletal injuries overall (HR = 1.15, 95% CI = 0.95 – 1.39, P = 0.14). Conclusions Results illustrate the risk of musculoskeletal injury with physical activity. Musculoskeletal injury risk rises with increasing physical activity. Despite this modest increase in musculoskeletal injuries, the known benefits of aerobic and resistance physical activities should not hinder physicians from encouraging patients to meet current physical activity guidelines for both moderate-to-vigorous exercise and resistance exercise behaviors with the intent of achieving health benefits

  5. Prolonging survival in vascularized bone allograft transplantation: developing specific immune unresponsiveness

    SciTech Connect

    Paskert, J.P.; Yaremchuk, M.J.; Randolph, M.A.; Weiland, A.J.

    1987-04-01

    Vascularized bone allografts (VBAs) could be useful adjuncts to the clinical reconstructive surgeon's arsenal. These grafts are known experimentally to be subject to host rejection. One way to control the rejection problem would be to develop specific immune unresponsiveness via host conditioning. Using a proven reliable model in inbred rats for studying heterotopic VBA transplantation, recipient animals were conditioned preoperatively with third-party unrelated blood, donor-specific blood (DSB) alone and with cyclosporine, and ultraviolet irradiated donor-specific blood. The combination of DSB plus cyclosporine delayed rejection of grafts across a strong histocompatibility barrier for three to four weeks. However, rejection was delayed across a weak histocompatibility barrier for five to six weeks using this same host pretreatment. The implications are that specific immunosuppression, although possible, is difficult to achieve in VBA transplantation, and that such techniques will rely on tissue-matching to minimize the genetic disparity between graft and host.

  6. Ten-year protocol biopsy findings of renal allografts in the calcineurin inhibitor era.

    PubMed

    Okamoto, Masahiko; Akioka, Kiyokazu; Ushigome, Hidetaka; Higuchi, Atsushi; Nobori, Shuji; Ogino, Shiro; Uryuhara, Kenji; Kaihara, Satoshi; Hatta, Tsuguru; Urasaki, Koji; Yoshimura, Norio

    2006-01-01

    Ten-year protocol biopsies were performed in 16 patients treated with calcineurin inhibitor (CNI) continuously. All kidney grafts were functioning well at the time of biopsy with the mean serum creatinine level of 1.6 +/- 0.8 mg/dL. The specimen of biopsy showed various degrees of tissue injury. According to the Banff grading, allograft glomerulopathy (cg) was observed in one case. Interstitial fibrosis (ci) and tubular atrophy (ct) were observed more frequently in 13 (81%) and 15 (93%) cases, respectively. Fibrous intimal thickening (cv) was seen in one (7%) case. Arteriolar hyaline thickening (ah) was seen in 14 (87%) cases. These findings were associated with chronic rejection in one case, recurrence of original disease in four (25%) cases, toxicity of CNI in 14 (87%) cases. Longer follow-up studies are needed to confirm whether CNI should be continued or not in the long-term period following kidney transplantation for better graft survival.

  7. Ultrasound Examination of Pediatric Musculoskeletal Diseases and Neonatal Spine.

    PubMed

    Karnik, Alka Sudhir; Karnik, Alpana; Joshi, Alpana

    2016-06-01

    Ultrasound (US) is a simple, non-invasive imaging modality which allows high-resolution imaging of the musculoskeletal (MSK) system. Its increasing popularity in pediatrics is due to the fact that it does not involve radiation, has an ability to visualize non-ossified cartilaginous and vascular structures, allows dynamic imaging and quick contralateral comparison. US is the primary imaging modality in some pediatric MSK conditions like infant hip in developmental dysplasia (DDH), hip joint effusion, epiphyseal trauma and evaluation of the neonatal spine. US is the modality of choice in infants with DDH, both in the initial evaluation and post-treatment follow-up. US has a sensitivity equivalent to MRI in evaluation of the neonatal spine in experienced hands and is a good screening modality in neonates with suspected occult neural tube defects. In other MSK applications, it is often used for the initial diagnosis or in addition to other imaging modalities. In trauma and infections, US can often detect early and subtle soft tissue abnormalities and a quick comparison with the contralateral side aids in diagnoses. Dynamic imaging is crucial in evaluating congenital instabilities and dislocations, soft tissue and ligamentous injuries, epiphyseal injuries and fracture separations. High-resolution imaging along with color Doppler (CD) is useful in the characterization of soft tissue masses. This article reviews the applications of US in pediatric MSK with emphasis on conditions where it is a primary modality. Limitations of US include inability to penetrate bone, hence, limited diagnosis of intraosseous pathology and operator dependency. PMID:26830280

  8. A latent autoimmune diabetes in adults patient manifesting severe musculoskeletal complications.

    PubMed

    Yang, In-Ho; Lee, Sun Hee; Chin, Sang Ouk; Chon, Suk

    2014-11-01

    Patients with diabetes have many different kinds of complications involving multiple organs, but those involving the musculoskeletal system are relatively uncommon. Diabetic muscle infarction (DMI) is a rare, painful, and potentially serious condition in patients with poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 diabetes eight years ago, visited with severe muscle pain in the right anteromedial thigh without any event of trauma. He had been treated with metformin, but his glycemic control was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painful thigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic resonance imaging and bone scan showed findings of DMI at vastus medialis muscle and an insufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopathy, neuropathy and microalbuminuria but not macrovascular complications. We also diagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on his low C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and early onset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose control with multiple daily insulin injections led to symptom improvement. This is an unusual case of a young man with LADA experiencing severe musculoskeletal complication of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears to have unaccounted soft tissue pain, musculoskeletal complications such as DMI associated with hyperglycemia should be considered.

  9. A single subcutaneous dose of tramadol for mild to moderate musculoskeletal trauma in the emergency department

    PubMed Central

    Cardozo, Alejandro; Silva, Carlos; Dominguez, Luis; Botero, Beatriz; Zambrano, Paulo; Bareno, Jose

    2014-01-01

    BACKGROUND: Mild to moderate musculoskeletal trauma is a common cause for an emergency room visit, and frequent pain is one of the cardinal symptoms of consultation. The objective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadol for pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraise the perception of pain by subcutaneous injection. METHODS: A total of 77 patients, who met inclusion criteria, received a single subcutaneous dose of tramadol. Pain control was evaluated based on the verbal numerical pain scale (0–10) at baseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneous injection of the analgesic. RESULTS: On admission, the average pain perceived by patients was 8; twenty minutes later, 89% of the patients reported five or less, and after sixty minutes, 94% had three or less on the verbal numerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 or less by injection of the drug, and 6.5% required a second analgesic for pain control. Two events with drug administration (soft tissue infection and mild abdominal rectus injection) were reported. CONCLUSION: We conclude that a single subcutaneous dose of tramadol is a safe and effective option for the management of patients with mild to moderate pain and musculoskeletal disease in the emergency department. PMID:25548601

  10. Evaluation of Copper and Hydrogen Peroxide Treatments on the Biology, Biomechanics, and Cytotoxicity of Decellularized Dermal Allografts.

    PubMed

    Leow-Dyke, Sophie F; Rooney, Paul; Kearney, John N

    2016-03-01

    Decellularized tissue allografts are paving the way as an alternative to cellular tissue transplantation. Effective sterilization or decontamination of tissue allografts is paramount for the safety of the allograft; however, some of the current sterilization procedures have a detrimental effect on the tissue scaffold. The bactericidal and virucidal activity of copper (II) ions and hydrogen peroxide (H2O2) have been widely reported, however, their effect on the biology, biochemistry, and biocompatibility of decellularized tissue have yet to be elucidated. In this study, decellularized human dermis (dCELL human dermis) was treated with copper (II) chloride (CuCl2) and H2O2; both singly and in combination, and parameters, including concentration, pH, and synergy between CuCl2 and H2O2, were evaluated to identify conditions where any detrimental effects on the tissue scaffold were observed. Skin from 13 human donors was retrieved with appropriate consent and processed into dCELL human dermis. The dCELL human dermis was then treated for 3 h with 0.1 mg/L-1 g/L (w/v) CuCl2 and 0.01-7.5% (v/v) H2O2 and combinations of both of these in the same concentration range. dCELL human dermis treated with solutions of 0.1 mg/L-1 g/L CuCl2 or 0.01-7.5% H2O2 caused no detrimental effects on gross histology, collagen denaturation, collagen orientation, and biomechanical properties of the tissue or cytotoxicity. The highest combined concentration of CuCl2 and H2O2 demonstrated an increase in ultimate tensile strength, loss of collagen type IV immunostaining at the dermal-epidermal junction, and in vitro cytotoxicity. Combinations within the range of up to 10 mg/L CuCl2 with up to 0.5% H2O2 had no effect. The data identify the concentrations of CuCl2 and H2O2 solutions that have no effect on the biological, biomechanical, and biochemical properties of dCELL human dermis, while retaining biocompatibility. These treatments may be suitable for use as sterilization

  11. Use of Ultrasound Elastography in the Assessment of the Musculoskeletal System

    PubMed Central

    Paluch, Łukasz; Nawrocka-Laskus, Ewa; Wieczorek, Janusz; Mruk, Bartosz; Frel, Małgorzata; Walecki, Jerzy

    2016-01-01

    Summary This article presents possible applications of ultrasound elastography in musculoskeletal imaging based on the available literature, as well as the possibility of extending indications for the use of elastography in the future. Ultrasound elastography (EUS) is a new method that shows structural changes in tissues following application of physical stress. Elastography techniques have been widely used to assess muscles and tendons in vitro since the early parts of the twentieth century. Only recently with the advent of new technology and creation of highly specialized ultrasound devices, has elastography gained widespread use in numerous applications. The authors performed a search of the Medline/PubMed databases for original research and reviewed publications on the application of ultrasound elastography for musculoskeletal imaging. All publications demonstrate possible uses of ultrasound elastography in examinations of the musculoskeletal system. The most widely studied areas include the muscles, tendons and rheumatic diseases. There are also reports on the employment in vessel imaging. The main limitation of elastography as a technique is above all the variability of applied pressure during imaging, which is operator-dependent. It would therefore be reasonable to provide clear guidelines on the technique applied, as well as clear indications for performing the test. It is important to develop methods for creating artifact-free, closed-loop, compression-decompression cycles. The main advantages include cost-effectiveness, short duration of the study, non-invasive nature of the procedure, as well as a potentially broader clinical availability. There are no clear guidelines with regard to indications as well as examination techniques. Ultrasound elastography is a new and still poorly researched method. We conclude, however, that it can be widely used in the examinations of musculoskeletal system. Therefore, it is necessary to conduct large, multi

  12. Use of Ultrasound Elastography in the Assessment of the Musculoskeletal System.

    PubMed

    Paluch, Łukasz; Nawrocka-Laskus, Ewa; Wieczorek, Janusz; Mruk, Bartosz; Frel, Małgorzata; Walecki, Jerzy

    2016-01-01

    This article presents possible applications of ultrasound elastography in musculoskeletal imaging based on the available literature, as well as the possibility of extending indications for the use of elastography in the future. Ultrasound elastography (EUS) is a new method that shows structural changes in tissues following application of physical stress. Elastography techniques have been widely used to assess muscles and tendons in vitro since the early parts of the twentieth century. Only recently with the advent of new technology and creation of highly specialized ultrasound devices, has elastography gained widespread use in numerous applications. The authors performed a search of the Medline/PubMed databases for original research and reviewed publications on the application of ultrasound elastography for musculoskeletal imaging. All publications demonstrate possible uses of ultrasound elastography in examinations of the musculoskeletal system. The most widely studied areas include the muscles, tendons and rheumatic diseases. There are also reports on the employment in vessel imaging. The main limitation of elastography as a technique is above all the variability of applied pressure during imaging, which is operator-dependent. It would therefore be reasonable to provide clear guidelines on the technique applied, as well as clear indications for performing the test. It is important to develop methods for creating artifact-free, closed-loop, compression-decompression cycles. The main advantages include cost-effectiveness, short duration of the study, non-invasive nature of the procedure, as well as a potentially broader clinical availability. There are no clear guidelines with regard to indications as well as examination techniques. Ultrasound elastography is a new and still poorly researched method. We conclude, however, that it can be widely used in the examinations of musculoskeletal system. Therefore, it is necessary to conduct large, multi-center studies to

  13. Clinical utilization of musculoskeletal sonography involving non-physician rehabilitation providers: A scoping review

    PubMed Central

    Roll, Shawn C.; Asai, Christina; Tsai, Julieann

    2015-01-01

    Background Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers. Aim To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice. Design Scoping Review Setting Inpatient, Outpatient, Other Population Musculoskeletal conditions Methods Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included. Results Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses. Conclusion This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention. Clinical Rehabilitation Impact Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care. PMID:26201705

  14. Muscle moment arms and sensitivity analysis of a mouse hindlimb musculoskeletal model.

    PubMed

    Charles, James P; Cappellari, Ornella; Spence, Andrew J; Wells, Dominic J; Hutchinson, John R

    2016-10-01

    Musculoskeletal modelling has become a valuable tool with which to understand how neural, muscular, skeletal and other tissues are integrated to produce movement. Most musculoskeletal modelling work has to date focused on humans or their close relatives, with few examples of quadrupedal animal limb models. A musculoskeletal model of the mouse hindlimb could have broad utility for questions in medicine, genetics, locomotion and neuroscience. This is due to this species' position as a premier model of human disease, having an array of genetic tools for manipulation of the animal in vivo, and being a small quadruped, a category for which few models exist. Here, the methods used to develop the first three-dimensional (3D) model of a mouse hindlimb and pelvis are described. The model, which represents bones, joints and 39 musculotendon units, was created through a combination of previously gathered muscle architecture data from microdissections, contrast-enhanced micro-computed tomography (CT) scanning and digital segmentation. The model allowed muscle moment arms as well as muscle forces to be estimated for each musculotendon unit throughout a range of joint rotations. Moment arm analysis supported the reliability of musculotendon unit placement within the model, and comparison to a previously published rat hindlimb model further supported the model's reliability. A sensitivity analysis performed on both the force-generating parameters and muscle's attachment points of the model indicated that the maximal isometric muscle moment is generally most sensitive to changes in either tendon slack length or the coordinates of insertion, although the degree to which the moment is affected depends on several factors. This model represents the first step in the creation of a fully dynamic 3D computer model of the mouse hindlimb and pelvis that has application to neuromuscular disease, comparative biomechanics and the neuromechanical basis of movement. Capturing the morphology

  15. Musculoskeletal overuse injuries and heart rate variability: Is there a link?

    PubMed

    Gisselman, Angela Spontelli; Baxter, G David; Wright, Alexis; Hegedus, Eric; Tumilty, Steve

    2016-02-01

    Accurate detection and prevention of overuse musculoskeletal injuries is limited by the nature of somatic tissue injury. In the pathogenesis of overuse injuries, it is well recognized that an abnormal inflammatory response occurs within somatic tissue before pain is perceived which can disrupt the normal remodeling process and lead to subsequent degeneration. Current overuse injury prevention methods focused on biomechanical faults or performance standards lack the sensitivity needed to identify the status of tissue injury or repair. Recent evidence has revealed an apparent increase in the prevalence and impact of overuse musculoskeletal injuries in athletics. When compared to acute injuries, overuse injuries have a potentially greater negative impact on athletes' overall health burden. Further, return to sport rehabilitation following overuse injury is complicated by the fact that the absence of pain does not equate to complete physiological healing of the injured tissue. Together, this highlights the need for exercise monitoring and injury prevention methods which incorporate assessment of somatic tissue response to loading. One system primarily involved in the activation of pathways and neuromediators responsible for somatic tissue repair is the autonomic nervous system (ANS). Although not completely understood, emerging research supports the critical importance of peripheral ANS activity in the health and repair of somatic tissue injury. Due to its significant contributions to cardiac function, ANS activity can be measured indirectly with heart rate monitoring. Heart rate variability (HRV) is one index of ANS activity that has been used to investigate the relationship between athletes' physiological response to accumulating training load. Research findings indicated that HRV may provide a reflection of ANS homeostasis, or the body's stress-recovery status. This noninvasive marker of the body's primary driver of recovery has the potential to incorporate

  16. Risk factors associated with musculoskeletal symptoms in Korean dental practitioners

    PubMed Central

    Cho, KiHun; Cho, Hwi-young; Han, Gyeong-Soon

    2016-01-01

    [Purpose] The purpose of this study was to investigate the association between psychosocial stress, occupational stress, and musculoskeletal symptoms in Korean dental practitioners. [Subjects and Methods] Self-reported questionnaires were distributed to 401 dental practitioners in Korea. To assess the risk factors related to musculoskeletal disorders, the Nordic Musculoskeletal Questionnaire, the Korean Occupational Stress Scale, and Psychosocial Well-Being Index Short Form were used. General and work-related characteristics of the subjects consisted of seven items, including age, career, height, weight, working days/week, working hours/day, and physical strain levels. [Results] In this study, 86.8% of the practitioners experienced musculoskeletal symptoms (shoulders, 72.8%; neck, 69.3%; waist, 68.3%; wrist, 58.4%; back, 44.1%; ankle, 38.7%; knee, 36.9%; hip, 20.4%; and elbows, 9.2%). Moreover, psychosocial and occupational stress can affect the occurrence of musculoskeletal disorders. In particular, we found that psychosocial stress has significant influence on the occurrence of musculoskeletal disorders. [Conclusion] To increase the quality of life and provide high-quality medical service for dental practitioners, risk factors for musculoskeletal disorders must be managed. Accordingly, dental practitioners must maintain good posture, get an appropriate amount of rest, and perform regular stretching exercise to reduce psychological stress and improve the work environment. PMID:26957728

  17. Operative technique for human composite flexor tendon allograft procurement and engraftment.

    PubMed

    DeGeorge, Brent R; Rodeheaver, George T; Drake, David B

    2014-01-01

    Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment.

