Relationship between new surrogate marks of insulin resistance and bone mineral content in adolescents / 中国学校卫生

Objective@#To analyze the relationship between new surrogate marks of insulin resistance (IR) and bone mineral content (BMC) in adolescents, and predictive value of the new surrogate marks on low bone mass, so as to provide scientific basis for early identification and prevention of skeletal related diseases in adolescents.@*Methods@#A total of 1 594 adolescents aged 12-18 years in Yinchuan City were selected by convenience sampling and stratified cluster random sampling from September 2017 to September 2020, and triglyceride and glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI) and triglyceride/high density lipoprotein cholesterol (TG/HDL-C) were calculated as new simplified IR index. The correlation between different simplified IR indexes and BMC level was analyzed by partial correlation. Binary Logistic regression was used to analyze the relationship between IR index and low bone mass, and receiver operating characteristic (ROC) curve was constructed to analyze its evaluation effect on low bone mass.@*Results@#After adjusting for confounding factors such as gender, age, smoking, drinking, family history of hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP), the new surrogate marks of IR were positively correlated with BMC level (TyG: r =0.11, TyG-BMI: r =0.58, TG/HDL-C: r =0.21, P <0.01). After further adjustment of body mass index (BMI), fat mass (FM) and lean mass (LM), the relationship between IR indexes and BMC turned into negative correlation (TyG: r =-0.20, TyG-BMI: r =-0.18, TG/HDL-C: r=-0.14, P <0.01). After adjusting for confounding factors such as gender, age, smoking, drinking, family history of hypertension, SBP and DBP, Logistic regression results showed that the increase of TyG, TyG-BMI and TG/HDL-C levels reduced the possibility of low bone mass in adolescents (TyG: OR=0.63, 95%CI = 0.40-0.98, TyG-BMI: OR=0.94, 95%CI =0.93-0.96, TG/HDL-C: OR=0.31, 95%CI=0.17-0.58, P <0.01). After adjusting BMI, FM and LM, the above results were completely reversed. Girls with high TyG and TG/HDL-C levels were 4.95 and 4.38 times more likely to have low bone mass than those with low TyG and TG/HDL-C levels (TyG: OR=4.95, 95%CI =1.29- 18.95 , TG/HDL-C: OR=4.38, 95%CI=1.04-18.50, P <0.05). ROC curve showed that TyG-BMI had the best predictive value on low bone mass (AUC=0.80, 95% CI=0.77-0.83, P <0.01).@*Conclusion@#The new surrogate marks of IR in adolescents are negatively correlated with adolescent BMC, of which TyG-BMI is the best for assessing of low bone mass and can serving as a reliable indicator for early identification of low bone mass.

Ubiquitin-specific protease 42 regulates osteogenic differentiation of human adipose-derived stem cells / 北京大学学报(医学版)

