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In the present study, we studied the effect of apolipoprotein A-1 (APOA1) on the spatial and molecular characteristics of bone marrow adipocytes, using well-characterized ApoA1 knockout mice. APOA1 is a central regulator of high-density lipoprotein cholesterol (HDL-C) metabolism, and thus HDL; our recent work showed that deficiency of APOA1 increases bone marrow adiposity in mice. We found that ApoA1 deficient mice have greatly elevated adipocytes within their bone marrow compared to wild type counterparts. Morphologically, the increased adipocytes were sim-ilar to white adipocytes, and displayed proximal tibial-end localization. Marrow adipocytes from wild type mice were significantly fewer and did not display a bone-end distribution pattern. The mRNA levels of the brown/beige adipocyte-specific markers Ucp1, Dio2, Pat2, and Pgc1a; and the expression of leptin were greatly reduced in the ApoA1 knock-out in comparison to the wild-type mice. In the knock-out mice, adiponectin was remarkably elevated. In keeping with the close ties of hematopoietic stem cells and marrow adipocytes, using flow cytometry we found that the elevated adiposity in the ApoA1 knockout mice is associated with a significant reduction in the compartments of hematopoietic stem cells and common myeloid, but not of the common lymphoid, progenitors. Moreover, the ‘beiging’-related marker osteopontin and the angiogenic factor VEGF were also reduced in the ApoA1 knock-out mice, further supporting the notion that APOA1—and most proba-bly HDL-C—regulate bone marrow microenvironment, favoring beige/brown adipocyte character-istics. © 2022 by the author. Licensee MDPI, Basel, Switzerland.

Aim of the video: In this video, we present the case of a late-detected sinus formation 4 years after a TOT placement. Method: A combined surgical approach (transvaginal and transcutaneous routes) performed by a urogynecologist and an orthopaedic surgeon was chosen to carry out a radical en bloc excision of the sinus tract with the right half of the tape. This combined approach has the advantage of completely removing the biofilm adhered to the surface of the tape and the surrounding tissues, thus making antibiotic therapy more effective. Conclusion: Surgical removal of these microbial commmunities is very important for the resolution of device-related infections. Severe infectious complications of transobturator slings should be managed by a tertiary multidisciplinary team to optimize patient care. © 2019, The International Urogynecological Association.