  18. Anatomical networks reveal the musculoskeletal modularity of the human head.

    PubMed

    Esteve-Altava, Borja; Diogo, Rui; Smith, Christopher; Boughner, Julia C; Rasskin-Gutman, Diego

    2015-02-06

    Mosaic evolution is a key mechanism that promotes robustness and evolvability in living beings. For the human head, to have a modular organization would imply that each phenotypic module could grow and function semi-independently. Delimiting the boundaries of head modules, and even assessing their existence, is essential to understand human evolution. Here we provide the first study of the human head using anatomical network analysis (AnNA), offering the most complete overview of the modularity of the head to date. Our analysis integrates the many biological dependences that tie hard and soft tissues together, arising as a consequence of development, growth, stresses and loads, and motion. We created an anatomical network model of the human head, where nodes represent anatomical units and links represent their physical articulations. The analysis of the human head network uncovers the presence of 10 musculoskeletal modules, deep-rooted in these biological dependences, of developmental and evolutionary significance. In sum, this study uncovers new anatomical and functional modules of the human head using a novel quantitative method that enables a more comprehensive understanding of the evolutionary anatomy of our lineage, including the evolution of facial expression and facial asymmetry.

  19. Corticosteroid Injections for Common Musculoskeletal Conditions.

    PubMed

    Foster, Zoë J; Voss, Tyler T; Hatch, Jacquelynn; Frimodig, Adam

    2015-10-15

    Family physicians considering corticosteroid injections as part of a comprehensive treatment plan for musculoskeletal diagnoses will find few high-quality studies to assist with evidence-based decision making. Most studies of corticosteroid injections for the treatment of osteoarthritis, tendinopathy, bursitis, or neuropathy include only small numbers of patients and have inconsistent long-term follow-up. Corticosteroid injections for the treatment of adhesive capsulitis result in short-term improvements in pain and range of motion. For subacromial impingement syndrome, corticosteroid injections provide short-term pain relief and improvement in function. In medial and lateral epicondylitis, corticosteroid injections offer only short-term improvement of symptoms and have a high rate of symptom recurrence. Corticosteroid injections for carpal tunnel syndrome may help patients avoid or delay surgery. Trigger finger and de Quervain tenosynovitis may be treated effectively with corticosteroid injections. Patients with hip or knee osteoarthritis may have short-term symptom relief with corticosteroid injections.

  20. Interventional musculoskeletal ultrasonography: Precautions and contraindications.

    PubMed

    Draghi, F; Robotti, G; Jacob, D; Bianchi, S

    2010-09-01

    In recent years ultrasonography (US) has emerged as the imaging technique of choice for guiding diagnostic and therapeutic procedures including those related to the musculoskeletal system. However, the absence of ionizing radiation and the elevated safety of the method must not lead us to forget that there are precautions and contraindications to keep in mind, which are crucial to the protection of both the patient and the physician.Among these precautions it is first of all essential to obtain the patient's accurate clinical history including current medication, particularly if it involves drugs influencing the blood clotting, and information related to possible allergies. The patient should furthermore receive detailed information concerning the procedure (sterile precautions as well as possible side-effects of the drugs which will be injected). In addition to this, there must be a close contact between the radiologist and the patient's general physician (GP) in order to obtain the best possible result of the procedure.

  1. Psychological Aspects of Chronic Musculoskeletal Pain

    PubMed Central

    Crofford, Leslie J.

    2015-01-01

    Chronic musculoskeletal pain, by its very nature, will be associated with negative emotions and psychological distress. There are individual differences in personality, coping skills, behavioral adaptation, and social support that dramatically alter the psychological outcomes of patients with chronic pain. Patients that have an aspect of central pain amplification associated with mechanical or inflammatory pain and patients with fibromyalgia (FM) are likely to exhibit higher levels of psychological distress and illness behaviors. This manuscript will discuss several different constructs for the association between chronic pain, central pain amplification, and psychological distress. The first key question addresses mechanisms shared in common between chronic pain and mood disorders, including the individual factors that influence psychological comorbidity. Second, how pain affects mood and vice versa. Finally, the utility of cognitive behavioral approaches to the management of chronic pain symptoms will be discussed. PMID:26267008

  2. Kidney retransplantation for BK virus nephropathy with active viremia without allograft nephrectomy.

    PubMed

    Huang, Jingbo; Danovitch, Gabriel; Pham, Phuong-Thu; Bunnapradist, Suphamai; Huang, Edmund

    2015-12-01

    BK virus nephropathy is an important cause of kidney allograft failure. Retransplantation has been successfully performed for patients with previous allograft loss due to BK virus nephropathy; however, whether allograft nephrectomy and viral clearance are required prior to retransplantation is controversial. Some recent studies have suggested that retransplantion can be successfully achieved without allograft nephrectomy if viremia is cleared prior to retransplant. The only published experience of successful retransplantation in the presence of active viremia occurred in the presence of concomitant allograft nephrectomy of the failing kidney. In this report, we describe a case of successful repeat kidney transplant in a patient with high-grade BK viremia and fulminant hepatic failure without concomitant allograft nephrectomy performed under the setting of a simultaneous liver-kidney transplant.

  3. In-111 WBC imaging in musculoskeletal sepsis

    SciTech Connect

    Thompson, L.; Ouzounian, T.J.; Webber, M.M.; Amstutz, H.C.

    1984-01-01

    This study evaluated the accuracy and utility of the In-111 labeled WBC imaging in a series of patients who were suspected of having musculoskeletal sepsis. The labeling of the WBCs was patterned after a method previously described, in which the WBCs are labeled with In-111 oxine in plasma. The WBCs from 100 ml of blood are separated and incubated with In-111 oxine complex, and then 500 ..mu..Ci. of the labeled cells were reinjected into the patient. Images of the areas in question were obtained at 24 hrs. In some instances, 48 hour images were also obtained. Images were interpreted using consistent criteria. Forty imaging procedures were done on 39 patients. These included 39 total joint protheses, and 17 other images to evaluate possible osteomyelitis, septic arthritis or deep abscesses. Of these studies, 15 were positive, and 42 negative. The findings were then correlated with operative culture and pathology in 21, aspiration cultures and gram stains in 14, and with clinical findings in the remaining 21. This correlation showed 41 true negatives, 12 true positives, 1 false negative, and 2 false positives. The sensitivity was 92.9% and the specificity was 95.2%l. The false negative occurred in a patient on chronic suppressive antibiotic therapy for an infected total hip replacement. The false positive images occurred in a patient with active rheumatoid arthritis and in a patient imaged one month post operative placement of the prosthesis. These images were very useful in several septic patients who had many possible sites of infection. The authors conclude that In-III imaging is an accurate and useful non-invasive method of evaluating musculoskeletal sepsis.

  4. Musculoskeletal manifestations in patients with malignant disease.

    PubMed

    Gheita, Tamer A; Ezzat, Yasser; Sayed, Safaa; El-Mardenly, Ghada; Hammam, Waleed

    2010-02-01

    To detect and describe the incidence of musculoskeletal manifestations in different malignant diseases as well as their relation to the treatment received whether by chemotherapy or radiation therapy. Sixty patients with different malignant diseases were included in this study, 45 with solid tumors and 15 patients with hematological malignancy. The mean age was 46.55 +/- 11.04 years and the mean disease duration was 2 +/- 0.75 years. The patients were fully examined for any rheumatologic involvement, laboratory investigations were performed as well as dual energy X-ray absorptiometry study for bone densitometry. Treatment strategies were assessed including the chemotherapeutics, radiation therapy, and/or surgery. Myalgias and arthralgias were the most frequent followed by flexor tenosynovitis, frozen shoulder, and fibromyalgia syndrome. Hypertrophic osteoarthropathy was seen in five patients, cutaneous vasculitis in two patients as well as arthritis. Osteonecrosis was present in one of the lunate carpal bones of a patient with non-Hodgkin's lymphoma (1.67%) and receiving high dose steroids. Rheumatoid factor was positive in four patients, three of which had hepatitis C virus positivity and cryoglobulins. Anti-neutrophil cytoplasmic antibody was negative in all the studied patients. The bone mineral density was significantly reduced in the patients with malignancy compared to the control. Mild to moderate osteoporosis was present, being more evident in the spine and forearm. The bone loss was higher in those with solid tumors and even more obvious in those receiving aromatase inhibitors. Musculoskeletal manifestations occurring during malignancies and following the treatment represent a significant percentage of symptoms and signs which may raise a clue to differential diagnosis.

  5. Musculoskeletal pain in children and adolescents

    PubMed Central

    Kamper, Steve J.; Henschke, Nicholas; Hestbaek, Lise; Dunn, Kate M.; Williams, Christopher M.

    2016-01-01

    ABSTRACT Introduction Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research. Results Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults. Conclusion Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies. PMID:27437719

  6. Prevalence of Musculoskeletal Disorders Among Saskatchewan Farmers.

    PubMed

    McMillan, Michelle; Trask, Catherine; Dosman, James; Hagel, Louise; Pickett, William

    2015-01-01

    The extent of the musculoskeletal disorder (MSD) problem is not well understood among Canadian farmers, and little too is known about their epidemiology. The purpose of this study was therefore to (1) determine the prevalence of MSDs among farmers in one Canadian province; and (2) describe the types and severities of these disorders and patterns in their occurrence. This cross-sectional analysis was conducted using baseline survey data from the Saskatchewan Farm Injury Cohort Study. Reports of MSDs, demographic and health-related variables, reports of farm-related injuries, and economic conditions of individual farms were available for 2595 adult participants from 1212 farms in Saskatchewan, Canada. Relationships between MSDs and time spent doing farm work were investigated using tests of association. The participation rate was 48.8%. Most (85.6%) of participants reported having musculoskeletal pain in at least one body part over the past year. The lower back was most frequently affected (57.7%), followed by shoulders (44.0%), and neck (39.6%). More serious pain prevented 27.9% of respondents from performing regular work activities. MSD prevalence did not vary by sex, commodity type, or by total hours of farm work completed; prevalence was significantly (P < .05) related to time spent performing biomechanically demanding tasks such as heavy lifting and working with arms overhead. The most common MSD site in farmers was the low back, followed by the upper and then lower extremities. Although this study aimed to identify high-risk groups, lack of differences between demographic groups suggests that the majority of farmers are at risk for MSDs. PMID:26237719

  7. Planning, Building, and Maintaining a Successful Musculoskeletal Service Line.

    PubMed

    Sayeed, Zain; El-Othmani, Mouhanad M; Anoushiravani, Afshin A; Chambers, Monique C; Saleh, Khaled J

    2016-10-01

    Within the past 3 decades, a recent trend in the growth of musculoskeletal service lines has been seen nationally. Orthopedics offers an appealing concourse for implementation of service-line care. Within this review, the authors address the components involved in planning and building a musculoskeletal service line. The authors also address methods by which orthopedic surgeons can maintain the efficacy of their service lines by examining how orthopedic surgeons can navigate their service line through recent advents in health care reform. Finally, the authors review successful examples of musculoskeletal service lines currently in practice within the orthopedic community. PMID:27637654

  8. Safety climate, hardiness, and musculoskeletal complaints: a mediated moderation model.

    PubMed

    Golubovich, Juliya; Chang, Chu-Hsiang; Eatough, Erin M

    2014-05-01

    This study explores the mechanisms linking the psychosocial characteristics of the workplace with employees' work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees' reports of musculoskeletal discomforts. Results from an employee sample supported that when employees' perceived safety was considered a priority, they experienced less frustration and reported fewer work-related upper body musculoskeletal symptoms. Psychological hardiness, a personality trait that is indicative of individuals' resilience and success in managing stressful circumstances, moderated these relationships. Interestingly, employees with high hardiness were more affected by poor safety climate.

  9. A Pre-Clinical Canine Model for Composite Tissue Transplantation

    PubMed Central

    Mathes, David W.; Noland, Marie; Graves, Scott; Schlenker, Robert; Miwongtum, Tiffany; Storb, Rainer

    2010-01-01

    The feasibility of composite tissue allografts (CTA) has been demonstrated by the successful transplantation of the hand, abdomen and face. However, the survival of these transplants is dependent on immunosupression. Our laboratory is interested in achieving tolerance in order to decrease the risks associated with the use of chronic immunosuppression. The purpose of this experiment was to develop a large animal model for CTA. Four canine flaps were auto-transplanted to examine the use of a myocutaneous rectus flap based on the deep inferior epigastric vessels. Five CTA transplants were performed between Dog Leukocyte Antigen (DLA) identical littermates without any therapy. The allografts were followed clinically and underwent routine biopsies. The anatomic dissections and auto-transplants were all successful and revealed that the flap could be divided into two separate components. Skin is routinely perfused by the superficial epigastric artery. Rectus muscle is perfused by the deep inferior epigastrc system. This allows the allografts to be transplanted as muscle, skin or with both components based on the external iliac artery and veins. The DLA-identical littermates rejected the allografts in 15 to 30 days. This study demonstrates the versatility of the myocutaneous rectus flap for use in canines as composite tissue allograft models. PMID:20108180

  10. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumors, and inflammation.

    PubMed

    Bley, Thorsten A; Wieben, Oliver; Uhl, Markus

    2009-05-01

    Diffusion-weighted imaging is a noninvasive magnetic resonance technique that is capable of measuring icroscopic movement of water molecules (ie, random or Brownian motion) within biologic tissues. Diffusion weighting is achieved with a pulsed-field gradient that leaves "static" spins unaffected but causes dephasing of spin ensembles that experience different motion histories according to their diffusion paths, with respect to the direction of the gradient. This article focuses on the interesting opportunities of the use of diffusion weighted imaging in the diagnosis of musculoskeletal diseases, including trauma, tumor, and inflammation.

