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After the publication of the original article, the authors noticed an error in the departmental affiliation of one of the contributors, Don MASCARENHAS. The corrected version of the department is provided below, and the original article has been updated accordingly. Archana BHAT < sup > 1 < /sup > , Manjunath J < sup > 1 < /sup > , Don MASCARENHAS < sup > 2 < /sup > < br / > Department of < sup > 1 < /sup > Pathology and < sup > 2 < /sup > Pulmonology, Father Muller Medical College, MANGALORE, INDIA.
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Actinomicosis , Neoplasias Pulmonares , Metaplasia , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Actinomicosis/diagnóstico , Actinomicosis/patología , Actinomicosis/microbiología , Diagnóstico Diferencial , Masculino , Bronquiectasia/diagnóstico , Bronquiectasia/microbiología , Bronquiectasia/patología , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/patologíaRESUMEN
Skeletal disorders encompass a wide array of conditions, many of which are associated with short stature. Among these, Desbuquois dysplasia is a rare but severe condition characterized by profound dwarfism, distinct facial features, joint hypermobility with multiple dislocations, and unique vertebral and metaphyseal anomalies. Desbuquois dysplasia is inherited in an autosomal recessive manner, with both the DBQD1 (MIM 251450) and DBQD2 (MIM 615777) forms resulting from biallelic mutations. Specifically, DBQD1 is associated with homozygous or compound heterozygous mutations in the CANT1 gene, while DBQD2 can result from mutations in either the CANT1 or XYLT1 genes. This review synthesizes the findings of 111 published case reports, including 54 cases of DBQD1, 39 cases of DBQD2, and 14 cases of the Kim variant (DDKV). Patients in this cohort had a median birth weight of 2505 g, a median length of 40 cm, and a median occipitofrontal circumference of 33 cm. The review highlights the phenotypic variations across Desbuquois dysplasia subtypes, particularly in facial characteristics, joint dislocations, and bone deformities. Genetic analyses revealed a considerable diversity in mutations, with over 35% of cases involving missense mutations, primarily affecting the CANT1 gene. Additionally, approximately 60% of patients had a history of parental consanguinity, indicating a potential genetic predisposition in certain populations. The identified mutations included deletions, insertions, and nucleotide substitutions, many of which resulted in premature stop codons and the production of truncated, likely nonfunctional proteins. These findings underscore the genetic and clinical complexity of Desbuquois dysplasia, highlighting the importance of early diagnosis and the potential for personalized therapeutic approaches. Continued research is essential to uncover the underlying mechanisms of this disorder and improve outcomes for affected individuals through targeted treatments.
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Enanismo , Mutación , Humanos , Enanismo/genética , Fenotipo , Inestabilidad de la Articulación/genética , Luxaciones Articulares/genética , Luxaciones Articulares/patología , Hidrolasas/genética , Femenino , Osteocondrodisplasias/genética , Osteocondrodisplasias/patología , Masculino , Nucleotidasas , Osificación Heterotópica , Polidactilia , Anomalías CraneofacialesRESUMEN
CASE: A 30-year-old man with a history of advanced HIV disease (AHD) presented with bilateral equinocavus, leg, and foot muscle paresis, Brooker grade 4 heterotopic ossification of hips and knee stiffness, and was unable to sit upright, stand independently, or walk. Electromyography showed demyelinating sensorimotor and axonal polyneuropathy of lower extremities. Multiple surgeries of bilateral hips, ankles, and feet enabled joint mobility, plantigrade feet, and independent ambulation. CONCLUSION: Patients with AHD may develop multijoint pathologies, secondary to HIV, antiretroviral therapy, or prolonged immobility, resulting in loss of ambulation and independence. Restoring ambulation may necessitate multiple surgeries, with potential for success.
