Comparison of Clinical Performance of Inlay versus Onlay Humerus Implants in Reverse Total Shoulder Arthroplasty

Background@#Reverse total shoulder arthroplasty (RTSA) has become the treatment of choice for the management of massive rotator cuff tears combined with cuff tear arthropathy, and many novel designs have been proposed to overcome the shortcomings of classic RTSA. This study sought to evaluate and compare RTSA outcomes among patients with cuff tear arthropathy treated by a medialized inlay humerus implant with a neck shaft angle of 155° or a lateralized onlay implant with a neck shaft angle of 145°. @*Methods@#A retrospective review of 32 inlay implants and 32 onlay implants was performed. The active range of motion (ROM), visual analog scale (VAS) for pain, motor power for elevation and external rotation, and functional scores including the American Shoulder and Elbow Surgeons score, Constant score, and Korean Shoulder Scoring system were assessed before surgery, at 3, 6, and 12 months after surgery, and at the last follow-up at least 24 months after surgery. Scapular notching, lateral humeral offset, and deltoid wrapping offset were assessed for radiographic evaluation. @*Results@#The preoperative demographic data of both groups showed no significant differences (p > 0.05). The mean follow-up period was 24.9 months. Significant improvements in forward flexion, functional scores, and pain VAS score were observed in both groups at the last follow-up. No significant differences in ROM or functional scores were found between two groups at each time point, except that the onlay implant group exhibited a significantly greater range of external rotation at 3 and 12 months after surgery and at the last follow-up. The rate of scapular notching and the final power improvement did not show significant differences between the groups. @*Conclusions@#Primary RTSA using inlay or onlay humerus implants was associated with recovery from pseudoparalysis and good clinical outcomes. However, RTSA with onlay humerus implantation led to clinically superior results in terms of external rotation.

Smad4 Mediated TGF-beta/BMP Signaling in Tooth Formation Using Smad4 Conditional Knockout Mouse

Col1a1-cre mediated activation of beta-catenin leads to aberrant dento-alveolar complex formation / 대한해부학회지

Wnt/beta-catenin signaling plays a critical role in bone formation and regeneration. Dentin and cementum share many similarities with bone in their biochemical compositions and biomechanical properties. Whether Wnt/beta-catenin signaling is involved in the dento-alveolar complex formation is unknown. To understand the roles of Wnt/beta-catenin signaling in the dento-alveolar complex formation, we generated conditional beta-catenin activation mice through intercross of Catnb+/lox(ex3) mice with Col1a1-cre mice. In mutant mice, tooth formation and eruption was disturbed. Lower incisors and molars did not erupt. Bone formation was increased in the mandible but tooth formation was severely disturbed. Hypomineralized dentin was deposited in the crown but roots of molars were extremely short and distorted. In the odontoblasts of mutant molars, expression of dentin matrix proteins was obviously downregulated following the activation of beta-catenin whereas that of mineralization inhibitor was increased. Cementum and periodontal ligament were hypoplastic but periodontal space was narrow due to increased alveolar bone formation. While cementum matrix proteins were decreased, bone matrix proteins were increased in the cementum and alveolar bone of mutant mice. These results indicate that local activation of beta-catenin in the osteoblasts and odontoblasts leads to aberrant dento-alveolar complex formation. Therefore, appropriate inhibition of Wnt/beta-catenin signaling is important for the dento-alveolar complex formation.

Mesenchymal Smad4 mediated signaling is essential for palate development

INTRODUCTION: A cleft palate is a common birth defect in humans with an incidence of 1/500 to 1/1,000 births. It appears to be caused by multiple genetic and environmental factors during palatogenesis. Many molecules are involved in palate formation but the biological mechanisms underlying the normal palate formation and cleft palate are unclear. Accumulating evidence suggests that transforming growth factor beta/bone morphogenetic proteins (TGF-beta/BMP) family members mediate the epithelial-mesenchymal interactions during palate formation. However, their roles in palatal morphogenesis are not completely understood. MATERIALS AND METHODS: To understand the roles of TGF-beta/BMP signaling in vivo during palatogenesis, mice with a palatal mesenchyme-specific deletion of Smad4, a key intracellular mediator of TGF-beta/BMP signaling, were generated and analyzed using the Osr2Ires-Cre mice. RESULTS: The mutant mice were alive at the time of birth with open eyelids and complete cleft palate but died within 24 hours after birth. In skeletal preparation, the horizontal processes of the palatine bones in mutants were not formed and resulted in a complete cleft palate. At E13.5, the palatal shelves of the mutants were growing as normally as those of theirwild type littermates. However, the palatal shelves of the mutants were not elevated at E14.5 in contrast to the elevated palatal shelves of the wild type mice. At E15.5, the palatal shelves of the mutants were elevated over the tongue but did not come in contact with each other, resulting in a cleft palate. CONCLUSION: These results suggest that mesenchymal Smad4 mediated signaling is essential for the growth of palatal processes and suggests that TGF-beta/BMP family members are essential regulators during palate development.