  11. Imaging-based diagnosis of acute renal allograft rejection

    PubMed Central

    Thölking, Gerold; Schuette-Nuetgen, Katharina; Kentrup, Dominik; Pawelski, Helga; Reuter, Stefan

    2016-01-01

    Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the “gold-standard”. However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasound-based methods. PMID:27011915

  12. Total lymphoid irradiation for treatment of intractable cardiac allograft rejection

    SciTech Connect

    Hunt, S.A.; Strober, S.; Hoppe, R.T.; Stinson, E.B. )

    1991-03-01

    The ability of postoperative total lymphoid irradiation to reverse otherwise intractable cardiac allograft rejection was examined in a group of 10 patients in whom conventional rejection therapy (including pulsed steroids and monoclonal or polyclonal anti-T-cell antibody therapy) had failed to provide sustained freedom from rejection. Follow-up periods range from 73 to 1119 days since the start of total lymphoid irradiation. No patient died or sustained serious morbidity because of the irradiation. Three patients have had no further rejection (follow-up periods, 105 to 365 days). Two patients died--one in cardiogenic shock during the course of total lymphoid irradiation, the other with recurrent rejection caused by noncompliance with his medical regimen. Total lymphoid irradiation appears to be a safe and a moderately effective immunosuppressive modality for 'salvage' therapy of cardiac allograft rejection unresponsive to conventional therapy.

  13. Experimental rat models of chronic allograft nephropathy: a review

    PubMed Central

    Shrestha, Badri; Haylor, John

    2014-01-01

    Chronic allograft nephropathy (CAN) is the leading cause of late allograft loss after renal transplantation (RT), which continues to remain an unresolved problem. A rat model of CAN was first described in 1969 by White et al. Although the rat model of RT can be technically challenging, it is attractive because the pathogenesis of CAN is similar to that following human RT and the pathological features of CAN develop within months as compared with years in human RT. The rat model of RT is considered as a useful investigational tool in the field of experimental transplantation research. We have reviewed the literature on studies of rat RT reporting the donor and recipient strain combinations that have investigated resultant survival and histological outcomes. Several different combinations of inbred and outbred rat combinations have been reported to investigate the multiple aspects of transplantation, including acute rejection, cellular and humoral rejection mechanisms and their treatments, CAN, and potential targets for its prevention. PMID:25092995

  14. Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs.

    PubMed

    Ye, Hui; Wang, Dong-Ping; Zhang, Chuan-Zhao; Zhang, Long-Juan; Wang, Hao-Chen; Li, Zhuo-Hui; Chen, Zhen; Zhang, Tao; Cai, Chang-Jie; Ju, Wei-Qiang; Ma, Yi; Guo, Zhi-Yong; He, Xiao-Shun

    2014-10-01

    Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

  15. Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion.

    PubMed

    Xue, Qingyun; Li, Haisheng; Zou, Xuenong; Bünger, Mathias; Egund, Niels; Lind, Martin; Christensen, Finn Bjarke; Bünger, Cody

    2005-04-01

    This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily for 3 months. The histological fusion rate was 2/5 in alendronate-treated allograft and 3/5 in non-treated allograft. The mean bone volume was 39% and 37.2% in alendronate-treated or non-treated allograft (NS), respectively. No statistical difference was found between the same grafted cage comparing two groups. The histological fusion rate was 7/10 in all autograft cage levels and 5/10 in combined allograft cage levels. No fusion was found at all in empty cage levels. With the numbers available, no statistically significant difference was found in histological fusion between autograft and allograft applications. There was a significant difference of mean bone volume between autograft (49.2%) and empty cage (27.5%) (P<0.01). In conclusion, this study did not demonstrate different healing properties of alendronate-treated and non-treated allograft for anterior lumbar interbody fusion in pigs. PMID:15248057

  16. Prolongation of segmental and pancreaticoduodenal allografts in the primate with total-lymphoid irradiation and cyclosporine

    SciTech Connect

    Du Toit, D.F.; Heydenrych, J.J.; Smit, B.; Louw, G.; Zuurmond, T.; Els, D.; Du Toit, L.B.; Weideman, A.; Davids, H.; van der Merwe, E.

    1987-09-01

    The prolongation of segmental and pancreaticoduodenal allografts (PDA) by total lymphoid irradiation (TLI) and in combination with cyclosporine (CsA) was assessed in a well established total pancreatectomy, diabetic, primate transplantation model. Pancreatic transplantation was performed in 119 pancreatectomized baboons (Papio ursinus). Of a total of 109 allografts performed, 71 were segmental allografts (open duct drainage) and 38 PDA. Of 119 graft recipients, 10 received segmental pancreatic autografts. TLI and CsA administered separately to segmental allograft recipients resulted in modest allograft survival and indefinite graft survival was not observed. 8 of 17 (47%) segmental allograft recipients that received TLI and CsA had graft survival beyond 100 days, indicating highly significant pancreatic allograft survival. All long-term segmental allograft recipients were rendered normoglycemic (plasma glucose less than 8 mmol/L) by this immunosuppressive regimen. In contrast, poor results were observed in PDA recipients treated with TLI and CsA. Mean survival in 18 treated PDA recipients was 23.8 days, 8 survived longer than 20 days (44.4%), and 1 greater than 100 days (5.5%). Despite treatment, early rejection of the duodenum in PDA recipients frequently resulted in necrosis and perforation and contributed to a high morbidity and mortality. This study indicates that, in contrast to the significant prolongation of segmental allografts by TLI and CsA, poor immunosuppression was achieved by this regimen in PDA recipients and was associated with a high morbidity and mortality caused by early rejection of the duodenum.

  17. Immunomodulation of vascular endothelium: Effects of ultraviolet B irradiation on vein allograft rejection

    SciTech Connect

    Marin, M.L.; Hardy, M.A.; Gordon, R.E.; Reemtsma, K.; Benvenisty, A.I. )

    1990-01-01

    Prosthetic grafts of vein allografts are inadequate as small-diameter vessel substitutes. We have applied ultraviolet B (UVB) irradiation to modulate the immunogenicity of vein allografts to avoid immunologic injury. The veins of male ACI rats were irradiated with UVB (60 mJ/cm2) in situ and transplanted to male ACI rats (autografts) and female Lewis rats (allografts). Nonirradiated veins served as controls. At 4, 7, 14, and 28 days, all grafts were patent and were studied for morphologic changes by scanning electron microscopy and for immunogold labeling of major histocompatibility complex class II antigen expression. In autografts, scanning electron microscopy demonstrated minimal endothelial loss after grafting, regardless of UVB irradiation. Untreated allografts showed severe endothelial injury 4, 7, and 14 days after transplantation. UVB irradiation of veins protected allografts from injury to the endothelium and basement membrane. Major histocompatibility complex class II-positive endothelial cells were not seen in autografts but were seen in 40% of cells 4 days after transplantation in untreated allografts. UVB-treated allografts showed MHC class II antigen expression labeling of 20% of the endothelial cells. Barr body analysis demonstrated the donor origin of these endothelial cells. UVB irradiation of rat vein allografts prolongs endothelial survival while decreasing endothelial surface expression of class II antigens. These data suggest that modification of vein immunogenicity with UVB irradiation may permit functional survival of small-vessel allografts without chronic immunosuppression.

  18. Quantitative podocyte parameters predict human native kidney and allograft half-lives

    PubMed Central

    Naik, Abhijit S.; Afshinnia, Farsad; Cibrik, Diane; Hodgin, Jeffrey B.; Zhang, Min; Kikuchi, Masao; Wickman, Larysa; Samaniego, Milagros; Bitzer, Markus; Wiggins, Jocelyn E.; Ojo, Akinlolu; Li, Yi; Wiggins, Roger C.

    2016-01-01

    BACKGROUND. Kidney function decreases with age. A potential mechanistic explanation for kidney and allograft half-life has evolved through the realization that linear reduction in glomerular podocyte density could drive progressive glomerulosclerosis to impact both native kidney and allograft half-lives. METHODS. Predictions from podometrics (quantitation of podocyte parameters) were tested using independent pathologic, functional, and outcome data for native kidneys and allografts derived from published reports and large registries. RESULTS. With age, native kidneys exponentially develop glomerulosclerosis, reduced renal function, and end-stage kidney disease, projecting a finite average kidney life span. The slope of allograft failure rate versus age parallels that of reduction in podocyte density versus age. Quantitative modeling projects allograft half-life at any donor age, and rate of podocyte detachment parallels the observed allograft loss rate. CONCLUSION. Native kidneys are designed to have a limited average life span of about 100–140 years. Allografts undergo an accelerated aging-like process that accounts for their unexpectedly short half-life (about 15 years), the observation that older donor age is associated with shorter allograft half-life, and the fact that long-term allograft survival has not substantially improved. Podometrics provides potential readouts for these processes, thereby offering new approaches for monitoring and intervention. FUNDING: National Institutes of Health. PMID:27280173

  19. 21 CFR 862.1163 - Cardiac allograft gene expression profiling test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1163 Cardiac allograft gene expression profiling test system....

  20. 21 CFR 862.1163 - Cardiac allograft gene expression profiling test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1163 Cardiac allograft gene expression profiling test system....

  1. 21 CFR 862.1163 - Cardiac allograft gene expression profiling test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1163 Cardiac allograft gene expression profiling test system....

  2. 21 CFR 862.1163 - Cardiac allograft gene expression profiling test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1163 Cardiac allograft gene expression profiling test system....

  3. 21 CFR 862.1163 - Cardiac allograft gene expression profiling test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1163 Cardiac allograft gene expression profiling test system....

  4. The effects of immunosuppression and anticoagulation on fibrin deposition and swelling in rat cardiac allografts.

    PubMed

    Christmas, S E; Jasani, M K; Jayson, M I

    1987-01-01

    Rat cardiac allograft recipients were injected with radiolabeled human fibrinogen at intervals after transplantation. There was a progressive increase in tracer accumulation within graft ventricles, peaking at the time of rejection at about 30-fold that within syngeneic grafts. Protein extraction experiments indicated that ca. 90% of tracer was present as cross-linked fibrin at the time of rejection. Exudation within rejecting allografts was nearly threefold that in syngeneic grafts. The weight of allografts at different times after transplantation increased in close concordance with fibrin deposition. Pharmacologically immunosuppressed recipients showed negligible fibrin deposition and swelling whereas "B" rats and thoracic-duct-lymph-drained recipients showed moderate allograft swelling in the absence of significant fibrin deposition or rejection. The decreased fibrin deposition was not a result of depressed plasma clotting factor levels. B rats reconstituted with thoracic duct lymphocytes still had reduced allograft fibrin deposition in the presence of normal amounts of swelling and exudation. The anticoagulants warfarin and heparin greatly decreased allograft fibrin but were almost without effect on allograft swelling, exudation, and rejection. The possible participation of infiltrating macrophages in allograft fibrin deposition is discussed. Unlike cutaneous delayed hypersensitivity reactions, normal amounts of fibrin deposition appear not to be essential for full cardiac allograft rejection.

  5. The biomechanical behavior on the interface of tumor arthrosis/allograft prosthetic composite by finite element analysis

    NASA Astrophysics Data System (ADS)

    Chen, H. Z.; Jiang, W.; Zou, W.; Luo, J. M.; Chen, J. Y.; Tu, C. Q.; Xing, B. B.; Gu, Z. W.; Zhang, X. D.

    2008-11-01

    The biomechanical behavior of the uniting interface between the allograft bone and the autogenetic bone plays an important role in the treatment of the proximal femur massive defects with artificial tumor arthrosis/allograft prosthetic composite (TAAPC). According to the CT data of a patient, a 3D medical treatment model of TAAPC was established. Under the loads of 1.5 and 2.5 times standard body weight (70 kg), the mechanical behavior of the treatment model was analyzed by finite element analysis (FEA) for three typical healing periods. The results show that there are significant differences in the stress values and distribution in different healing periods. With healing of osteotomy, the hardness of the tissue of the uniting interface increases, the stress in uniting area was increased greatly and the stress concentration decreased. After cured the stress almost reached the level of normal bone. In the initial stage of healing, the healing training is not encouraged because there is an obvious risk of fracture of prosthesis and bone cement. In addition, porous hydroxyapatite (HA) ceramic used as bone tissue scaffold for this case, not only facilitates the generation of new bone, but also can avoid this risk caused by the non-uniting interface.

  6. Splenic microenvironment and self recognition as factors in allograft rejection in rats. A study using indium-111-labeled cells

    SciTech Connect

    Pollak, R.; Blanchard, J.M.; Lazda, V.A.

    1986-11-01

    Splenectomy facilitates organ allograft survival in some rat strains, and in weak donor-recipient histoincompatible pairs. We have found using a heart spleen twin graft model, using ACI rats as recipients and Lewis rats as donors, that the transplanted heart will survive in most recipients after delayed host splenectomy. The presence of a viable mass of splenic tissue will allow rejection to proceed only when the transplanted spleen is of host origin, and not when it comes from the donor (i.e., when it is allogeneic). The use of 111In-labeled cells has allowed us to show that lymphocyte traffic and trapping is markedly altered in the transplanted allogeneic spleens, when compared with control transplanted syngeneic spleens. Thus, despite the presence of the splenic ''microenvironment,'' cardiac allograft rejection does not occur in the absence of syngeneic splenic tissue. We conclude that the role of the spleen in the immune response is to facilitate the recognition of self and the acquisition of alloreactivity in weak responder rat strains and donor-recipient pairs.

  7. Significance of urinary proteome pattern in renal allograft recipients.

    PubMed

    Suhail, Sufi M

    2014-01-01

    Urinary proteomics is developing as a platform of urinary biomarkers of immense potential in recent years. The definition of urinary proteome in the context of renal allograft and characterization of different proteome patterns in various graft dysfunctions have led to the development of a distinct science of this noninvasive tool. Substantial numbers of studies have shown that different renal allograft disease states, both acute and chronic, could portray unique urinary proteome pattern enabling early diagnosis of graft dysfunction and proper manipulation of immunosuppressive strategy that could impact graft prognosis. The methodology of the urinary proteome is nonetheless not more complex than that of other sophisticated assays of conventional urinary protein analysis. Moreover, the need for a centralized database is also felt by the researchers as more and more studies have been presenting their results from different corners and as systems of organizing these newly emerging data being developed at international and national levels. In this context concept of urinary proteomics in renal allograft recipients would be of significant importance in clinical transplantation.

  8. Renal allograft tuberculosis with infected lymphocele transmitted from the donor.

    PubMed

    Al-Nesf, Maryam Ali; Al-Ani, Omar Isam; Al-Ani, Ahmed Abdul-Rahman; Rashed, Awad Hamed

    2014-03-01

    Transmission of tuberculosis (TB) from a donor through renal transplantation is a rare incident. We are reporting a 53-year-old Qatari woman diagnosed with renal allograft TB infection. The disease was confirmed by isolation of Mycobacterium tuberculosis from fluid from the lymphocele and demonstration of caseating granuloma in graft biopsy with acid-fast bacilli seen on Ziehl-Neelsen staining. The diagnosis was made quite early post-transplantation. The presence of the granuloma, which is unusual with patients on intensive immunosuppressant medications, suggests that transmission of the infection occurred from the donor rather than from the activation of latent infection. In reviewing the literature, we found ten case reports of TB in transplanted kidney with transmission of TB infection from the donor. The presence of TB in lymphocele in association with the infected transplant by TB, to the best of our knowledge, was reported only once in the literature. Our case had unfavorable outcome and ended by renal allograft nephrectomy and hemodialysis. We are presenting this case of TB infection of renal allograft and lymphocele diagnosed early post-transplantation transmitted from the donor and pertinent review from the literature.

  9. Significance of urinary proteome pattern in renal allograft recipients.

    PubMed

    Suhail, Sufi M

    2014-01-01

    Urinary proteomics is developing as a platform of urinary biomarkers of immense potential in recent years. The definition of urinary proteome in the context of renal allograft and characterization of different proteome patterns in various graft dysfunctions have led to the development of a distinct science of this noninvasive tool. Substantial numbers of studies have shown that different renal allograft disease states, both acute and chronic, could portray unique urinary proteome pattern enabling early diagnosis of graft dysfunction and proper manipulation of immunosuppressive strategy that could impact graft prognosis. The methodology of the urinary proteome is nonetheless not more complex than that of other sophisticated assays of conventional urinary protein analysis. Moreover, the need for a centralized database is also felt by the researchers as more and more studies have been presenting their results from different corners and as systems of organizing these newly emerging data being developed at international and national levels. In this context concept of urinary proteomics in renal allograft recipients would be of significant importance in clinical transplantation. PMID:24757556

  10. Biomechanical Strength of Large Diaphyseal Deep-frozen Allografts.

    PubMed

    Nather, A; Goh, J C

    2000-01-01

    The aim of this paper is to study the biomechanical strength of deep-frozen allografts as they heal. Twenty-eight adult cats were used with the tibia as the experimental model site. Deep-frozen allografts stored at -80 degrees C were used to reconstruct a large tibial defect (at least two-thirds of the diaphysis). An intra-medullary rod was used for fixation. The healing was studied by X-ray at observation periods of 4, 6, 8, 12, 16, 24 and 36 weeks. Post-transplantation biomechanical testing was performed using the Shimadzu Universal Testing Machine DCS series with a torsion test device of 50 kg force metre. Parameters studied included maximum torque, torsional stiffness and energy of absorption. The transplanted grafts were compared to the mechanical properties of the internal controls of the normal opposite tibia of each cat. The results of the mechanical tests demonstrated that deep-frozen allografts did not regain normal strength. At nine months, only about 60% of normal torque strength and about 80% of normal torsional stiffness was achieved. Clinically, it is important to employ strong and rigid internal fixation using intra-medullary nailing rather than plating to allow for immediate mobilisation and reduce the rate of graft fracture.