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Infecciones por VIH , Humanos , Masculino , Adulto , Infecciones por VIH/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Osificación Heterotópica/etiologíaRESUMEN
BACKGROUND Eagle syndrome is an uncommon medical illness that can manifest as neck pain in primary care. It results from an abnormally unilateral or bilateral long styloid process that may compress and affect adjacent structures, which leads to the symptoms. Classical Eagle syndrome has been commonly reported, but this case highlights the uncommon involvement of autonomic nerve dysfunction. CASE REPORT This case report details a 43-year-old woman with chronic neck pain for 5 years who saw numerous medical professionals and underwent 8 physiotherapy sessions. Marginal improvement of her neck pain and recent development of imbalance and a floating sensation prompted escalation of radiological imaging that eventually led to the diagnosis of Eagle syndrome. She was subsequently subjected to tonsillectomy and styloidectomy to address the sources of her neck pain. CONCLUSIONS Neck pain is a common complaint in primary care, but Eagle syndrome is often overlooked due to its complex symptoms, which mimic other conditions resulting in missed diagnoses and prolonged diagnostic evaluations. To improve patient care and outcomes, primary care physicians should consider Eagle syndrome when evaluating neck pain. This involves taking a detailed clinical history, conducting a thorough physical examination, using appropriate imaging techniques, and knowing the treatment options. By considering this potential diagnosis, primary care physicians, other healthcare professionals, and physical therapists play an important role in referring these patients to an otorhinolaryngologist or a maxillofacial surgeon for a comprehensive evaluation and management.
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Dolor Crónico , Dolor de Cuello , Osificación Heterotópica , Hueso Temporal , Humanos , Femenino , Adulto , Dolor de Cuello/etiología , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Hueso Temporal/anomalías , Hueso Temporal/diagnóstico por imagen , Dolor Crónico/etiología , Atención Primaria de SaludRESUMEN
When a genetic disease is characterized by the abnormal activation of normal molecular pathways and cellular events, it is illuminating to critically examine the places and times of these activities both in health and disease. Therefore, because heterotopic ossification (HO) in fibrodysplasia ossificans progressiva (FOP) is by far the disease's most prominent symptom, attention is also directed toward the pathways and processes of bone formation during skeletal development. FOP is recognizable by effects of the causative mutation on skeletal development even before HO manifests, specifically in the malformation of the great toes. This signature skeletal phenotype is the most highly penetrant, but is only one among several skeletal abnormalities associated with FOP. Patients may present clinically with joint malformation and ankylosis, particularly in the cervical spine and costovertebral joints, as well as characteristic facial features and a litany of less common, non-skeletal symptoms, all stemming from missense mutations in the ACVR1 gene. In the same way that studying the genetic cause of HO advanced our understanding of HO initiation and progression, insight into the roles of ACVR1 signaling during tissue development, particularly in the musculoskeletal system, can be gained from examining altered skeletal development in individuals with FOP. This review will detail what is known about the molecular mechanisms of developmental phenotypes in FOP and the early role of ACVR1 in skeletal patterning and growth, as well as highlight how better understanding these processes may serve to advance patient care, assessments of patient outcomes, and the fields of bone and joint biology.
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Miositis Osificante , Osificación Heterotópica , Miositis Osificante/genética , Miositis Osificante/metabolismo , Miositis Osificante/patología , Humanos , Osificación Heterotópica/genética , Osificación Heterotópica/metabolismo , Osificación Heterotópica/patología , Animales , Receptores de Activinas Tipo I/genética , Receptores de Activinas Tipo I/metabolismo , Dedos del Pie/anomalíasRESUMEN
Heterotopic ossification (HO), characterized by the formation of ectopic bone, is a benign mass observed in soft tissues. Depending on its location, it can cause symptoms beyond compression, such as mechanical blockage when associated with joints, leading to limitations in joint movements. In the majority of cases, involvement of the hip and elbow joints is common, while HO can sometimes be observed in atypical locations. Trauma, head injury, and spinal cord injuries are well-recognized risk factors for HO development. However, on rare occasions, in non-traumatic cases are identified without any known risk factors. Herein, we present a rare non-traumatic HO case associated with the flexor hallucis longus (FHL) tendon in a 58-year-old female patient. She complained of pain under the first toe of her right foot while wearing shoes for a year, and a mass was detected on the plantar surface of the foot along with limitation of movement in the first metatarsophalangeal joint. Further examinations revealed that the identified mass was a mature HO lesion. Surgical treatment was performed, and during one-year follow-up, the pain subsided, and joint movements returned to normal, resulting in a satisfactory outcome. In conclusion, although many cases of HO are associated with traumatic injuries, it can sometimes be idiopathic, as in our case, and rarely it is accompanied tendon such as FHL in the foot.