Purpose: To translate and investigate the reliability and validity of the Greek version of the Functional Mobility Scale (FMS). Methods: FMS was translated into Greek. Test-retest reliability (Cohen’s weighted kappa coefficient, κw) and concurrent validity (Spearman’s rank correlation coefficient, rs) of the Greek version of FMS were assessed in children with Cerebral Palsy (CP). Sixty children (mean age 7.82 ± 3.20 years) were recruited. Physical therapists administered the FMS by interviewing parents about their children’s mobility status. The Gross Motor Function Classification System (GMFCS) was additionally used for testing concurrent validity. Results: The translation of the FMS was deemed easy to understand and administer. The Greek FMS was demonstrated to have almost perfect test-retest reliability (κw =0.98–1.00), and very strong correlation with the GMFCS (–0.85 ≤ rs ≤ −0.89, p < 0.001). Conclusions: The Greek version of the FMS was shown to be a reliable and valid classification system for CP and can be used with confidence by Greek physical therapists.Implications for rehabilitation The FMS provides a very simple and practical outcome measure of functional mobility in children with CP. The use of the reliable and valid Greek FMS will enhance the physical therapy assessment process in the Greek population, by offering the feasibility to detect the motor performance changes in children with CP as they grow or following interventions. The current study renders the Greek FMS available for utilization by physical therapists in order to quantify the independent mobility in children with CP. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Knowing the initial hematocrit of a polytrauma patient can assist his trauma management. This paper describes a four-year study of 88 polytrauma patients. Fifty-nine were transfused, and eight were women (13.5%). The mean cost of the first hospitalization of patients who were transfused was 14,503 €; the mean cost of patients who were not transfused was 5,718 €. HCT did not correlate with ICU stay; nor did days of hospitalization. The mean HCT of those who died was not much different from that of survivors (33.23 with standard deviation [SD] 7.43 versus 32.37 with SD 5.89). This study showed that initial HCT does not correlate with days of hospitalization or days in ICU, but that transfusion can predict higher total cost. © 2020 by Begell House, Inc. www.begellhouse.com.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation. Recently, ultrasonography has been introduced as a promising noninvasive diagnostic alternative. In this study, the authors compared ultrasonography with neurophysiological findings for the diagnosis of CTS in 96 patients/hands with clinical symptoms of CTS. The latency, amplitude, distance, and velocity of the median and ulnar nerves were measured. Needle electromyography was performed in the abductor pollicis brevis, in addition to muscles of the arm and forearm, to exclude proximal median nerve, brachial plexus, or radicular abnormalities. Ultrasonography was based on the morphologic/anatomic changes of the median nerve crosssectional area in the sagittal plane of the wrist at the level of the pisiform bone, the changes of its regional echogenicity, and the identification of coexisting pathologies, such as tenosynovitis, space-occupying lesions, supplementary muscles, and vessels, that may provoke indirectly an increase of the pressure in the carpal tunnel. Eighty-seven (90%) of the 96 patients/hands with clinical symptoms of CTS showed positive findings in both ultrasonography and nerve conduction studies. Six (6%) patients showed positive findings only in nerve conduction studies, and 3 (3%) patients showed positive findings only in ultrasonography; the difference was not statistically significant. The sensitivity and the specificity of nerve conduction studies compared with ultrasonography was 97% and 89% compared with 94% and 55%, respectively. A positive correlation and proportional increase of the ultrasonography measurements compared with the increase of the nerve conduction studies severity was observed. Copyright © SLACK Incorporated.

Soft tissue sarcomas (STS) are rare tumors; they do not even equate to 1% of all malignant tumor cases. One-fifth of all STS occur in the upper extremities, where epithelioid sarcoma, synovial sarcoma, clear cell sarcoma and malignant fibrohistiocytoma are the most frequent subtypes. Surgical resection is the cornerstone of treatment. However, accomplishment of optimal oncological and functional results of STS of the upper extremities may represent a challenge for hand surgeons, due to the complex anatomy. In several cases, preoperative therapies are needed to facilitate tumor resection and improve the oncological outcome. Oligometastatic disease may also be a challenging scenario as curative strategies can be applied. Radiotherapy and chemotherapy are commonly used for this purpose albeit with conflicting evidence. Novel drug combinations have also been approved in the metastatic setting, further improving the quality of life and survival of eligible patients. Thus, prior to any approach, every case should be individually discussed in sarcoma centers with specialized multidisciplinary tumor boards. The aim of the present review was to gather the multidisciplinary experiences of the available therapeutic strategies for STS of the upper extremities. © 2019, Spandidos Publications. All rights reserved.

Trauma is a multifactor problem with economic, social, and political burdens. In this article, we estimate its economic extension. This 3-yr study includes 69 patients above 14 yr of age, who experienced multiple traumatic injuries. We review their economic impact on the National Health System of Greece. Mean patient age is 38.91 yr, and most are male (85.5%), nonsmoking (69.6%), and without open fractures (78.3%). As a result of their injuries, most patients (76.8%) stayed in the intensive care unit (ICU), underwent surgery (76.8%), were transfused (68.1%), and became infected (63.8%). Mean cost was 16,365.65€, median cost 10,399.07€, minimum value 554.17€, and maximum value 89,243.52€. Of the 69 patients, 12 died. The number of polytrauma patients is relatively small compared to the total amount of patients in hospital care, but their impact on health services is very high. Patients admitted to the ICU are at great risk of infection, which can almost triple financial cost and increase hospital stay. © 2019 by Begell House, Inc.