  11. Musculoskeletal impairments and physical disablement among the aged.

    PubMed

    Jette, A M; Branch, L G; Berlin, J

    1990-11-01

    This article summarizes the results of a longitudinal investigation of the progression of sight, hearing, and musculoskeletal impairments and their association with change in physical disability, in 10 ADLs among members of the Massachusetts Health Care Panel Study. The findings confirm widely held clinical beliefs that specific types of musculoskeletal decrement are an important cause of physical disability among older persons. Decrement in hand function is a significant musculoskeletal impairment influencing limitations in Basic ADL, and progression of Instrumental ADL dysfunction is influenced by progression of lower extremity impairments. Progression of sight and hearing impairments was not associated with change in physical disability. Musculoskeletal impairments, one of the most prevalent and symptomatic chronic complaints of middle and old age, deserve increased attention from epidemiologists, disability researchers, and clinicians seeking ways to prevent disablement among the aged. PMID:2229943

  12. CD8 T-cell recognition of acquired alloantigen promotes acute allograft rejection

    PubMed Central

    Harper, Simon J. F.; Ali, Jason M.; Wlodek, Elizabeth; Negus, Marg C.; Harper, Ines G.; Chhabra, Manu; Qureshi, M. Saeed; Mallik, Mekhola; Bolton, Eleanor; Bradley, J. Andrew; Pettigrew, Gavin J.

    2015-01-01

    Adaptive CD8 T-cell immunity is the principal arm of the cellular alloimmune response, but its development requires help. This can be provided by CD4 T cells that recognize alloantigen “indirectly,” as self-restricted allopeptide, but this process remains unexplained, because the target epitopes for CD4 and CD8 T-cell recognition are “unlinked” on different cells (recipient and donor antigen presenting cells (APCs), respectively). Here, we test the hypothesis that the presentation of intact and processed MHC class I alloantigen by recipient dendritic cells (DCs) (the “semidirect” pathway) allows linked help to be delivered by indirect-pathway CD4 T cells for generating destructive cytotoxic CD8 T-cell alloresponses. We show that CD8 T-cell–mediated rejection of murine heart allografts that lack hematopoietic APCs requires host secondary lymphoid tissue (SLT). SLT is necessary because within it, recipient dendritic cells can acquire MHC from graft parenchymal cells and simultaneously present it as intact protein to alloreactive CD8 T cells and as processed peptide alloantigen for recognition by indirect-pathway CD4 T cells. This enables delivery of essential help for generating cytotoxic CD8 T-cell responses that cause rapid allograft rejection. In demonstrating the functional relevance of the semidirect pathway to transplant rejection, our findings provide a solution to a long-standing conundrum as to why SLT is required for CD8 T-cell allorecognition of graft parenchymal cells and suggest a mechanism by which indirect-pathway CD4 T cells provide help for generating effector cytotoxic CD8 T-cell alloresponses at late time points after transplantation. PMID:26420874

  13. A Computational Gene Expression Score for Predicting Immune Injury in Renal Allografts

    PubMed Central

    Tran, Tim Q.; Hsieh, Szu-Chuan; Roedder, Silke; Damm, Izabella; Vincenti, Flavio; Sarwal, Minnie M.

    2015-01-01

    Background Whole genome microarray meta-analyses of 1030 kidney, heart, lung and liver allograft biopsies identified a common immune response module (CRM) of 11 genes that define acute rejection (AR) across different engrafted tissues. We evaluated if the CRM genes can provide a molecular microscope to quantify graft injury in acute rejection (AR) and predict risk of progressive interstitial fibrosis and tubular atrophy (IFTA) in histologically normal kidney biopsies. Methods Computational modeling was done on tissue qPCR based gene expression measurements for the 11 CRM genes in 146 independent renal allografts from 122 unique patients with AR (n = 54) and no-AR (n = 92). 24 demographically matched patients with no-AR had 6 and 24 month paired protocol biopsies; all had histologically normal 6 month biopsies, and 12 had evidence of progressive IFTA (pIFTA) on their 24 month biopsies. Results were correlated with demographic, clinical and pathology variables. Results The 11 gene qPCR based tissue CRM score (tCRM) was significantly increased in AR (5.68 ± 0.91) when compared to STA (1.29 ± 0.28; p < 0.001) and pIFTA (7.94 ± 2.278 versus 2.28 ± 0.66; p = 0.04), with greatest significance for CXCL9 and CXCL10 in AR (p <0.001) and CD6 (p<0.01), CXCL9 (p<0.05), and LCK (p<0.01) in pIFTA. tCRM was a significant independent correlate of biopsy confirmed AR (p < 0.001; AUC of 0.900; 95% CI = 0.705–903). Gene expression modeling of 6 month biopsies across 7/11 genes (CD6, INPP5D, ISG20, NKG7, PSMB9, RUNX3, and TAP1) significantly (p = 0.037) predicted the development of pIFTA at 24 months. Conclusions Genome-wide tissue gene expression data mining has supported the development of a tCRM-qPCR based assay for evaluating graft immune inflammation. The tCRM score quantifies injury in AR and stratifies patients at increased risk of future pIFTA prior to any perturbation of graft function or histology. PMID:26367000

  14. Effect of physical activity on musculoskeletal discomforts among handicraft workers

    PubMed Central

    Shakerian, Mahnaz; Rismanchian, Masoud; Khalili, Pejman; Torki, Akram

    2016-01-01

    Introduction: Handicrafts seems to be one of the high-risk jobs regarding work-related musculoskeletal disorders (WMSDs) which necessitate the implementation of different corrective intervention like regular physical activities. This study aimed to investigate the impact of physical activity on WMSDs among craftsmen. Methods: This cross-sectional study was an analytical – descriptive study carried out on 100 craftsmen working in Isfahan, Iran, in 2013. The sampling method was census, and all workshops involved with this job were included. Information on demographic parameters and physical activity was collected by demographic forms. The data related to worker's musculoskeletal discomforts were conducted using Cornell Musculoskeletal Discomfort Questionnaire. The data were analyzed using statistical tests including independent t-test, Chi-square, and ANOVA. The statistical analysis was performed using SPSS 18. Results: The highest percentages of complaints related to severe musculoskeletal discomfort were reported in right shoulder (%36), right wrist (%26), neck (%25), and upper right arm (%24), respectively. A significant relationship was observed between physical activity and musculoskeletal discomforts of left wrist (P = 0.012), lower back (P = 0.016), and neck (P = 0.006). Discussion and Conclusion: Based on the study results, it can be inferred that regular but not too heavy physical activity can have a positive impact on decreasing the musculoskeletal discomforts. PMID:27512700

  15. [Musculoskeletal disorders and housework in Italy].

    PubMed

    Rosano, A; Moccaldi, R; Cioppa, M; Lanzieri, G; Persechino, B; Spagnolo, A

    2004-01-01

    The housework exposes to the risk of musculoskeletal disorders, which may appear as disabling diseases, both temporary and permanent ones. To evaluate the epidemiology of the phenomenon a retrospective survey was conducted by administering a mail questionnaire to a sample of 1,000 families residing in the whole national territory. The participation rate was 31.7%. Among respondents 20.5% reported spinal pain, 65.6% of them with continuous pains (41.4% assumed pain-killer drugs). 37.0% of the interviewed persons reported to disorders in upper limbs. It was analysed the association between the presence of disorders and the frequency in making some housework duties. Washing clothes (OR=1.8; C.I. 95%: 0.6-4.5), making beds (OR=1.5; C.I. 95%: 0.2-13.1), and taking care of pets (OR=1.4; C.I. 95%: 0.6-3.4) were associated, even if not in a statistically significant way, with the presence of spinal pain. Upper limbs disorders were associated with duties naturally related to such a disorder, like washing dishes (OR=4.6; C.I. 95%: 1.3-16.5), cleaning clothes (OR=3.1; C.I. 95%: 1.3-7.0), cleaning up carpets (OR=2.3; C.I. 95%: 1.3-3.9). To assist the relatives in state of need was identified as risk factor for both the body areas (OR=2.9; C.I. 95%: 1.2-6.7 for the spine, OR=2.6; C.I. 95%: 1.3-5.2 for upper limbs), putting in evidence the physical stress attributable to the duty. The exact identification of the typology of housework which can induce musculoskeletal disorders, and the level of related risks, are essential information to devise campaigns and protocols of health education aimed at the prevention of chronic pathologies caused by the housework. PMID:15368941

  16. Evaluation of a Musculoskeletal Model with Prosthetic Knee through Six Experimental Gait Trials

    PubMed Central

    Kia, Mohammad; Stylianou, Antonis P.; Guess, Trent M.

    2015-01-01

    Knowledge of the forces acting on musculoskeletal joint tissues during movement benefits tissue engineering, artificial joint replacement, and our understanding of ligament and cartilage injury. Computational models can be used to predict these internal forces, but musculoskeletal models that simultaneously calculate muscle force and the resulting loading on joint structures are rare. This study used publicly available gait, skeletal geometry, and instrumented prosthetic knee loading data [1] to evaluate muscle driven forward dynamics simulations of walking. Inputs to the simulation were measured kinematics and outputs included muscle, ground reaction, ligament, and joint contact forces. A full body musculoskeletal model with subject specific lower extremity geometries was developed in the multibody framework. A compliant contact was defined between the prosthetic femoral component and tibia insert geometries. Ligament structures were modeled with a nonlinear force-strain relationship. The model included 45 muscles on the right lower leg. During forward dynamics simulations a feedback control scheme calculated muscle forces using the error signal between the current muscle lengths and the lengths recorded during inverse kinematics simulations. Predicted tibiofemoral contact force, ground reaction forces, and muscle forces were compared to experimental measurements for six different gait trials using three different gait types (normal, trunk sway, and medial thrust). The mean average deviation (MAD) and root mean square deviation (RMSD) over one gait cycle are reported. The muscle driven forward dynamics simulations were computationally efficient and consistently reproduced the inverse kinematics motion. The forward simulations also predicted total knee contact forces (166 N < MAD < 404 N, 212 N < RMSD < 448 N) and vertical ground reaction forces (66 N < MAD < 90 N, 97 N < RMSD < 128 N) well within 28% and 16% of experimental loads respectively. However the

  17. Secreted trophic factors of mesenchymal stem cells support neurovascular and musculoskeletal therapies.

    PubMed

    Hofer, Heidi R; Tuan, Rocky S

    2016-01-01

    Adult mesenchymal stem cells (MSCs) represent a subject of intense experimental and biomedical interest. Recently, trophic activities of MSCs have become the topic of a number of revealing studies that span both basic and clinical fields. In this review, we focus on recent investigations that have elucidated trophic mechanisms and shed light on MSC clinical efficacy relevant to musculoskeletal applications. Innate differences due to MSC sourcing may play a role in the clinical utility of isolated MSCs. Pain management, osteochondral, nerve, or blood vessel support by MSCs derived from both autologous and allogeneic sources have been examined. Recent mechanistic insights into the trophic activities of these cells point to ultimate regulation by nitric oxide, nuclear factor-kB, and indoleamine, among other signaling pathways. Classic growth factors and cytokines-such as VEGF, CNTF, GDNF, TGF-β, interleukins (IL-1β, IL-6, and IL-8), and C-C ligands (CCL-2, CCL-5, and CCL-23)-serve as paracrine control molecules secreted or packaged into extracellular vesicles, or exosomes, by MSCs. Recent studies have also implicated signaling by microRNAs contained in MSC-derived exosomes. The response of target cells is further regulated by their microenvironment, involving the extracellular matrix, which may be modified by MSC-produced matrix metalloproteinases (MMPs) and tissue inhibitor of MMPs. Trophic activities of MSCs, either resident or introduced exogenously, are thus intricately controlled, and may be further fine-tuned via implant material modifications. MSCs are actively being investigated for the repair and regeneration of both osteochondral and other musculoskeletal tissues, such as tendon/ligament and meniscus. Future rational and effective MSC-based musculoskeletal therapies will benefit from better mechanistic understanding of MSC trophic activities, for example using analytical "-omics" profiling approaches. PMID:27612948

  18. Evaluation of a musculoskeletal model with prosthetic knee through six experimental gait trials.

    PubMed

    Kia, Mohammad; Stylianou, Antonis P; Guess, Trent M

    2014-03-01

    Knowledge of the forces acting on musculoskeletal joint tissues during movement benefits tissue engineering, artificial joint replacement, and our understanding of ligament and cartilage injury. Computational models can be used to predict these internal forces, but musculoskeletal models that simultaneously calculate muscle force and the resulting loading on joint structures are rare. This study used publicly available gait, skeletal geometry, and instrumented prosthetic knee loading data [1] to evaluate muscle driven forward dynamics simulations of walking. Inputs to the simulation were measured kinematics and outputs included muscle, ground reaction, ligament, and joint contact forces. A full body musculoskeletal model with subject specific lower extremity geometries was developed in the multibody framework. A compliant contact was defined between the prosthetic femoral component and tibia insert geometries. Ligament structures were modeled with a nonlinear force-strain relationship. The model included 45 muscles on the right lower leg. During forward dynamics simulations a feedback control scheme calculated muscle forces using the error signal between the current muscle lengths and the lengths recorded during inverse kinematics simulations. Predicted tibio-femoral contact force, ground reaction forces, and muscle forces were compared to experimental measurements for six different gait trials using three different gait types (normal, trunk sway, and medial thrust). The mean average deviation (MAD) and root mean square deviation (RMSD) over one gait cycle are reported. The muscle driven forward dynamics simulations were computationally efficient and consistently reproduced the inverse kinematics motion. The forward simulations also predicted total knee contact forces (166N

  19. Biomedical testing of cryopreserved tissues.

    PubMed

    Costa, Blas Melissari

    2005-01-01

    The Laboratory of Biomechanics of the Testing of Materials Institute of the Uruguayan Engineering School has ongoing biomechanical research for thr last 25 years. First about fixators employed in osteosynthesis and now also on the characterisation of biological tissues. A multidisciplinary group with physicians, chemists and statistical and mechanical engineers was integrated for that purpose. Research of biological tissues is carried out together with the National Organs and Tissues Bank. All materials are provided from cadaver donors. The objective is the biomechanical evaluation of tissues to be used as all allografts and the improvement of preservation methods. Elastic properties are determined for example in compression, tensile and bending tests. Sample extraction and preparation, equipments, testing procedures and some results for tendons and bones are detailed. Evaluation of fresh and cryopreserved vascular tissues is described and conclusions about their biomechanical difference between them are drawn.

  20. NASA Musculoskeletal Space Medicine and Reconditioning Program

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Scheuring, Richard

    2011-01-01

    The Astronaut Strength, Conditioning, and Rehabilitation (ASCR) group is comprised of certified strength and conditioning coaches and licensed and certified athletic trainers. The ASCR group works within NASA s Space Medicine Division providing direction and supervision to the astronaut corp with regards to physical readiness throughout all phases of space flight. The ASCR group is overseen by flight surgeons with specialized training in sports medicine or physical medicine and rehabilitation. The goals of the ASCR group include 1) designing and administering strength and conditioning programs that maximize the potential for physical performance while minimizing the rate of injury, 2) providing appropriate injury management and rehabilitation services, 3) collaborating with medical, research, engineering, and mission operations groups to develop and implement safe and effective in-flight exercise countermeasures, and 4) providing a structured, individualized post-flight reconditioning program for long duration crew members. This Panel will present the current approach to the management of musculoskeletal injuries commonly seen within the astronaut corp and will present an overview of the pre-flight physical training, in-flight exercise countermeasures, and post-flight reconditioning program for ISS astronauts.