Objective:To explore the effect of ubiquitin-specific protease 42(USP42)on osteogenic differentiation of human adipose-derived stem cells(hASCs)in vivo and in vitro.Methods:A combina-tion of experiments was carried out with genetic depletion of USP42 using a lentiviral strategy.Alkaline phosphatase(ALP)staining and quantification,alizarin red S(ARS)staining and quantification were used to determine the osteogenic differentiation ability of hASCs under osteogenic induction between the experimental group(knockdown group and overexpression group)and the control group.Quantitative re-verse transcription PCR(qRT-PCR)was used to detect the expression levels of osteogenesis related genes in the experimental group and control group,and Western blotting was used to detect the expression levels of osteogenesis related proteins in the experimental group and control group.Nude mice ectopic im-plantation experiment was used to evaluate the effect of USP42 on the osteogenic differentiation of hASCs in vivo.Results:The mRNA and protein expressions of USP42 in knockdown group were significantly lower than those in control group,and those in overexpression group were significantly higher than those in control group.After 7 days of osteogenic induction,the ALP activity in the knockdown group was sig-nificantly higher than that in the control group,and ALP activity in overexpression group was significantly lower than that in control group.After 14 days of osteogenic induction,ARS staining was significantly deeper in the knockdown group than in the control group,and significantly lighter in overexpression group than in the control group.The results of qRT-PCR showed that the mRNA expression levels of ALP,os-terix(OSX)and collagen type Ⅰ(COL Ⅰ)in the knockdown group were significantly higher than those in the control group after 14 days of osteogenic induction,and those in overexpression group were signifi-cantly lower than those in control group.The results of Western blotting showed that the expression levels of runt-related transcription factor 2(RUNX2),OSX and COL Ⅰ in the knockout group were significant-ly higher than those in the control group at 14 days after osteogenic induction,while the expression levels of RUNX2,OSX and COL Ⅰ in the overexpression group were significantly lower than those in the control group.Hematoxylin-eosin staining of subcutaneous grafts in nude mice showed that the percentage of osteoid area in the knockdown group was significantly higher than that in the control group.Conclusion:Knockdown of USP42 can significantly promote the osteogenic differentiation of hASCs in vitro and in vi-vo,and overexpression of USP42 significantly inhibits in vivo osteogenic differentiation of hASCs,and USP42 can provide a potential therapeutic target for bone tissue engineering.

Effects of different polymers on biomimetic mineralization of small intestine submu-cosal scaffolds / 北京大学学报(医学版)

Objective:To explore the effects of different polymers on in vitro biomimetic mineralization of small intestinal submucosa(SIS)scaffolds,and to evaluate the physicochemical properties and bio-compatibility of the SIS scaffolds.Methods:The SIS scaffolds prepared by freeze-drying method were im-mersed in simulated body fluid(SBF),mineralized liquid containing polyacrylic acid(PAA)and mine-ralized liquid containing PAA and polyaspartic acid(PASP).After two weeks in the mineralized solu-tion,the liquid was changed every other day.SBF@SIS,PAA@SIS,PAA/PASP@SIS scaffolds were ob-tained.The SIS scaffolds were used as control group to evaluate their physicochemical properties and bio-compatibility.We observed the bulk morphology of the scaffolds in each group,analyzed the microscopic morphology by environment scanning electron microscopy and determined the porosity and pore size.We also analyzed the surface elements by energy dispersive X-ray spectroscopy(EDX),analyzed the struc-ture of functional groups by Flourier transformed infrared spectroscopy(FTIR),detected the water ab-sorption rate by using specific gravity method,and evaluated the compression strength by universal me-chanical testing machine.The pro-cell proliferation effect of each group of scaffolds were evaluated by CCK-8 cell proliferation method.Results:Under scanning electron microscopy,the scaffolds of each group showed a three-dimensional porous structure with suitable pore size and porosity,and crystal was observed in all the mineralized scaffolds of each group,in which the crystal deposition of PAA/PASP@SIS scaffolds was more regular.At the same time,the collagen fibers could be seen to thicken.EDX analysis showed that the characteristic peaks of Ca and P were found in the three groups of mineralized scaffolds,and the highest peaks were found in the PAA/PASP@SIS scaffolds.FTIR analysis proved that all the three groups of mineralized scaffolds were able to combine hydroxyapatite with SIS.All the scaf-folds had good hydrophilicity.The compressive strength of the mineralized scaffold in the three groups was higher than that in the control group,and the best compressive strength was found in PAA/PASP@SIS scaffold.The scaffolds of all the groups could effectively adsorb proteins,and PAA/PASP@SIS group had the best adsorption capacity.In the CCK-8 cell proliferation experiment,the PAA/PASP@SIS scaffold showed the best ability to promote cell proliferation with the largest number of living cells observed.Con-clusion:Compared with other mineralized scaffolds,PAA/PASP@SIS scaffolds prepared by mineralized solution containing both PAA and PASP have better physicochemical properties and biocompatibility and have potential applications in bone tissue engineering.