Background: Selective Percutaneous Myofascial Lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. Objective: This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. Methods: Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. Results: A significant improvement of Global GGDI was found (p

Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. Ultrasound imaging techniques display a plethora of advantages that have pervaded regional anesthesia practice. In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed. © 2019 EDIZIONI MINERVA MEDICA

During the past few years, considerable evidence has uncovered a strong relationship between fat and bone metabolism. Consequently, alterations in plasma lipid metabolic pathways strongly affect bone mass and quality. We recently showed that the deficiency of apolipoprotein A-1 (APOA1), a central regulator of high-density lipoprotein cholesterol (HDL-C) metabolism, results in reduced bone mass in C57BL/6 mice. It is documented that apolipoprotein E (APOE), a lipoprotein know for its atheroprotective functions and de novo biogenesis of HDL-C, is associated with the accumulation of fat in the liver and other organs and regulates bone mass in mice. We further studied the mechanism of APOE in bone metabolism using well-characterized APOE knockout mice. We found that bone mass was remarkably reduced in APOE deficient mice fed Western-type diet (WTD) compared to wild type counterparts. Static (microCT-based) and dynamic histomorphometry showed that the reduced bone mass in APOΕ− / − mice is attributed to both decreased osteoblastic bone synthesis and elevated osteoclastic bone resorption. Interestingly, histologic analysis of femoral sections revealed a significant reduction in the number of bone marrow lipoblasts in APOΕ− / − compared to wild type mice under WTD. Analyses of whole bone marrow cells obtained from femora of both animal groups showed that APOE null mice had significantly reduced levels of the osteoblastic (RUNX2 and Osterix) and lipoblastic (PPARγ and CEBPα) cardinal regulators. Additionally, the modulators of bone remodeling RANK, RANKL, and cathepsin K were greatly increased, while OPG and the OPG/RANKL ratio were remarkably decreased in APOΕ− / − mice fed WTD, compared to their wild-type counterparts. These findings suggest that APOE deficiency challenged with WTD reduces osteoblastic and lipoblastic differentiation and activity, whereas it enhances osteoclastic function, ultimately resulting in reduced bone mass, in mice. © 2018, United States & Canadian Academy of Pathology.

Tumors of the hand comprise a vast array of lesions involving skin, soft tissue and bone. The majority of tumors in the hand are benign. Malignant tumors, although rare, do occur and frequently have unique characteristics in this specific anatomic location. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. However, straightforward most of the time, hand tumor management does have pitfalls; caution is advised, as a missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences. This article reviews the clinical spectrum of the most common benign and malignant bone and soft tissue tumors of the hand and discusses the clinicopathological findings, imaging features and current concepts in treatment for these tumors. © 2017, Springer-Verlag France.

Pseudomonas oryzihabitans is a saprophytic gram-negative microorganism usually found in damp environments, only occasionally responsible for human pathology. Infection mainly occurs in malnourished, immunocompromised individuals with indwelling catheters. There is no previous published record of infection after joint arthroplasty. To enhance the literature, in this article we report a patient with a Pseudomonas oryzihabitans infected total hip arthroplasty, and discuss the diagnosis and management of this unusual infection. © 2016 Georgios N. Panagopoulos et al.