  1. [Aging at work and musculoskeletal disorders].

    PubMed

    Occhipinti, E; Colombini, D

    2000-01-01

    By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the recommended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance.

  2. Estimating cranial musculoskeletal constraints in theropod dinosaurs.

    PubMed

    Lautenschlager, Stephan

    2015-11-01

    Many inferences on the biology, behaviour and ecology of extinct vertebrates are based on the reconstruction of the musculature and rely considerably on its accuracy. Although the advent of digital reconstruction techniques has facilitated the creation and testing of musculoskeletal hypotheses in recent years, muscle strain capabilities have rarely been considered. Here, a digital modelling approach using the freely available visualization and animation software Blender is applied to estimate cranial muscle length changes and optimal and maximal possible gape in different theropod dinosaurs. Models of living archosaur taxa (Alligator mississippiensis, Buteo buteo) were used in an extant phylogenetically bracketed framework to validate the method. Results of this study demonstrate that Tyrannosaurus rex, Allosaurus fragilis and Erlikosaurus andrewsi show distinct differences in the recruitment of the jaw adductor musculature and resulting gape, confirming previous dietary and ecological assumptions. While the carnivorous taxa T. rex and Allo. fragilis were capable of a wide gape and sustained muscle force, the herbivorous therizinosaurian E. andrewsi was constrained to small gape angles.

  3. Estimating cranial musculoskeletal constraints in theropod dinosaurs.

    PubMed

    Lautenschlager, Stephan

    2015-11-01

    Many inferences on the biology, behaviour and ecology of extinct vertebrates are based on the reconstruction of the musculature and rely considerably on its accuracy. Although the advent of digital reconstruction techniques has facilitated the creation and testing of musculoskeletal hypotheses in recent years, muscle strain capabilities have rarely been considered. Here, a digital modelling approach using the freely available visualization and animation software Blender is applied to estimate cranial muscle length changes and optimal and maximal possible gape in different theropod dinosaurs. Models of living archosaur taxa (Alligator mississippiensis, Buteo buteo) were used in an extant phylogenetically bracketed framework to validate the method. Results of this study demonstrate that Tyrannosaurus rex, Allosaurus fragilis and Erlikosaurus andrewsi show distinct differences in the recruitment of the jaw adductor musculature and resulting gape, confirming previous dietary and ecological assumptions. While the carnivorous taxa T. rex and Allo. fragilis were capable of a wide gape and sustained muscle force, the herbivorous therizinosaurian E. andrewsi was constrained to small gape angles. PMID:26716007

  4. Estimating cranial musculoskeletal constraints in theropod dinosaurs

    PubMed Central

    Lautenschlager, Stephan

    2015-01-01

    Many inferences on the biology, behaviour and ecology of extinct vertebrates are based on the reconstruction of the musculature and rely considerably on its accuracy. Although the advent of digital reconstruction techniques has facilitated the creation and testing of musculoskeletal hypotheses in recent years, muscle strain capabilities have rarely been considered. Here, a digital modelling approach using the freely available visualization and animation software Blender is applied to estimate cranial muscle length changes and optimal and maximal possible gape in different theropod dinosaurs. Models of living archosaur taxa (Alligator mississippiensis, Buteo buteo) were used in an extant phylogenetically bracketed framework to validate the method. Results of this study demonstrate that Tyrannosaurus rex, Allosaurus fragilis and Erlikosaurus andrewsi show distinct differences in the recruitment of the jaw adductor musculature and resulting gape, confirming previous dietary and ecological assumptions. While the carnivorous taxa T. rex and Allo. fragilis were capable of a wide gape and sustained muscle force, the herbivorous therizinosaurian E. andrewsi was constrained to small gape angles. PMID:26716007

  5. MUSCULOSKELETAL SCREENING AND FUNCTIONAL TESTING: CONSIDERATIONS FOR BASKETBALL ATHLETES

    PubMed Central

    Markwick, William J.

    2016-01-01

    Background and Purpose Youth participation in basketball is on the rise, with basketball one of the top five participation sports in Australia. With increased participation there is a need for greater awareness of the importance of the pre-participation examination, including musculoskeletal screening and functional performance testing as part of a multidisciplinary approach to reducing the risk for future injuries. As majority of all basketball injuries affect the lower extremities, pre-participation musculoskeletal screening and functional performance testing should assess fundamental movement qualities throughout the kinetic chain with an emphasis on lower extremity force characteristics, specifically eccentric loading tasks. Thus, the purpose of this clinical commentary is to review the existing literature elucidating pre-participation musculoskeletal screening and functional performance tests that can be used as a framework for rehabilitation professionals in assessing basketball athletes’ readiness to safely perform the movement demands of their sport. Methods Relevant articles published between 2000 and 2016 using the search terms ‘musculoskeletal screening’, ‘functional testing’, ‘youth athletes’, and ‘basketball’ were identified using MEDLINE. From a basketball-specific perspective, several relevant musculoskeletal assessments were identified, including: the Functional Hop Test Combination, the Landing Error Scoring System, the Tuck Jump Assessment, the Weight-Bearing Lunge Test, and the Star Excursion Balance Test. Each of these assessments creates movement demands that allow for easy identification of inefficient and/or compensatory movement tendencies. A basic understanding of musculoskeletal deficits including bilateral strength and flexibility imbalances, lower crossed syndrome, and dominance-related factors are key components in determination of injury risk. Discussion Assessment of sport-specific movement demands through

  6. Musculoskeletal Ultrasonography to Distinguish Muscle Changes in Complex Regional Pain Syndrome Type 1 from Those of Neuropathic Pain: An Observational Study.

    PubMed

    Vas, Lakshmi; Pai, Renuka

    2016-01-01

    Musculoskeletal ultrasonography (MSK USG) can identify myofascial structural lesions. We describe in this retrospective report the observational findings of USG data of muscles from limbs affected with neuropathic pain in 7 patients and compare them with muscles affected with complex regional pain syndrome type 1 (CRPS-1) in 7 patients. We highlight findings that distinguish between the 2 conditions. Musculoskeletal ultrasonography of muscles in CRPS was characterized by a variable or/and global intramuscular structural disruption with loss of muscle bulk. Adjacent muscles coalesced with one another to present an uniform hyperechogenic mass of tissue. Muscle edema was found in some patients. In comparison, MSK USG in muscles affected by neuropathic pain exhibited structural normalcy, but also showed considerable reduction in muscle bulk. Musculoskeletal ultrasonography shows promise as a diagnostic modality to distinguish between these 2 conditions which presently have only clinical diagnostic criteria to aid diagnosis.

  7. [Effect of embryonic anlage allografts of the rat spinal cord on growth of regenerating fibers of the recipient nerve].

    PubMed

    Petrova, E S; Isaeva, E N

    2014-01-01

    A comparative study of the effect of tissue and suspension allografts of an embryonic spinal cord on regeneration of nerve fibers of impaired (by application of a ligature) sciatic nerve in rats was conducted. It was demonstrated that unlike tissue grafts that reach a large volume 21 and 60 days after transplantation, suspension grafts do not inhibit the growth of axons of the recipient to the periphery. It was established that introduction of a suspension of dissociated cells of the spinal cord embryonic anlages (but not fragments of these anlages) into the impaired sciatic nerve in rats results in an increase in the amount of myelinated regenerating nerve fibers of the recipient 60 days after the operation.

  8. Recurrent 2,8-dihydroxyadenine nephropathy: a rare but preventable cause of renal allograft failure

    PubMed Central

    Zaidan, Mohamad; Palsson, Runolfur; Gall, Emilie Cornec-Le; Garstka, Antoine; Maggiore, Umberto; Deteix, Patrice; Battista, Michele; Gagné, Eve-Reine; Ceballos-Picot, Irène; Van Huyen, Jean-Paul Duong; Legendre, Christophe; Daudon, Michel; Edvardsson, Vidar O.; Knebelmann, Bertrand

    2015-01-01

    Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive enzyme defect of purine metabolism that usually manifests as 2,8-dihydroxyadenine (2,8-DHA) nephrolithiasis and more rarely chronic kidney disease. The disease is most often misdiagnosed and can recur in the renal allograft. We analyzed 9 patients with recurrent 2,8-DHA crystalline nephropathy, in all of whom the diagnosis had been missed prior to renal transplantation. The diagnosis was established for a median of 5 (range, 1.5–312) weeks following the transplant procedure. Patients had delayed graft function (n=2), acute-on-chronic (n=5) or acute (n=1) allograft dysfunction, whereas one patient had normal graft function at the time of diagnosis. Analysis of allograft biopsies showed birefringent 2,8-DHA crystals in renal tubular lumens, within tubular epithelial cells and interstitium. Fourier transformed infrared microscopy confirmed the diagnosis in all cases, which was further supported by 2,8-DHA crystalluria, undetectable erythrocyte APRT enzyme activity, and genetic testing. With allopurinol therapy, the allograft function improved (n=7), remained stable (n=1), or worsened (n=1). At last follow-up, 2 patients had experienced allograft loss and 5 had persistent chronic allograft dysfunction. 2,8-DHA nephropathy is a rare but underdiagnosed and preventable disorder that can recur in the renal allograft and may lead to allograft loss. PMID:25307253

  9. CT Lesion Model-Based Structural Allografts: Custom Fabrication and Clinical Experience

    PubMed Central

    Brune, Jan Claas; Hesselbarth, Uwe; Seifert, Philipp; Nowack, Dimitri; von Versen, Rüdiger; Smith, Mark David; Seifert, Dirk

    2012-01-01

    Summary Background Patients requiring knee and hip revision arthroplasty often present with difficult anatomical situations that limit options for surgery. Customised mega-implants may be one of few remaining treatment options. However, extensive damage to residual bone stock may also be present, and in such cases even customised prosthetics may be difficult to implant. Small quantities of lost bone can be replaced with standard allografts or autologous bone. Larger defects may require structural macro-allografts, sometimes in combination with implants (allograft-prosthesis composites). Methods Herein, we describe a process for manufacturing lesion-specific large structural allografts according to a 3D, full-scale, lithographically generated defect model. These macro-allografts deliver the volume and the mechanical stability necessary for certain complex revisions. They are patient-and implant-matched, negate some requirements for additional implants and biomaterials and save time in the operating theatre by eliminating the requirement for intra-operative sizing and shaping of standard allografts. Conclusion While a robust data set from long-term follow-up of patients receiving customised macro-allografts is not yet available, initial clinical experience and results suggest that lesion-matched macro-allografts can be an important component of revision joint surgery. PMID:23800856

  10. Spleen tyrosine kinase contributes to acute renal allograft rejection in the rat.

    PubMed

    Ramessur Chandran, Sharmila; Tesch, Greg H; Han, Yingjie; Woodman, Naomi; Mulley, William R; Kanellis, John; Blease, Kate; Ma, Frank Y; Nikolic-Paterson, David J

    2015-02-01

    Kidney allografts induce strong T-cell and antibody responses which mediate acute rejection. Spleen tyrosine kinase (Syk) is expressed by most leucocytes, except mature T cells, and is involved in intracellular signalling following activation of the Fcγ-receptor, B-cell receptor and some integrins. A role for Syk signalling has been established in antibody-dependent native kidney disease, but little is known of Syk in acute renal allograft rejection. Sprague-Dawley rats underwent bilateral nephrectomy and received an orthotopic Wistar renal allograft. Recipient rats were treated with a Syk inhibitor (CC0482417, 30 mg/kg/bid), or vehicle, from 1 h before surgery until being killed 5 days later. Vehicle-treated recipients developed severe allograft failure with marked histologic damage in association with dense leucocyte infiltration (T cells, macrophages, neutrophils and NK cells) and deposition of IgM, IgG and C3. Immunostaining identified Syk expression by many infiltrating leucocytes. CC0482417 treatment significantly improved allograft function and reduced histologic damage, although allograft injury was still clearly evident. CC0482417 failed to prevent T-cell infiltration and activation within the allograft. However, CC0482417 significantly attenuated acute tubular necrosis, infiltration of macrophages and neutrophils and thrombosis of peritubular capillaries. In conclusion, this study identifies a role for Syk in acute renal allograft rejection. Syk inhibition may be a useful addition to T-cell-based immunotherapy in renal transplantation.

  11. B cells assist allograft rejection in the deficiency of protein kinase c-theta.

    PubMed

    Yan, Wenwei; Xu, Rui; Ma, Lian Li; Han, Wei; Geevarghese, Sunil K; Williams, Phillip E; Sciammas, Roger; Chong, Anita S; Yin, Deng Ping

    2013-09-01

    We have previously shown that mice deficient in protein kinase C theta (PKCθ) have the ability to reject cardiac allografts, but are susceptible to tolerance induction. Here we tested role of B cells in assisting alloimmune responses in the absence of PKCθ. Mouse cardiac allograft transplantations were performed from Balb/c (H-2d) to PKCθ knockout (PKCθ(-/-)), PKCθ and B cell double-knockout (PBDK, H-2b) mice and wild-type (WT) C57BL/6 (H-2b) mice. PBDK mice spontaneously accepted the allografts with the inhibition of NF-κB activation in the donor cardiac allograft. Anti-B cell antibody (rituximab) significantly delayed allograft rejection in PKCθ(-/-), but not in WT mice. Co-transfer of PKCθ(-/-) T plus PKCθ(-/-) B cells or primed sera triggered allograft rejection in Rag1(-/-) mice, and only major histocompatibility complex class II-enriched B cells, but not class I-enriched B cells, were able to promote rejection. This, together with the inability of PKCθ(-/-) and CD28(-/-) double-deficient (PCDK) mice to acutely reject allografts, suggested that an effective cognate interaction between PKCθ(-/-) T and B cells for acute rejection is CD28 molecule dependent. We conclude that T-B cell interactions synergize with PKCθ(-/-) T cells to mediate acute allograft rejection.