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Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/patología , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/diagnóstico , Femenino , Persona de Mediana Edad , Tendones/patología , Resultado del Tratamiento , Articulación Metatarsofalángica/patología , Articulación Metatarsofalángica/lesiones , Articulación Metatarsofalángica/diagnóstico por imagen , Imagen por Resonancia MagnéticaAsunto(s)
Ligamento Amarillo , Osificación Heterotópica , Humanos , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/patología , Ligamento Amarillo/diagnóstico por imagen , Ligamento Amarillo/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Femenino , MasculinoRESUMEN
BACKGROUND Long-term clinical practice has suggested a possible association between ossification of cervical ligament (OCL) and primary osteoporosis (POP). However, there is a lack of relevant research data. This study aimed to clarify the potential relationship between OCL and POP, and propose new strategies for preventing the onset of POP. MATERIAL AND METHODS The study involved 107 patients. The patients' diagnosis included OCL (ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and ossification of the nuchal ligament) and POP. Bone mineral density (BMD), types of OCL, types of ossification of posterior longitudinal ligament, age, sex, serum calcium, serum phosphorus, alkaline phosphatase, type I collagen amino-terminal extension peptide, type I collagen degradation products, osteocalcin N-terminal molecular fragments, 25-hydroxyvitamin D, and history of taking steroid drugs were collected. SPSS24.0 and GraphPad Prism 8 were used to obtain the risk factors for POP. RESULTS One-way analysis of variance found that OCL, ossification of posterior longitudinal ligament, alkaline phosphatase, and osteocalcin N-terminal molecular fragments had statistical significance on BMD of the femoral neck (P<0.05). The independent sample t test showed that patient sex had statistical significant effect on BMD (femoral neck) (P=0.036). Incorporating the above factors into multiple linear regression analysis, it was found that OCL, alkaline phosphatase, and osteocalcin N-terminal molecular fragments were risk factors affecting BMD of femoral neck (P<0.05). CONCLUSIONS OCL, osteocalcin N-terminal molecular fragments, and alkaline phosphatase are risk factors for POP.
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Fosfatasa Alcalina , Densidad Ósea , Osificación del Ligamento Longitudinal Posterior , Osteocalcina , Osteoporosis , Humanos , Femenino , Masculino , Factores de Riesgo , Persona de Mediana Edad , Fosfatasa Alcalina/sangre , Fosfatasa Alcalina/metabolismo , Anciano , Osteocalcina/metabolismo , Osteocalcina/sangre , Adulto , Osificación Heterotópica , Vitamina D/análogos & derivados , Vitamina D/metabolismo , Vitamina D/sangre , Ligamentos , Cuello Femoral/metabolismo , Vértebras CervicalesRESUMEN
BACKGROUND: The foramen transversarium is a vital anatomical structure found in the cervical vertebrae of the spine. Typically, it serves as a passageway for important neurovascular structures, including the vertebral artery and vein, as well as the vertebral nerve. However, abnormal calcification or ossification of soft tissues in and around this area can lead to various clinical implications. Understanding the presence and implications of abnormal ossified structures in and around the foramen transversarium is crucial for clinicians involved in the diagnosis and management of cervical spine disorders. AIMS: Accordingly, this present study was designed to evaluate the abnormal ossified structures anatomically and radiologically within and around the foramen transversarium. MATERIALS AND METHODS: This study was conducted on 182 (26 sets of cervical vertebrae) dried human cervical vertebrae obtained from the respective departments of anatomy and on 190 (95 males and 95 females) adult patients who visited the radiology department for neck-related problems such as stiff neck, neck/shoulder pain, dizziness, vertigo, imbalance, visual disturbances, and cognitive impairment. RESULTS: Among 182 examined cervical vertebrae, unilateral complete accessory foramen transversarium was found in 23 vertebrae (12.63%), bilateral complete in 19 (10.44%), bilateral incomplete in 6 (3.29%), unilateral complete double in 4 (2.19%), and unilateral complete absence of foramen transversarium in 3 (1.64%). Stenosis due to aberrant osteophytes was noted in 9 vertebrae (4.9%). Out of 190 patients, three males presented with cervical kyphosis, severe spinal canal stenosis, and spinal cord compression due to ossification of the posterior longitudinal ligament and osteophyte complexes at C3-C6, with the most significant compression at C5-C6. CONCLUSION: A thorough understanding of abnormal ossifications in and around the foramen transversarium is crucial for the management of cervical spine disorders; imaging modalities such as X-ray, computed tomography, and magnetic resonance imaging are crucial for recognizing and intervening in these cases, which is essential to prevent adverse neurological outcomes associated with vertebral artery involvement.