Objective: The purpose of this study was to present the functional outcomes of percutaneous tenorrhaphy of the Achilles tendon with a minimum follow-up of 10 years. Methods: The medical records of patients who underwent percutaneous surgery for acute unilateral Achilles tendon rupture between 2000 and 2004 were retrospectively reviewed. Results: A total of 11 male patients met the inclusion criteria and were followed for a mean of 12.6 years (range: 10-13 years). The average age at the time of surgery was 39.3 years (range: 29-53 years). Patients returned to work at an average of 2.7 months (range: 1-4 months) after surgery and to normal daily activities (NDA) at an average of 4.1 months (range: 3-6 months) postoperatively. The mean strength ratio between the injured and normal sides was 90%. Compared with the contralateral normal side, the thickness of the operated tendon increased by a mean of 0.7 cm, while the circumference of the affected calf diminished by a mean of 1.1 cm. No difference in active and passive range of motion (ROM) was recorded between the affected and the contralateral normal ankle joints. Isometric plantar flexion was 87% of normal. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after surgery. The sensory defect had completely resolved by 6 months postoperatively. Conclusion: Long-term outcomes of our series support the effectiveness of percutaneous tenorrhaphy in Achilles function rehabilitation of patients with acute ruptures. © 2015 Turkish Association of Orthopaedics and Traumatology.

Paget's disease of bone is a focal skeletal disorder characterized by the formation of structurally abnormal bone, skeletal deformities, and other complications leading to bone pain and significant disability. It can involve one or more areas in a single bone (monostotic) or multiple bones (polyostotic). Most of the time the disease is asymptomatic and the diagnosis is made incidentally by increased levels of bone metabolism markers, especially alkaline phosphatase and is confirmed by specific findings in radiographs and radionuclide bone scan. In this report, we describe the case of a 65-year-old female with clinical and radiological findings of active Paget's disease of bone, but with absence of abnormal biochemical markers. The patient was given a dose of 5 mg zoledronic acid intravenously with significant clinical improvement within the next 6 months. The present case not only shows that Paget's disease of bone can occur in the setting of normal markers of bone metabolism but also that, in such cases, the response to treatment can be monitored by improvement in the clinical picture or by correct evaluation of the imaging findings. Clin Rheumatol

Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction. Int Orthop

INTRODUCTION: The accumulated knowledge of erythropoietin (EPO) interaction in neural injury has led to potentially novel therapeutic strategies. Previous experimental studies of recombinant human EPO (rhEPO) administration have shown favorable results after central and peripheral neural injury. In the present study we used the aneurysmal clip model to evaluate the efficacy of two different regimes of rhEPO administration on the functional outcome after severe acute spinal cord injury (ASCI). MATERIALS AND METHODS: Thirty rats were operated on with posterior laminectomy at thoracic 10th vertebra. Spinal cord trauma produced by extradural placement of the aneurysm clip, for 1 min. Animals were divided into three groups; the first group received a low total EPO dose (EPO-L), (2 doses of 1,000 IU each s.c.). The second group was administered the high total EPO dose (EPO-H), (14 doses of 1,000 IU each s.c.), and the third was the Control group, which received normal saline in the same time fashion with EPO-H group. Follow-up was for 6 weeks. Estimation of the functional progress of each rat was calculated using the locomotor rating scale of Basso et al, with a range from 0 to 21. RESULTS: After surgery the animals suffered paraplegia with urinary disturbances. Rats that received EPO demonstrated statistically significant functional improvement compared to the Control group, throughout study interval. On the last follow-up at 6 weeks the EPO-L rats achieved a mean score 17.3 +/- 1.15, the EPO-H 14.7 +/- 1.82, and the control group 8.2 +/- 0.78. Comparison between the two EPO groups reveals superior final outcome of the group treated with lower total dose. CONCLUSION: Our study supports current knowledge, that EPO administration has a positive effect on functional recovery after experimental ASCI. These data reflect the positive impact of EPO on the pathophysiologic cascade of secondary neural damage. However, we observed a dose-related effect on functional recovery. Interestingly, large doses do not seem to favor the neurological recovery as lower doses do. Arch Orthop Trauma Surg