  12. Concise Review: The Clinical Application of Mesenchymal Stem Cells for Musculoskeletal Regeneration: Current Status and Perspectives

    PubMed Central

    Steinert, Andre F.; Rackwitz, Lars; Gilbert, Fabian; Nöth, Ulrich

    2012-01-01

    Regenerative therapies in the musculoskeletal system are based on the suitable application of cells, biomaterials, and/or factors. For an effective approach, numerous aspects have to be taken into consideration, including age, disease, target tissue, and several environmental factors. Significant research efforts have been undertaken in the last decade to develop specific cell-based therapies, and in particular adult multipotent mesenchymal stem cells hold great promise for such regenerative strategies. Clinical translation of such therapies, however, remains a work in progress. In the clinical arena, autologous cells have been harvested, processed, and readministered according to protocols distinct for the target application. As outlined in this review, such applications range from simple single-step approaches, such as direct injection of unprocessed or concentrated blood or bone marrow aspirates, to fabrication of engineered constructs by seeding of natural or synthetic scaffolds with cells, which were released from autologous tissues and propagated under good manufacturing practice conditions (for example, autologous chondrocyte implantation). However, only relatively few of these cell-based approaches have entered the clinic, and none of these treatments has become a “standard of care” treatment for an orthopaedic disease to date. The multifaceted reasons for the current status from the medical, research, and regulatory perspectives are discussed here. In summary, this review presents the scientific background, current state, and implications of clinical mesenchymal stem cell application in the musculoskeletal system and provides perspectives for future developments. PMID:23197783

  13. Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

    PubMed Central

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner; Høilund-Carlsen, Poul Flemming; Haghfelt, Torben; Hartvigsen, Jan

    2008-01-01

    disease, and to compare and indirectly validate the musculoskeletal diagnosis, myocardial perfusion scintigraphy is performed in all patients 2–4 weeks following discharge. Descriptive statistics including parametric and non-parametric methods will be applied in order to compare patients with and without musculoskeletal chest pain in relation to their scintigraphic findings. The decision making process of the chiropractor will be elucidated and reconstructed using the CART method. Out of the 300 patients 120 intended patients with suspected musculoskeletal chest pain will be randomized into one of two groups: a) a course of chiropractic treatment (therapy group) of up to ten treatment sessions focusing on high velocity, low amplitude manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect, and cost-effectiveness. Discussion This study may potentially demonstrate that a chiropractor is able to identify a subset of patients suffering from chest pain predominantly of musculoskeletal origin among patients discharged from an acute chest pain clinic with no apparent cardiac condition. Furthermore knowledge about the benefits of manual treatment of patients with musculoskeletal chest pain will inform clinical decision and policy development in relation to clinical practice. Trial registration NCT00462241 and NCT00373828 PMID:18377636

  14. A liquidus tracking approach to the cryopreservation of human cartilage allografts.

    PubMed

    Kay, A G; Hoyland, J A; Rooney, P; Kearney, J N; Pegg, D E

    2015-08-01

    In the "liquidus tracking" (LT) approach to cryopreservation both the temperature and the concentration of cryoprotectant (CPA) are controlled such that solution composition "tracks" the liquidus (melting point) line for that system. Ice crystal formation is prevented but the tissue is not exposed to CPA concentrations exceeding those experienced by cells during conventional cryopreservation. This approach is particularly appropriate for articular cartilage because chondrocytes in situ are exquisitely susceptible to damage by the crystallisation of ice. This project aimed to develop a suitable process for tissue to be used in the surgical repair of damaged human knee joints. A high proportion of the chondrocytes should be alive. Human articular cartilage was obtained from deceased donors and dimethyl sulphoxide (DMSO) was used as the CPA, cooling was at 0.14°C/min and warming at 0.42°C/min. The vehicle solution was CPTes2. A program of increasing DMSO concentration was developed for cooling and this gave satisfactory tissue concentrations but reduction of DMSO concentration during warming was inadequate, resulting in higher tissue concentrations than required. Biomechanical testing indicated a compressive modulus of 9.5±1.3 MPa in LT-processed cartilage, with control values of 11.6±0.8 MPa (p>0.05, Student's t-test). Measurement of GAG synthesis sometimes approached 65% or 85% of control, but the variability of replicate data prevented firm conclusions. Ideally allograft tissue should score 1A or above on the Noyes scale and the donor age should be less than 46 years but the cartilage used in this study did not meet these standards.

  15. Improved education in musculoskeletal conditions is necessary for all doctors.

    PubMed Central

    Akesson, Kristina; Dreinhöfer, Karsten E.; Woolf, A. D.

    2003-01-01

    It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals' quality of life but also, importantly, on people's ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels--and the resulting competence and confidence of many doctors--do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system. PMID:14710510

  16. Lymphocyte migration patterns in organ allograft recipients.

    PubMed

    Kupiec-Weglinski, J W; Tilney, N L

    1989-04-01

    A central tenet of immunology is the observation, made 30 years ago, that lymphocytes recirculate continuously between peripheral blood and lymphoid tissues. In recent years, the subject of lymphocyte migration, both under physiological conditions and in states of alloresponsiveness, has become more enigmatic. It lies outside most current topics of immunological investigations, labelling and tracing techniques are problematic, and many experimental findings are phenomenological and difficult to interpret. Indeed, our overall knowledge of the functional differences between the various host lymphoid compartments and their constituent cell populations remains rudimentary. However, as understanding increases regarding the host immunological events responding to an antigenic stimulus such as a graft, with growing definition of the distinctive and interconnecting roles of lymphocyte subpopulations and their products acting on each other to produce graft destruction, the conceptual importance of lymphocyte migration again is becoming obvious. This role includes many facets of immunity such as the effects of antigen specificity, immunologic memory, differential behavior of recirculating or sessile populations, and local and systemic contact between antigen and effector cells. It has become evident that lymphocytes migrate in a non-random and highly dynamic fashion determined by a range of specific and non-specific factors; in the setting of organ transplantation, patterns are profoundly affected by the interrelated cellular and humoral components of the immunological cascade which may lead either to graft rejection or to its prolongation in untreated and immunologically modified recipients, respectively. Thus, the traffic of lymphocytes throughout host lymphoid and non-lymphoid compartments and their activity within these compartments should be considered an integral part of the host immunomodulation triggered by transplantation of histoincompatible tissue. Gradual filling

  17. The use of nano-computed tomography to enhance musculoskeletal research

    PubMed Central

    Khoury, Basma M.; Bigelow, Erin M. R.; Smith, Lauren M.; Schlecht, Stephen H.; Scheller, Erica L.; Andarawis-Puri, Nelly; Jepsen, Karl J.

    2015-01-01

    Advances in computed tomography (CT) imaging are opening new avenues toward more precise characterization and quantification of connective tissue microarchitecture. In the last two decades, micro-computed tomography (microCT) has significantly augmented destructive methods for the 3D micro-analysis of tissue structure, primarily in the bone research field. Recently, microCT has been employed in combination with contrast agents to generate contrast-enhanced images of soft tissues that are otherwise difficult to visualize due to their native radiodensity. More recent advances in CT technology have enabled ultra-high resolution imaging by utilizing a more powerful nano-focused X-ray source, such as that found in nano-computed tomography (nanoCT) systems. NanoCT imaging has facilitated the expansion of musculoskeletal research by reducing acquisition time and significantly expanding the range of samples that can be imaged in terms of size, age and tissue-type (bone, muscle, tendon, cartilage, vessels and adipose tissue). We present the application and early results of nanoCT imaging in various tissue types and how this ultra-high resolution imaging modality is capable of characterizing microstructures at levels of details previously not possible. Contrast-enhanced imaging techniques to enable soft-tissue visualization and characterization are also outlined. PMID:25646568

  18. Meniscal allograft transplantation--part I: background, results, graft selection and preservation, and surgical considerations.

    PubMed

    Rijk, Paul C

    2004-09-01

    Removal of the meniscus leads to progressive degenerative arthritis of the knee on a long-term basis. Therefore, meniscal allograft transplantation has been proposed as an alternative to meniscectomy. Although several experimental and clinical studies have documented that meniscal allografts show capsular ingrowth in meniscectomized knees, it remains to be established whether meniscal allograft transplantation can prevent degenerative changes after meniscectomy. Part 1 of this Current Concepts review will discuss the function, anatomy, and composition of the meniscus, followed by the history of surgery of meniscal tears and the healing of meniscal allografts in experimental and clinical studies. In addition, issues concerning preservation techniques, immunological reactions, sizing, disease transmission, indications, surgical technique, graft fixation, rehabilitation, and complications, will be taken into consideration. It can be concluded that the use of meniscal allografts in clinical practice has progressed to a point where relief of pain may be expected for the short-term.

  19. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

    PubMed

    Kim, Hyung-Kee; Ryuk, Jong-Pil; Choi, Hyang Hee; Kwon, Sang-Hwy; Huh, Seung

    2009-02-01

    Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

  20. Meniscal allograft transplantation--part I: background, results, graft selection and preservation, and surgical considerations.

    PubMed

    Rijk, Paul C

    2004-09-01

    Removal of the meniscus leads to progressive degenerative arthritis of the knee on a long-term basis. Therefore, meniscal allograft transplantation has been proposed as an alternative to meniscectomy. Although several experimental and clinical studies have documented that meniscal allografts show capsular ingrowth in meniscectomized knees, it remains to be established whether meniscal allograft transplantation can prevent degenerative changes after meniscectomy. Part 1 of this Current Concepts review will discuss the function, anatomy, and composition of the meniscus, followed by the history of surgery of meniscal tears and the healing of meniscal allografts in experimental and clinical studies. In addition, issues concerning preservation techniques, immunological reactions, sizing, disease transmission, indications, surgical technique, graft fixation, rehabilitation, and complications, will be taken into consideration. It can be concluded that the use of meniscal allografts in clinical practice has progressed to a point where relief of pain may be expected for the short-term. PMID:15346115

  1. Three-dimensional virtual bone bank system workflow for structural bone allograft selection: a technical report.

    PubMed

    Ritacco, Lucas Eduardo; Farfalli, German Luis; Milano, Federico Edgardo; Ayerza, Miguel Angel; Muscolo, Domingo Luis; Aponte-Tinao, Luis

    2013-01-01

    Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays. Thanks to preoperative planning platforms, three-dimensional (3D) CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtual bone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone bank system has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery. In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor.

  2. Development of a cyclosporin-A-induced immune tolerant rat model to test marrow allograft cell type effects on bone repair.

    PubMed

    Espitalier, Florent; Durand, Nicolas; Rémy, Séverine; Corre, Pierre; Sourice, Sophie; Pilet, Paul; Weiss, Pierre; Guicheux, Jérôme; Malard, Olivier

    2015-05-01

    Bone repair is an important concept in tissue engineering, and the ability to repair bone in hypotrophic conditions such as that of irradiated bone, represents a challenge for this field. Previous studies have shown that a combination of bone marrow and (BCP) was effective to repair irradiated bone. However, the origin and role played by each cell type in bone healing still remains unclear. In order to track the grafted cells, the development of an animal model that is immunotolerant to an allograft of bone marrow would be useful. Furthermore, because the immune system interacts with bone turnover, it is of critical importance to demonstrate that immunosuppressive drugs do not interfere with bone repair. After a preliminary study of immunotolerance, cyclosporin-A was chosen to be used in immunosuppressive therapy. Ten rats were included to observe qualitative and quantitative bone repair 8 days and 6 weeks after the creation of bone defects. The defects were filled with an allograft of bone marrow alone or in association with BCP under immunosuppressive treatment (cyclosporin-A). The results showed that there was no significant interaction of cyclosporin-A with osseous regeneration. The use of this new immunotolerant rat model of bone marrow allograft in future studies will provide insight on how the cells within the bone marrow graft contribute to bone healing, especially in irradiated conditions.

  3. Effect of platelet-rich plasma on the healing of mandibular defects treated with fresh frozen bone allograft: a radiographic study in dogs.

    PubMed

    Messora, Michel R; Nagata, Maria J H; Fucini, Stephen E; Pola, Natália M; Campos, Natália; de Oliveira, Guillermo C V; Bosco, Alvaro F; Garcia, Valdir G; Furlaneto, Flávia A C

    2014-10-01

    The purpose of this study was to radiographically analyze the effect of autologous platelet rich plasma (PRP) on the healing of fresh frozen bone allograft (FFBA) placed in surgically created resection defects in mandibles of dogs. Bilateral resection defects measuring 1.5 cm × 1 cm were surgically created on the inferior border of the mandible in 10 adult male dogs. The defects were randomly divided into three groups: C, FFBA, and FFBA/PRP. In Group C, the defect was filled by blood clot only. In Group FFBA, the defect was filled with particulate fresh frozen bone allograft. In Group FFBA/PRP, it was filled with particulate fresh frozen bone allograft combined with PRP. At 90 days postoperative, standardized radiographs of the mandibles were obtained and results were quantitatively evaluated. Analysis of digitized radiographs indicated that non-PRP grafts were significantly less dense than the PRP grafts. Group FFBA/PRP also presented a statistically greater mineralized tissue area than Groups C and FFBA. Within the limits of this study, it can be concluded that PRP enhanced the healing of FFBA in resection defects in mandibles of dogs.

  4. Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur

    PubMed Central

    Larousserie, Frédérique; Thévenin, Fabrice; Piperno-Neumann, Sophie; Anract, Philippe

    2009-01-01

    The use of allograft-prosthesis composites for reconstruction after bone tumor resection at the proximal femur has generated considerable interest since the mid1980s on the basis that their use would improve function and survival, and restore bone stock. Although functional improvement has been documented, it is unknown whether these composites survive long periods and whether they restore bone stock. We therefore determined long-term allograft-prosthesis composite survival, identified major complications that led to revision, and determined whether allograft bone stock could be spared at the time of revision. We also compared the radiographic appearance of allografts sterilized by gamma radiation and fresh-frozen allografts. We retrospectively reviewed 32 patients with bone malignancy in the proximal femur who underwent reconstruction with a cemented allograft-prosthesis composite. The allograft-prosthesis composite was a primary reconstruction for 23 patients and a revision procedure for nine. The minimum followup was 2 months (median, 68 months; range, 2–232 months). The cumulative incidence of revision for any reason was 14% at 5 years (95% confidence interval, 1%–28%) and 19% at 10 years (95% confidence interval, 3%–34%). Nine patients (28%) had revision of the reconstruction during followup; four of these patients had revision surgery for infection. Allografts sterilized by gamma radiation showed worse resorption than fresh-frozen allografts. Based on reported results, allograft-composite prostheses do not appear to improve survival compared with megaprostheses. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19851817

  5. Characteristic patterns in the fibrotic lung. Comparing idiopathic pulmonary fibrosis with chronic lung allograft dysfunction.

    PubMed

    Fernandez, Isis E; Heinzelmann, Katharina; Verleden, Stijn; Eickelberg, Oliver

    2015-03-01

    Tissue fibrosis, a major cause of death worldwide, leads to significant organ dysfunction in any organ of the human body. In the lung, fibrosis critically impairs gas exchange, tissue oxygenation, and immune function. Idiopathic pulmonary fibrosis (IPF) is the most detrimental and lethal fibrotic disease of the lung, with an estimated median survival of 50% after 3-5 years. Lung transplantation currently remains the only therapeutic alternative for IPF and other end-stage pulmonary disorders. Posttransplant lung function, however, is compromised by short- and long-term complications, most importantly chronic lung allograft dysfunction (CLAD). CLAD affects up to 50% of all transplanted lungs after 5 years, and is characterized by small airway obstruction with pronounced epithelial injury, aberrant wound healing, and subepithelial and interstitial fibrosis. Intriguingly, the mechanisms leading to the fibrotic processes in the engrafted lung exhibit striking similarities to those in IPF; therefore, antifibrotic therapies may contribute to increased graft function and survival in CLAD. In this review, we focus on these common fibrosis-related mechanisms in IPF and CLAD, comparing and contrasting clinical phenotypes, the mechanisms of fibrogenesis, and biomarkers to monitor, predict, or prognosticate disease status.

  6. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft.

    PubMed

    Mei-Dan, Omer; Mann, Gideon; Steinbacher, Gilbert; Ballester, Soleda J; Cugat, Ramon Bertomeu; Alvarez, Pedro Diaz

    2008-01-01

    Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone-patellar-tendon-bone allograft.

  7. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft.

    PubMed

    Mei-Dan, Omer; Mann, Gideon; Steinbacher, Gilbert; Ballester, Soleda J; Cugat, Ramon Bertomeu; Alvarez, Pedro Diaz

    2008-01-01

    Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone-patellar-tendon-bone allograft. PMID:17684731

  8. [Musculoskeletal pain in Venezuelan oil tanker crews].

    PubMed

    Fernández-D'Pool, Janice; Jameson, Robby; Brito, Angel

    2014-06-01

    The objective of this investigation was to analyze the prevalence of musculoskeletal pain (MSP) in oil tanker crew members in Venezuela. A descriptive cross-sectional study was implemented, using a modified version of the Standardized Nordic Questionnaires. The prevalence of MSP in 127 men was 82%. The mean age was statistically different (p < 0.05) between the MSP group (39.29 +/- 10.16 years, range 24-60) and the no-MSP group (34.9 +/- 9.76 years, range 24-58 years). There was no significant difference between the body mass indexes (BMI) of the MSP group (29.94 +/- 4.31 kg/m2) and the no-MSP group (30.02 +/- 4.96 km/m2). The majority of the crew members with MSP (83%) had < or = 10 years seniority, mean value of 4.31 +/- 2.44 years. MSP occurrence was the same (50%) for crew members located in engine rooms and decks. The MSP frequency for anatomical region was 57% in lower back, 32% knees, 24% in neck and upper back and 19% shoulders. There was a significant association between lower back pain and seniority (p < 0.05), also between age and BMI (p < 0.01); and an inverse significant correlation (p < 0.01) between lower back pain and knee pain, age and neck pain and seniority in the job. The crew members in the deck area showed a higher occurrence of neck pain (33%) than the engine crew (16%) (p< 0.01). Our findings suggest the need to implement health programs to reduce the occurrence of MSP in the workplace.