Résumé Contexte:Le foramen transversarium est une structure anatomique vitale trouvée dans les vertèbres cervicales de la colonne vertébrale. Généralement, il sert de passage pour d'importantes structures neurovasculaires, notamment l'artère et la veine vertébrale, ainsi que le nerf vertébral. Cependant, anormal la calcification ou l'ossification des tissus mous dans et autour de cette zone peut entraîner diverses implications cliniques. Comprendre la présence et Les implications des structures ossifiées anormales dans et autour du foramen transversarium sont cruciales pour les cliniciens impliqués dans le diagnostic et prise en charge des troubles de la colonne cervicale.Objectifs:En conséquence, cette présente étude a été conçue pour évaluer les structures ossifiées anormales anatomiquement et radiologiquement à l'intérieur et autour du foramen transversarium.Matériels et méthodes:Cette étude a été menée sur 182 (26 ensembles de vertèbres cervicales) vertèbres cervicales humaines séchées obtenues auprès des départements d'anatomie respectifs et sur 190 (95 hommes et 95 femmes) patients adultes qui ont consulté le service de radiologie pour des problèmes liés au cou tels qu'une raideur de la nuque, des douleurs au cou/à l'épaule, des étourdissements, vertiges, déséquilibre, troubles visuels et troubles cognitifs.Résultats:Parmi 182 vertèbres cervicales examinées, unilatérales completes un foramen transversarium accessoire a été trouvé dans 23 vertèbres (12,63%), bilatéral complet dans 19 (10,44%), bilatéral incomplet dans 6 (3,29%), double complet unilatéral chez 4 (2,19 %) et absence complète unilatérale de foramen transversarium chez 3 (1,64 %). Sténose due à une aberration des ostéophytes ont été notés dans 9 vertèbres (4,9 %). Sur 190 patients, trois hommes présentaient une cyphose cervicale, une sténose sévère du canal rachidien, et compression de la moelle épinière due à l'ossification du ligament longitudinal postérieur et des complexes ostéophytes en C3C6, le plus compression importante en C5C6.Conclusion:Une compréhension approfondie des ossifications anormales dans et autour du foramen transversarium est crucial pour la gestion des troubles de la colonne cervicale; modalités d'imagerie telles que les rayons X, la tomodensitométrie et la résonance magnétique l'imagerie est cruciale pour reconnaître et intervenir dans ces cas, ce qui est essentiel pour prévenir les conséquences neurologiques indésirables associées avec atteinte de l'artère vertébrale.
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Vértebras Cervicales , Humanos , Masculino , Femenino , Vértebras Cervicales/diagnóstico por imagen , Adulto , Persona de Mediana Edad , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Anciano , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/etiología , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/patología , RadiografíaRESUMEN
CASE: A 27-year-old man sustained chemical burns affecting 54% of his body caused by steam and acetic acid at a dyeing factory. He developed restricted bilateral elbow and shoulder motion because of heterotopic ossification (HO) beginning 3 months after the incident. The skin healed within 1 year, but ankylosis developed because of progressing ossification. We performed HO surgical excision in 4 stages. Two years after the final surgery, the function of both upper extremities had recovered. CONCLUSION: For HO caused by severe burns, improvement in upper extremity function can be achieved even if surgery is performed after skin healing.
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Articulación del Codo , Osificación Heterotópica , Articulación del Hombro , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Masculino , Adulto , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Quemaduras Químicas/cirugía , Quemaduras Químicas/complicacionesRESUMEN
Background: The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Methods: Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. Results: A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). Conclusions: In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.
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Artroscopía , Imagenología Tridimensional , Lesiones del Manguito de los Rotadores , Tomografía Computarizada por Rayos X , Humanos , Artroscopía/métodos , Femenino , Masculino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Anciano , Estudios Retrospectivos , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Manguito de los Rotadores/cirugía , Manguito de los Rotadores/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/cirugía , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , AdultoRESUMEN
Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.