We present a case of a 34-year-old white female patient who, 13 years ago, sustained a pathological intracapsular femoral neck fracture on a pre-existing aneurysmal bone cyst. Three months later radiographic and magnetic resonance imaging evaluation revealed both femoral neck fracture and stage IV osteonecrosis of the femoral head according to Steinberg classification system. Management was accomplished with combined free vascularized fibular grafting and internal osteosynthesis with a 130 degrees blade plate. Union was achieved in 7 months. Progression of osteonecrosis was arrested. Hip salvage and a satisfactory subjective and clinical outcome were achieved. At the last follow-up, 13 years postoperatively, the patient had satisfactory functional outcome. Microsurgery

Carpal tunnel syndrome (CTS) is a well-known clinical entity. Release of the transverse carpal ligament is considered to be the treatment of choice. Both open and endoscopic release of the transverse carpal ligament in CTS has yielded satisfactory results. Although these procedures are very common in surgical practice, inadequate release and intraoperative damage to neural elements are very frustrating complication for both the patient and the surgeon. The purpose of this study was to demonstrate incidental intraoperative findings of variations of the standard median nerve anatomy. We obtained incidental intraoperative identification of median nerve variations in 110 consecutive patients operated with open release of the transverse carpal ligament in CTS. Using the Amadio classification, we found intraoperatively variations of median nerve at the wrist in 11 patients. In three patients, there was an aberrant sensory branch arising from the ulnar side of the median nerve and piercing the ulnar margin of the transverse carpal ligament. Neural variations arising from the ulnar aspect of the median nerve were common and could be a cause of iatrogenic injury during endoscopic or open release. Surgeons should be aware of anomalous branches, which should be recognized and separately decompressed if needed. Clin Anat

A 22-year-old woman presented with pain on the dorsum of her left big toe. The patient had had an accident 1 year previously, when a heavy object fell on her left big toe. She experienced no pain in the hallux before the injury. Radiographic evaluation revealed a well-circumscribed osseous mass, in close relationship to the underlying dorsal cortex of the proximal phalanx. A 2 x 1.5 x 0.7 cm mass was resected. No communication was found between the undersurface of the bony mass and the medullar space of the phalanx. The histology report confirmed diagnosis of acquired osteochondroma. Removal of the bony mass resulted in disappearance of symptoms without any sign of recurrence 10 months later. J Foot Ankle Surg

The aim of the present study is to evaluate the effects of erythropoietin to the collateral sprouting by using systemically delivered erythropoietin in an end-to-side nerve repair model. Forty-five rats were evaluated in four groups: (A) end-to-side neurorrhaphy only, (B) end-to-side neurorrhaphy and erythropoietin administration, (C) end-to-end neurorrhaphy and (D) nerve stumps buried into neighboring muscles. In all animals, the contralateral healthy side served as control. Functional assessment of nerve regeneration was performed at intervals up to 5 months using the Peroneal Function Index. Evaluation 150 days after surgery included peroneal and tibial nerve morphometric examination, and wet weights of the tibialis anterior muscle. During the first three weeks after surgery, when erythropoietin was regularly administered, functional evaluation showed that erythropoietin may facilitate peripheral nerve regeneration. However, there was rapid deterioration in the functional recovery when erythropoietin's administration was discontinued. As a consequence, at the end of this study, erythropoietin failed to maintain its initial stimulating effect in axonal regeneration. The results of wet muscle weights revealed statistically significant differences between Groups A and C, and Group B. Furthermore, data on axonal counting showed significant difference between Groups A and C, and Group B. Erythropoietin appears to facilitate peripheral nerve regeneration at the initial phase of its administration. Further investigation will be necessary to optimise the conditions (dose, mode of administration) in order to maintain its effects. J Neurosci Methods

Femoral neck fractures, frequently complicated by non-union and femoral head osteonecrosis,present a difficult clinical situation, especially when young patients are concerned. Existing treatment options are valgus osteotomy to address the biomechanical factors or bone grafting to address the biologic factor. The authors describe the operative technique and results of combined subtrochanteric valgus osteotomy and free vascularized fibular grafting in management of five young patients with both non-union and avascular necrosis. Orthop Clin North Am