  9. Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor or metastatic carcinoma to bone.

    PubMed

    Puvanesarajah, Varun; Spiker, Andrea M; Shannon, Brett A; Grundy, Maureen; Levin, Adam S; Morris, Carol D

    2016-09-01

    Primary musculoskeletal cancer and metastatic disease to bone in pregnant patients presents major treatment challenges. Although uncommon, musculoskeletal malignancies in pregnant women have been reported. When diagnosing and treating these patients, the mother's health must be managed appropriately while ensuring that fetal development is not deleteriously affected. Extensive radiographic imaging and more advanced techniques are often necessary to fully characterize the extent of disease. When possible, magnetic resonance imaging should be used instead of computed tomography to limit exposure of the conceptus to radiation. If treatment is needed, therapeutic radiation, chemotherapy, and surgery should be considered. Surgical resection is the foundation of treatment of early-stage primary bone tumors and soft-tissue sarcomas during pregnancy. With surgery, anesthesia and thromboprophylaxis are important considerations. If chemotherapy is required, administration should be avoided in the first trimester to limit harm to the fetus. Therapeutic radiation should similarly be avoided during the first trimester and often can be postponed until after delivery. PMID:27566025

  10. Generation of suppressive blood cells for control of allograft rejection.

    PubMed

    Kleist, Christian; Sandra-Petrescu, Flavius; Jiga, Lucian; Dittmar, Laura; Mohr, Elisabeth; Greil, Johann; Mier, Walter; Becker, Luis E; Lang, Peter; Opelz, Gerhard; Terness, Peter

    2015-05-01

    Our previous studies in rats showed that incubation of monocytic dendritic cells (DCs) with the chemotherapeutic drug mitomycin C (MMC) renders the cells immunosuppressive. Donor-derived MMC-DCs injected into the recipient prior to transplantation prolonged heart allograft survival. Although the generation of DCs is labour-intensive and time-consuming, peripheral blood mononuclear cells (PBMCs) can be easily harvested. In the present study, we analyse under which conditions DCs can be replaced by PBMCs and examine their mode of action. When injected into rats, MMC-incubated donor PBMCs (MICs) strongly prolonged heart allograft survival. Removal of monocytes from PBMCs completely abrogated their suppressive effect, indicating that monocytes are the active cell population. Suppression of rejection was donor-specific. The injected MICs migrated into peripheral lymphoid organs and led to an increased number of regulatory T-cells (Tregs) expressing cluster of differentiation (CD) markers CD4 and CD25 and forkhead box protein 3 (FoxP3). Tolerance could be transferred to syngeneic recipients with blood or spleen cells. Depletion of Tregs from tolerogenic cells abrogated their suppressive effect, arguing for mediation of immunosuppression by CD4⁺CD25⁺FoxP3⁺ Tregs. Donor-derived MICs also prolonged kidney allograft survival in pigs. MICs generated from donor monocytes were applied for the first time in humans in a patient suffering from therapy-resistant rejection of a haploidentical stem cell transplant. We describe, in the present paper, a simple method for in vitro generation of suppressor blood cells for potential use in clinical organ transplantation. Although the case report does not allow us to draw any conclusion about their therapeutic effectiveness, it shows that MICs can be easily generated and applied in humans.

  11. Urine Metabolite Profiles Predictive of Human Kidney Allograft Status.

    PubMed

    Suhre, Karsten; Schwartz, Joseph E; Sharma, Vijay K; Chen, Qiuying; Lee, John R; Muthukumar, Thangamani; Dadhania, Darshana M; Ding, Ruchuang; Ikle, David N; Bridges, Nancy D; Williams, Nikki M; Kastenmüller, Gabi; Karoly, Edward D; Mohney, Robert P; Abecassis, Michael; Friedewald, John; Knechtle, Stuart J; Becker, Yolanda T; Samstein, Benjamin; Shaked, Abraham; Gross, Steven S; Suthanthiran, Manikkam

    2016-02-01

    Noninvasive diagnosis and prognostication of acute cellular rejection in the kidney allograft may help realize the full benefits of kidney transplantation. To investigate whether urine metabolites predict kidney allograft status, we determined levels of 749 metabolites in 1516 urine samples from 241 kidney graft recipients enrolled in the prospective multicenter Clinical Trials in Organ Transplantation-04 study. A metabolite signature of the ratio of 3-sialyllactose to xanthosine in biopsy specimen-matched urine supernatants best discriminated acute cellular rejection biopsy specimens from specimens without rejection. For clinical application, we developed a high-throughput mass spectrometry-based assay that enabled absolute and rapid quantification of the 3-sialyllactose-to-xanthosine ratio in urine samples. A composite signature of ratios of 3-sialyllactose to xanthosine and quinolinate to X-16397 and our previously reported urinary cell mRNA signature of 18S ribosomal RNA, CD3ε mRNA, and interferon-inducible protein-10 mRNA outperformed the metabolite signatures and the mRNA signature. The area under the receiver operating characteristics curve for the composite metabolite-mRNA signature was 0.93, and the signature was diagnostic of acute cellular rejection with a specificity of 84% and a sensitivity of 90%. The composite signature, developed using solely biopsy specimen-matched urine samples, predicted future acute cellular rejection when applied to pristine samples taken days to weeks before biopsy. We conclude that metabolite profiling of urine offers a noninvasive means of diagnosing and prognosticating acute cellular rejection in the human kidney allograft, and that the combined metabolite and mRNA signature is diagnostic and prognostic of acute cellular rejection with very high accuracy.

  12. No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques.

    PubMed

    Kovalik, E C; Schwab, S J; Gunnells, J C; Bowie, D; Smith, S R

    1996-06-01

    The previous methods to biopsy renal allografts at our institution involved the use of the Franklin-Silverman or Tru-Cut needles. Unfortunately they had a significant rate of post biopsy bleeding secondary to deep penetration when excess force was used to penetrate a tough transplant capsule. Although spring loaded biopsy devices have been widely used for native kidney biopsies over the past three years, the complication rate for renal allograft biopsies has not been sufficiently evaluated. We describe our experience using a disposable spring loaded biopsy device on transplanted renal grafts. Fifty-four biopsies were performed with the device, all under ultrasound guidance. The ASAP automatic biopsy system by Medi-tech was used comprising of a spring loaded gun with a 15 cm long 15 GA needle echogenic tip and 17 mm specimen notch. All patients were ultrasounded immediately post biopsy to look for hematomas. Compared to 55 previous biopsies performed using Tru-Cut needles, we conclude that the ASAP automated biopsy system proved equally effective in obtaining adequate tissue for diagnosis with fewer post-biopsy hematomas compared to traditional biopsy methods.

  13. Impact of cytokine expression in the pre-implanted donor lung on the development of chronic lung allograft dysfunction subtypes.

    PubMed

    Saito, T; Takahashi, H; Kaneda, H; Binnie, M; Azad, S; Sato, M; Waddell, T K; Cypel, M; Liu, M; Keshavjee, S

    2013-12-01

    The long-term success of lung transplantation continues to be challenged by the development of chronic lung allograft dysfunction (CLAD). The purpose of this study was to investigate the relationship between cytokine expression levels in pre-implanted donor lungs and the posttransplant development of CLAD and its subtypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Of 109 patients who underwent bilateral lung or heart-lung transplantation and survived for more than 3 months, 50 BOS, 21 RAS and 38 patients with No CLAD were identified by pulmonary function test results. Using donor lung tissue biopsies sampled from each patient, expression levels of IL-6, IL-1β, IL-8, IL-10, interferon-γ and tumor necrosis factor-α mRNA were measured. IL-6 expression levels were significantly higher in pre-implanted lungs of patients that ultimately developed BOS compared to RAS and No CLAD (p = 0.025 and 0.011, respectively). Cox regression analysis demonstrated an association between high IL-6 expression levels and BOS development (hazard ratio = 4.98; 95% confidence interval = 2.42-10.2, p < 0.001). In conclusion, high IL-6 mRNA expression levels in pre-implanted donor lungs were associated with the development of BOS, not RAS. This association further supports the contention that early graft injury impacts on both late graft function and early graft function. PMID:24164971

  14. Abnormal Localization of STK17A in Bile Canaliculi in Liver Allografts: An Early Sign of Chronic Rejection

    PubMed Central

    Aini, Wulamujiang; Tamaki, Keiji; Haga, Hironori; Miyagawa-Hayashino, Aya

    2015-01-01

    The biological significance of STK17A, a serine/threonine kinase, in the liver is not known. We analyzed STK17A expression in HepG2 cells and human liver tissue. Accordingly, we investigated whether STK17A could help in identifying earlier changes during the evolution of chronic rejection (CR) after liver transplantation. RT-PCR and immunofluorescence were used to analyze STK17A expression in HepG2 cells. Antibody microarray was performed using human liver samples from CR and healthy donors. Immunohistochemistry was used to verify the clinical utility of STK17A on sequential biopsies for the subsequent development of CR. A novel short isoform of STK17A was found in HepG2 cells. STK17A was localized in the nuclei and bile canaliculi in HepG2 cells and human livers. Microarray of STK17A revealed its decrease in failed liver allografts by CR. During the evolution of CR, the staining pattern of bile canalicular STK17A gradually changed from diffuse linear to focal intermittent. The focal intermittent staining pattern was observed before the definite diagnosis of CR. In conclusion, the present study was the first to find localization of STK17A in normal bile canaliculi. Abnormal expression and localization of STK17A were associated with CR of liver allografts since the early stage of the rejection process. PMID:26305096

  15. Extracorporeal shockwave therapy for plantar fasciitis and other musculoskeletal conditions utilizing the Ossatron--an update.

    PubMed

    Wilner, Joel M; Strash, Walter W

    2004-07-01

    Extracorporeal shockwave therapy for treatment of plantar fasciitis and other areas of the body has been well documented since the early 1990s. A high level of efficacy and patient satisfaction after undergoing electrohydraulic shock wave treatments has been reported not only for plantar fasciopathy but other musculoskeletal indications. Electrohydraulic devices have a bimodal response: early suppression of nocioceptor reactivity followed by subsequent target tissue remodeling and healing through neovascularization and recruitment of new tissue target specific cells. Both responses are not present with low energy electromagnetic devices. The focus of this article is treatment of chronic proximal plantar fasciitis; however, other pathologies of the lower extremity demonstrate great promise for this emerging technology.

  16. Hospital For Special Surgery/Immune System REgulation In Musculoskeletal Disorders

    SciTech Connect

    Eric Meffre; Lionel Ivashkiv

    2007-08-20

    Inflammation on musculoskeletal disorders such as rheumatoid arthritis (RA) is the result of dysregulation of the immune system. When the immune system, which maintains the integrity of the organism in an environment rich in infectious microbes, becomes misdirected toward components of one’s own tissue, autoimmune disease can result with autoantibodies contributing to the inflammation and tissue damage. RA is a chronic autoimmune disease marked by severe inflammation that causes pain, swelling, stiffness and loss of function in the joints, which is estimated to affect 1 percent of the US adult population. Furthermore, autoimmune diseases, which affect women at a higher rate, are the fourth largest cause of disability among women in the US and among the top ten causes of death. The long range goal of this study is to elucidate the mechanisms that regulate the generation of autoantibodies by B cells in normal individuals and in patients with autoimmune diseases and provide insights into potential therapeutic interventions.

  17. Role of Health Literacy in Self-Reported Musculoskeletal Disorders

    PubMed Central

    Hill, Catherine L.; Appleton, Sarah L.; Black, Julie; Hoon, Elizabeth; Rudd, Rima E.; Adams, Robert J.; Gill, Tiffany

    2015-01-01

    Self-report of musculoskeletal conditions is often used to estimate population prevalence and to determine disease burden and influence policy. However, self-report of certain musculoskeletal conditions is frequently inaccurate, suggesting inadequate communication to the patient of their diagnosis. The aim of this study is to determine the association between functional health literacy (FHL) and self-reported musculoskeletal conditions in a representative population survey. FHL was measured using Newest Vital Sign in 2824 randomly selected adults. Participants also self-reported medically diagnosed arthritis, gout, and osteoporosis. Multiple logistic regression was adjusted for age and sex. The prevalence of self-reported arthritis, gout, and osteoporosis was 25.2%, 4.9%, and 5.6%, respectively. The prevalence of those at risk for inadequate FHL was 24.0% and high likelihood of inadequate FHL was 21.0%. However, over 50% of respondents with arthritis or gout had at risk/inadequate FHL, increasing to 70% of those self-reporting osteoporosis. After adjustment for age and sex, respondents in the arthritis subgroup of “don't know” and self-reported osteoporosis were significantly more likely to have inadequate FHL than the general population. This study indicates a substantial burden of low health literacy amongst people with musculoskeletal disease. This has implications for provider-patient communication, individual healthcare, population estimates of musculoskeletal disease, and impact of public health messages. PMID:26357571

  18. Oxidative stress and gamma radiation-induced cancellous bone loss with musculoskeletal disuse

    PubMed Central

    Kondo, Hisataka; Yumoto, Kenji; Alwood, Joshua S.; Mojarrab, Rose; Wang, Angela; Almeida, Eduardo A. C.; Searby, Nancy D.; Limoli, Charles L.

    2010-01-01

    Exposure of astronauts in space to radiation during weightlessness may contribute to subsequent bone loss. Gamma irradiation of postpubertal mice rapidly increases the number of bone-resorbing osteoclasts and causes bone loss in cancellous tissue; similar changes occur in skeletal diseases associated with oxidative stress. Therefore, we hypothesized that increased oxidative stress mediates radiation-induced bone loss and that musculoskeletal disuse changes the sensitivity of cancellous tissue to radiation exposure. Musculoskeletal disuse by hindlimb unloading (1 or 2 wk) or total body gamma irradiation (1 or 2 Gy of 137Cs) of 4-mo-old, male C57BL/6 mice each decreased cancellous bone volume fraction in the proximal tibiae and lumbar vertebrae. The extent of radiation-induced acute cancellous bone loss in tibiae and lumbar vertebrae was similar in normally loaded and hindlimb-unloaded mice. Similarly, osteoclast surface in the tibiae increased 46% as a result of irradiation, 47% as a result of hindlimb unloading, and 64% as a result of irradiation + hindlimb unloading compared with normally loaded mice. Irradiation, but not hindlimb unloading, reduced viability and increased apoptosis of marrow cells and caused oxidative damage to lipids within mineralized tissue. Irradiation also stimulated generation of reactive oxygen species in marrow cells. Furthermore, injection of α-lipoic acid, an antioxidant, mitigated the acute bone loss caused by irradiation. Together, these results showed that disuse and gamma irradiation, alone or in combination, caused a similar degree of acute cancellous bone loss and shared a common cellular mechanism of increased bone resorption. Furthermore, irradiation, but not disuse, may increase the number of osteoclasts and the extent of acute bone loss via increased reactive oxygen species production and ensuing oxidative damage, implying different molecular mechanisms. The finding that α-lipoic acid protected cancellous tissue from the

  19. The evolving role of computer-assisted navigation in musculoskeletal oncology.

    PubMed

    Young, P S; Bell, S W; Mahendra, A

    2015-02-01

    We report our experience of using a computer navigation system to aid resection of malignant musculoskeletal tumours of the pelvis and limbs and, where appropriate, their subsequent reconstruction. We also highlight circumstances in which navigation should be used with caution. We resected a musculoskeletal tumour from 18 patients (15 male, three female, mean age of 30 years (13 to 75) using commercially available computer navigation software (Orthomap 3D) and assessed its impact on the accuracy of our surgery. Of nine pelvic tumours, three had a biological reconstruction with extracorporeal irradiation, four underwent endoprosthetic replacement (EPR) and two required no bony reconstruction. There were eight tumours of the bones of the limbs. Four diaphyseal tumours underwent biological reconstruction. Two patients with a sarcoma of the proximal femur and two with a sarcoma of the proximal humerus underwent extra-articular resection and, where appropriate, EPR. One soft-tissue sarcoma of the adductor compartment which involved the femur was resected and reconstructed using an EPR. Computer navigation was used to aid reconstruction in eight patients. Histological examination of the resected specimens revealed tumour-free margins in all patients. Post-operative radiographs and CT showed that the resection and reconstruction had been carried out as planned in all patients where navigation was used. In two patients, computer navigation had to be abandoned and the operation was completed under CT and radiological control. The use of computer navigation in musculoskeletal oncology allows accurate identification of the local anatomy and can define the extent of the tumour and proposed resection margins. Furthermore, it helps in reconstruction of limb length, rotation and overall alignment after resection of an appendicular tumour.