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Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Nervio Cubital/cirugía , Resultado del Tratamiento , Dimensión del Dolor , AncianoRESUMEN
PURPOSE: We aim to analyse and compare the efficacy of the excision of HO around the hip with and without CT-guided navigation. We also aim to compare the functional outcome between CT navigation guided versus conventional excision of HO. PATIENTS AND METHODS: This study is a retrospective analysis of prospectively collected data from 2015 to 2022. There were 23 patients (24 hips) in the final cohort. Intraoperative CT navigation guided excision was performed in 7 hips and conventional excision of HO was done in 17 hips. The HO was classified by Brooker's grading in radiographs. CT scan was taken preoperatively in all patients to exactly identify the volume, location and preoperative planning. The functional outcome was analysed according to Harris Hip Score (HHS) and International Hip Outcome Tool (iHOT) for self-ambulatory patients and improvement in the sitting or nursing care was assessed in patients mobilising with wheelchair or walker support. Any complications or recurrence noted postoperatively and in follow-up were recorded. RESULTS: The mean follow-up was 41.2 months in the CT navigation-guided excision group and 55 months in the conventional excision group. According to Brooker's grading, grade IV was present in 20 hips and grade III in four hips. Twelve patients were self-ambulatory and the other 12 patients were requiring support for mobilisation. There was a significant improvement in the HHS from 21.3 ± 3.7, 18.3 ± 2.5 preoperatively to 75.2 ± 8.3, 72.2 ± 4.3 postoperatively in the CT navigation guided and conventional group respectively (p < 0.001) in the self-ambulatory group. There was one anterior wall and one partial posterior wall fracture in the conventional group. One patient in the conventional group had a deep infection and recurrence. One patient had a superficial infection and another had superficial vein thrombosis in the CT guided excision group. CONCLUSION: Intraoperative CT navigation helps to exactly localize the HO and facilitates safe excision. Functional excision of the HO leads to better nursing care and functional outcomes between both groups.
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Osificación Heterotópica , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Adulto , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Resultado del Tratamiento , AncianoRESUMEN
Unveiling of the mechanism involved in the occurrence and development of trauma-induced heterotopic ossification (tHO) is highly demanding due to current ineffective clinical treatment for it. Previous studies proposed that hydrogen sulfide (H2S) was vital for fate determination of stem cells, suggesting a potential role in the regulation of tHO development. In the current study, We found that expression of metabolic enzyme within sulfur conversion pathway was enhanced after tendon injury, leading to H2S accumulation within the tHO region. Increased production of endogenous H2S was shown to promote aberrant osteogenic activity of tendon-derived stem cells (TDSCs), which accelerated tHO formation. The inhibition of metabolic enzyme of H2S production or directly absorption of H2S could abolished osteogenic induction of TDSCs and the formation of tHO. Mechanistically, through RNA sequencing combined with rescue experiments, we demonstrated that activation of Ca2+/ERK pathway was the downstream molecular event of H2S-induced osteogenic commitment of TDSCs and tHO. For treatment strategy exploration, zine oxide nanoparticles (ZnO) as an effective H2S elimination material was validated to ideally halt the tHO formation in this study. Furthermore, in terms of chirality of nanoparticles, D-ZnO or L-ZnO nanoparticles showed superiority over R-ZnO nanoparticles in both clearing of H2S and inhibition of tHO. Our study not only revealed the mechanism of tHO through the endogenous gas signaling event from a new perspective, but also presented a applicable platform for elimination of the inordinate gas production, thus aiding the development of clinical treatment for tHO.
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Sulfuro de Hidrógeno , Sistema de Señalización de MAP Quinasas , Osificación Heterotópica , Osteogénesis , Sulfuro de Hidrógeno/metabolismo , Sulfuro de Hidrógeno/farmacología , Osificación Heterotópica/metabolismo , Osificación Heterotópica/patología , Osteogénesis/efectos de los fármacos , Animales , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Calcio/metabolismo , Masculino , Células Madre/metabolismo , Células Madre/citología , Diferenciación Celular/efectos de los fármacos , Óxido de Zinc/química , Óxido de Zinc/farmacología , Ratas , Tendones/metabolismo , Tendones/patología , Humanos , Traumatismos de los Tendones/metabolismo , Traumatismos de los Tendones/patología , Nanopartículas/química , Heridas y Lesiones/metabolismo , Heridas y Lesiones/patología , Heridas y Lesiones/complicacionesRESUMEN
Background: Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies. Methodology: We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO. Results: In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2-22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9-21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1-2.0]; p = 0.016). Conclusions: Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.
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Osificación Heterotópica , Hueso Temporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/cirugía , Osificación Heterotópica/terapia , Osificación Heterotópica/epidemiología , Fenotipo , Hueso Temporal/anomalías , Hueso Temporal/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF. METHODS: Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching. RESULTS: In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P < 0.001). In both T-OPLL and T-OLF, the occurrence of perioperative complications led to longer hospital stay and higher medical costs. While fewer patients in T-OPLL were discharged home (51.6% vs. 65.1%, P < 0.001), patients were transferred to other hospitals more frequently (47.5% vs. 33.5%, P = 0.001). CONCLUSION: This research identified the perioperative complications of T-OPLL and T-OLF in PDF using a large national database, which revealed that the incidence of local complications was higher in the T-OPLL patients. Perioperative complications resulted in longer hospital stays and higher medical costs.
Asunto(s)
Bases de Datos Factuales , Descompresión Quirúrgica , Ligamento Amarillo , Osificación del Ligamento Longitudinal Posterior , Complicaciones Posoperatorias , Fusión Vertebral , Vértebras Torácicas , Humanos , Masculino , Femenino , Vértebras Torácicas/cirugía , Ligamento Amarillo/cirugía , Fusión Vertebral/economía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Persona de Mediana Edad , Descompresión Quirúrgica/economía , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Anciano , Osificación del Ligamento Longitudinal Posterior/cirugía , Osificación del Ligamento Longitudinal Posterior/economía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/economía , Japón/epidemiología , Osificación Heterotópica/cirugía , Osificación Heterotópica/economía , Osificación Heterotópica/epidemiología , Tiempo de Internación/economía , Reoperación/economía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Pacientes Internos , Resultado del TratamientoRESUMEN
PURPOSE: (1) To determine the prevalence, magnitude and distribution pattern of acetabular rim ossification in patients with femoroacetabular impingement syndrome (FAIS) and (2) to determine the association between acetabular rim ossification and rotational abnormalities of the hip. METHODS: Patients underwent hip arthroscopic surgery for FAIS at our institute between January 2021 and May 2022 were retrospectively reviewed. Patients were included if preoperative computed tomography (CT) images of the operated hip and ipsilateral distal femur were available for the measurement of femoral and acetabular anteversion. The presence and size of acetabular rim ossification were evaluated on coronal CT sections for the superior half of the acetabulum on each clockface location. The associations between acetabular rim ossification and radiographic parameters of hip rotational morphology were examined. RESULTS: A total of 214 hips were included. Acetabular rim ossification was found in 167 hips (78%) and the most common locations were 10 and 11 o'clock. Patients presenting with acetabular rim ossification had a mean size of 4.6 ± 1.6 mm. It was the largest at 9 o'clock position (4.9 ± 2.2 mm), with a decreasing trend in size from posterior to anterior. Logistics regression analysis found age was associated with the occurrence of posterior ossification (p = 0.002). Linear regression analysis found age (p = 0.049) and male sex (p < 0.001) were significantly correlated with the size of ossification. Patients with increased cranial combined anteversion had larger posterior ossification than patients with normal and decreased cranial combined anteversion (4.2 ± 2.9 vs. 3.1 ± 2.5 mm, p = 0.016; 4.2 ± 2.9 vs. 2.5 ± 2.4 mm, p = 0.005). CONCLUSION: Increased combined anteversion is associated with greater posterior acetabular rim ossification. The presence and size of acetabular rim ossification are positively associated with older age and male sex. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Acetábulo , Artroscopía , Pinzamiento Femoroacetabular , Tomografía Computarizada por Rayos X , Humanos , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/cirugía , Masculino , Femenino , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Anteversión Ósea/diagnóstico por imagen , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Adulto JovenRESUMEN
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.