  20. Factors Associated With Musculoskeletal Injuries in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

    PubMed Central

    Guy, Jeffrey A.; Knight, Lisa M.; Wang, Yinding; Jerrell, Jeanette M.

    2016-01-01

    Background: Musculoskeletal injuries may be associated with attention-deficit/hyperactivity disorder (ADHD) symptom severity, comorbid psychiatric or medical conditions, and the prescribed psychostimulant. Methods: A population-based, retrospective cohort design was employed using South Carolina’s Medicaid claims data set covering outpatient and inpatient medical services and medication prescriptions over an 11-year period (January 1, 1996, through December 31, 2006) for patients ≤ 17 years of age with ≥ 2 visits for ICD-9-CM diagnostic codes for ADHD. A cohort of 7,725 cases was identified and analyzed using logistic regression to compare risk factors for those who sustained focal musculoskeletal injuries and those who did not. Results: The risk of sustaining sprains, arthropathy and connective tissue disorders, or muscle and joint disorders was significantly related to being diagnosed with comorbid hypertension (adjusted odds ratios [aORs] = 1.60, 2.09, and 1.46, respectively) and a substance use disorder (aORs = 1.58, 1.38, and 1.28). Having a substance use disorder was also related to incident fractures and dorso/spinal injuries (aORs = 1.42 and 1.21). Diagnosed hypertension was related to incident concussions (aOR = 2.00), a diagnosed thyroid disorder was related to an increased risk of sprain and concussion (aORs = 1.44 and 2.05), a diagnosed anxiety disorder was related to an increased risk of dorso/spinal disorders (aOR = 1.71), and diagnosed diabetes was related to incident bone and cartilage disorders (aOR = 1.61). Conclusions: Comorbid hypertension, substance use disorders, and thyroid disorders deserve increased clinical surveillance in children and adolescents with ADHD because they may be associated with an increased risk of more than one musculoskeletal injury. PMID:27733957

  1. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury.

    PubMed

    Malanga, Gerard A; Yan, Ning; Stark, Jill

    2015-01-01

    Nonpharmacological treatment strategies for acute musculoskeletal injury revolve around pain reduction and promotion of healing in order to facilitate a return to normal function and activity. Heat and cold therapy modalities are often used to facilitate this outcome despite prevalent confusion about which modality (heat vs cold) to use and when to use it. Most recommendations for the use of heat and cold therapy are based on empirical experience, with limited evidence to support the efficacy of specific modalities. This literature review provides information for practitioners on the use of heat and cold therapies based on the mechanisms of action, physiological effects, and the medical evidence to support their clinical use. The physiological effects of cold therapy include reductions in pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand. There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS). The physiological effects of heat therapy include pain relief and increases in blood flow, metabolism, and elasticity of connective tissues. There is limited overall evidence to support the use of topical heat in general; however, RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy. There remains an ongoing need for more sufficiently powered high-quality RCTs on the effects of cold and heat therapy on recovery from acute musculoskeletal injury and DOMS. PMID:25526231

  2. Novel Musculoskeletal Loading System for Small Exercise Devices

    NASA Technical Reports Server (NTRS)

    Downs, Meghan; Newby, Nate; Trinh, Tinh; Hanson, Andrea

    2016-01-01

    Long duration spaceflight places astronauts at increased risk for muscle strain and bone fracture upon return to a 1-g or partial gravity environment. Functionally limiting decrements in musculoskeletal health are likely during Mars proving-ground and Earth-independent missions given extended transit times and the vehicle limitations for exercise devices (low-mass, small volume, little to no power). This is particularly alarming for exploration missions because astronauts will be required to perform novel and physically demanding tasks (i.e. vehicle egress, exploration, and habitat building activities) on unfamiliar terrain. Accordingly, NASA's exploration roadmap identifies the need for development of small exercise equipment that can prevent musculoskeletal atrophy and has the ability to assess musculoskeletal health at multiple time points during long-duration missions.

  3. [Working women with chronic musculoskeletal pain: a case series].

    PubMed

    Ordóñez-Hernández, Cecilia Andrea; Contreras-Estrada, Mónica Isabel; Soltero-Avelar, Ruben

    2015-10-01

    This study aimed to analyze the experience of working women suffering from chronic musculoskeletal pain, using a qualitative design with a phenomenological approach. The technique drew on in-depth interviews with five working women that presented to the orthopedics and neurosurgery departments of a hospital in Guadalajara, Mexico, with a complaint of musculoskeletal pain for more than six months. The study showed that the women felt rejection, segregation, discrimination, lack of support at the workplace, and feelings of frustration and powerlessness related to their health condition. The women also perceived as a barrier the lack of efficiency in disability proceedings and job reintegration or relocation. Financial and family responsibilities were their main reason for continuing to work despite their chronic musculoskeletal pain. PMID:26735388

  4. 77 FR 9671 - National Institute of Arthritis and Musculoskeletal and Skin Diseases; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-17

    ... Skin Diseases; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee... Musculoskeletal and Skin Diseases Special Emphasis Panel; Career Development, Research Training & Pathways to... Review Officer, Scientific Review Branch, National Institute of Arthritis, Musculoskeletal and...

  5. 75 FR 63492 - National Institute of Arthritis and Musculoskeletal and Skin Diseases; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ... Skin Diseases; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee... Musculoskeletal and Skin Diseases Special Emphasis Panel, Career Development, Research Training & Pathways to... Review Officer, Scientific Review Branch, National Institute of Arthritis, Musculoskeletal and...

  6. Angelman syndrome: A review highlighting musculoskeletal and anatomical aberrations.

    PubMed

    Sachdeva, Rohit; Donkers, Sarah J; Kim, Soo Y

    2016-07-01

    Angelman's syndrome (AS) is a genetic neurodevelopment disorder. The cause is a known abnormality involving the maternal inherited ubiquitin-protein ligase (UBE3A) gene. Clinical characteristics universal to the disorder are well documented in the literature and include developmental delay, seizures, ataxia, altered tone, severely impaired speech and intellect, as well as an overall happy demeanor, frequent bouts of laughter, and hypermotoric behavior. Associated with this disorder are several musculoskeletal aberrations. To date, a review of case studies reporting on these musculoskeletal changes has not been carried out. Thus, the purpose of this paper was to provide an overview of the musculoskeletal changes present in individuals with AS. In our review of 21 case reports from 1965-2013, the most consistently reported anatomical changes were of the craniofacial region. These include microcephaly, brachycephaly, a palpable occipital groove, prognathism, and wide spaced teeth. Other musculoskeletal abnormalities less frequently reported in the literature include scoliosis, excessive lumbar lordosis, and pes planus. Given that the majority of the case reports reviewed was of young children, the possibility of underreporting musculoskeletal changes which may manifest in the later years of life may be present. Early diagnosis and interventions to minimize secondary complications are crucial to maintain quality of life. An overall multidisciplinary approach is emphasized to maximize developmental potential for these individuals. Future prospective studies that follow patients into adulthood are needed to better understand the prevalence and development of secondary musculoskeletal changes, which in turn can inform intervention techniques and preventative measures. Clin. Anat. 29:561-567, 2016. © 2015 Wiley Periodicals, Inc.

  7. Recommendations from NASA's Operational and Research Musculoskeletal Summit

    NASA Technical Reports Server (NTRS)

    Jones, J. A.; Johnson-Throop, K. A.; Scheuring, R. A.; Walton, M. E.; Davis-Street, J. E.; Smaka, T.; McCulley, P. A.; Jones, J. A.; Stokes, C. R.; Parker, K. K.; Wear, M.; Johnson-Throop, K. A.

    2006-01-01

    Introduction: Continuously evolving medical standards of care, limited crew training time, and the inherent constraints of space flight necessitate regular revisions of the mission medical support infrastructure and methodology. A three-day Operational and Research Musculoskeletal Summit was held to review NASA s current strategy for preflight health maintenance and injury screening, risk mitigation for musculoskeletal injuries or syndromes, treatment methods during flight, and research topics to mitigate risks to astronaut health. The Summit also undertook consideration of the best evidence-based terrestrial musculoskeletal practices to recommend their adaptation for use in space. Methods: The types and frequencies of musculoskeletal injuries sustained by short- and long-duration astronauts were obtained from the Longitudinal Study of Astronaut Health. The Summit panel was comprised of experts from the clinical and research communities, as well as representatives from NASA Headquarters, the Astronaut corps, and the offices of JSC Medical Operations, JSC Human Adaptation and Countermeasures, Glenn Research Center Human Research, and Astronaut Strength Conditioning and Rehabilitation. Before the summit, panelists participated in a Web-based review of NASA s Space Medical Conditions List (SMCL). Results: The Summit generated seventy-five operational and research recommendations to the NASA Office of Space Medicine, including changes to the SMCL and to the musculoskeletal section of the ISS debrief questionnaire. From these recommendations, seven were assigned highest value and priority, and could be immediately adopted for the exploration architecture. Discussion: Optimized exercise and conditioning to improve performance and forestall musculoskeletal damage on orbit were the primary area of focus. Special attention was paid to exercise timing and muscle group specificity. The panel s recommendations are currently in various stages of consideration or integration

  8. Angelman syndrome: A review highlighting musculoskeletal and anatomical aberrations.

    PubMed

    Sachdeva, Rohit; Donkers, Sarah J; Kim, Soo Y

    2016-07-01

    Angelman's syndrome (AS) is a genetic neurodevelopment disorder. The cause is a known abnormality involving the maternal inherited ubiquitin-protein ligase (UBE3A) gene. Clinical characteristics universal to the disorder are well documented in the literature and include developmental delay, seizures, ataxia, altered tone, severely impaired speech and intellect, as well as an overall happy demeanor, frequent bouts of laughter, and hypermotoric behavior. Associated with this disorder are several musculoskeletal aberrations. To date, a review of case studies reporting on these musculoskeletal changes has not been carried out. Thus, the purpose of this paper was to provide an overview of the musculoskeletal changes present in individuals with AS. In our review of 21 case reports from 1965-2013, the most consistently reported anatomical changes were of the craniofacial region. These include microcephaly, brachycephaly, a palpable occipital groove, prognathism, and wide spaced teeth. Other musculoskeletal abnormalities less frequently reported in the literature include scoliosis, excessive lumbar lordosis, and pes planus. Given that the majority of the case reports reviewed was of young children, the possibility of underreporting musculoskeletal changes which may manifest in the later years of life may be present. Early diagnosis and interventions to minimize secondary complications are crucial to maintain quality of life. An overall multidisciplinary approach is emphasized to maximize developmental potential for these individuals. Future prospective studies that follow patients into adulthood are needed to better understand the prevalence and development of secondary musculoskeletal changes, which in turn can inform intervention techniques and preventative measures. Clin. Anat. 29:561-567, 2016. © 2015 Wiley Periodicals, Inc. PMID:26480021

  9. Prevalence of Musculoskeletal Conditions in Tennis-Teaching Professionals

    PubMed Central

    Colberg, Ricardo E.; Aune, Kyle T.; Propst, Matthew S.

    2016-01-01

    Background: Tennis-teaching professionals represent a significant proportion of all avid tennis players worldwide, with 15,000 belonging to the largest professional organization, the United States Professional Tennis Association (USPTA). However, there is no epidemiologic study to date reporting the prevalence of musculoskeletal conditions in these tennis-teaching professionals. Purpose: To investigate the prevalence of musculoskeletal conditions in tennis-teaching professionals following the International Tennis Federation’s (ITF) guidelines for epidemiologic studies. Study Design: Descriptive epidemiology study. Methods: Electronic surveys were distributed to 13,500 American members of the USPTA. The prevalence of musculoskeletal conditions was calculated. Results: A total of 1176 USPTA members completed the survey. Most participants reported teaching more than 5 days per week and more than 2 hours per day. The prevalence of musculoskeletal injury secondary to teaching tennis was 42%. The most affected area was the lower extremities (43% of all injuries) followed by the upper extremities (37%). The most commonly injured structures were muscles or tendons (36% of all injuries) and joints or ligaments (28%). The majority of injuries did not cause participants to miss more than 24 hours of teaching (57%). Conclusion: This is the first epidemiologic study on the occupational risk of musculoskeletal injuries and conditions in tennis-teaching professionals. Tennis-teaching professionals have a significant risk of musculoskeletal injuries or conditions related to their occupation. The prevalence of injury is consistent with previously published studies of injury prevalence among other tennis-playing populations. The proportions of upper and lower extremity injuries were fairly equitable. PMID:27790624

  10. The composition of the microbiota modulates allograft rejection.

    PubMed

    Lei, Yuk Man; Chen, Luqiu; Wang, Ying; Stefka, Andrew T; Molinero, Luciana L; Theriault, Betty; Aquino-Michaels, Keston; Sivan, Ayelet S; Nagler, Cathryn R; Gajewski, Thomas F; Chong, Anita S; Bartman, Caroline; Alegre, Maria-Luisa

    2016-07-01

    Transplantation is the only cure for end-stage organ failure, but without immunosuppression, T cells rapidly reject allografts. While genetic disparities between donor and recipient are major determinants of the kinetics of transplant rejection, little is known about the contribution of environmental factors. Because colonized organs have worse transplant outcome than sterile organs, we tested the influence of host and donor microbiota on skin transplant rejection. Compared with untreated conventional mice, pretreatment of donors and recipients with broad-spectrum antibiotics (Abx) or use of germ-free (GF) donors and recipients resulted in prolonged survival of minor antigen-mismatched skin grafts. Increased graft survival correlated with reduced type I IFN signaling in antigen-presenting cells (APCs) and decreased priming of alloreactive T cells. Colonization of GF mice with fecal material from untreated conventional mice, but not from Abx-pretreated mice, enhanced the ability of APCs to prime alloreactive T cells and accelerated graft rejection, suggesting that alloimmunity is modulated by the composition of microbiota rather than the quantity of bacteria. Abx pretreatment of conventional mice also delayed rejection of major antigen-mismatched skin and MHC class II-mismatched cardiac allografts. This study demonstrates that Abx pretreatment prolongs graft survival, suggesting that targeting microbial constituents is a potential therapeutic strategy for enhancing graft acceptance.

  11. B cells mediate chronic allograft rejection independently of antibody production.

    PubMed

    Zeng, Qiang; Ng, Yue-Harn; Singh, Tripti; Jiang, Ke; Sheriff, Khaleefathullah A; Ippolito, Renee; Zahalka, Salwa; Li, Qi; Randhawa, Parmjeet; Hoffman, Rosemary A; Ramaswami, Balathiripurasundari; Lund, Frances E; Chalasani, Geetha

    2014-03-01

    Chronic rejection is the primary cause of long-term failure of transplanted organs and is often viewed as an antibody-dependent process. Chronic rejection, however, is also observed in mice and humans with no detectable circulating alloantibodies, suggesting that antibody-independent pathways may also contribute to pathogenesis of transplant rejection. Here, we have provided direct evidence that chronic rejection of vascularized heart allografts occurs in the complete absence of antibodies, but requires the presence of B cells. Mice that were deficient for antibodies but not B cells experienced the same chronic allograft vasculopathy (CAV), which is a pathognomonic feature of chronic rejection, as WT mice; however, mice that were deficient for both B cells and antibodies were protected from CAV. B cells contributed to CAV by supporting splenic lymphoid architecture, T cell cytokine production, and infiltration of T cells into graft vessels. In chimeric mice, in which B cells were present but could not present antigen, both T cell responses and CAV were markedly reduced. These findings establis