Assessing peri-implant bone microarchitecture: conventional vs. osseodensification drilling - ex vivo analysis

Abstract: The aim was to evaluate primary implant stability and bone microarchitecture in two drilling situations, by comparing the conventional technique (CT) and osseodensification (OD) (Versah Burs - Jackson - Mississippi - USA). The implant insertion torque (IT), implant stability quotient (ISQ), and the peri-implant trabecular microstructure were assessed on bone fragments obtained from pig's tibia (n=12), divided between CT (n=6) and OD (n=6). After the drilling procedure, the implants were installed (3.5x8.5 mm, Epikut - SIN - São Paulo - Brazil). The IT and ISQ were measured using a digital torque wrench and resonance frequency analysis. Then, the bone fragments containing the implants were removed with a trephine and analyzed by Microtomography (µCT, 8.0 µm). The comparison between groups was performed using the unpaired t-test (α=0.05). The results revealed that OD promotes a higher insertion torque (CT: 7.67±2.44 Ncm; OD: 19.78±5.26 Ncm) (p=0.0005), although ISQ was not different (CT: 61.33±4.66; OD: 63.25±4.58) (p=0.48). There was a significant increase in peri-implant bone volume (CT: 23.17±3.39 mm3; OD: 32.01±5.75 mm3) (p=0.008), and trabecular parameters: separation (CT: 0.4357±0.03 mm; OD: 0.3865±0.04 mm) (p=0.0449), number (CT: 1.626±0.18 1/mm; OD: 1.946±0.13 1/mm) (p=0.007), and thickness (CT: 0.1130±0.009 mm; OD: 0.1328±0.015 mm) (p=0.02). Structure model index (SMI) data demonstrate no significant differences between groups (CT: 1.7±0.2; OD: 1.4±0.4) (p=0.12). In conclusion, OD increases the insertion torque values and promotes beneficial changes regarding bone microarchitecture compared with CT, revealing more peri-implant bone volume with consequent higher primary stability.

Resumo O objetivo deste estudo foi avaliar a estabilidade de implante e a microarquitetura óssea em duas técnicas de fresagem, comparando a técnica convencional (CT) e a osseodensificação (OD) (Versah Burs - Jackson - Mississippi - EUA). O torque de inserção do implante (IT), quociente de estabilidade primária (ISQ) e a estrutura trabecular peri-implantar foram avaliados em fragmentos ósseos obtidos de tíbia de porco (n=12), divididos entre CT (n=6) e OD (n=6). Após o procedimento de fresagem, foram instalados implantes (3,5x8,5 mm, Epikut - SIN - São Paulo - Brasil). O IT e o ISQ foram aferidos por meio de um torquimetro digital e análise de frequência de ressonância. Em seguida, os fragmentos ósseos contendo os implantes foram removidos com trefina e analisados ​​por microtomografia computadorizada (µCT, 8,0 µm). A comparação entre os grupos foi realizada por meio do teste-t não-pareado (α=0.05). Os resultados revelaram que a OD promove maior torque de inserção (CT: 7,67 ± 2,44º Ncm; OD: 19,78 ± 5,26 Ncm) (p=0,0005), embora a estabilidade primária não tenha sido diferente (CT: 61.33 ± 4.66; OD:63.25 ± 4.58) (p=0,48). Houve um aumento significativo no volume ósseo peri-implantar (CT: 23,17±3,39 mm3; OD: 32,01±5,75 mm3) (p=0,0089) e parâmetros trabeculares: separação (CT: 0,4357 ± 0,03 mm; OD: 0,3865 ± 0,04 mm) (p=0,0449), número (CT: 1,626 ± 0,18 1/mm; OD: 1,946 ± 0,13 1/mm) (p=0,007) e espessura (CT: 0,1130 ± 0,009 mm; OD: 0,1328 ± 0,015 mm) (p=0,02) O índice de modelo estrutural (SMI) não demostrou diferença estatisticamente significativa (p=0.1228). Concluindo, OD apresenta maiores valores de torque de inserção e promove mudanças benéficas na microarquitetura óssea em comparação com a TC, revelando maior volume ósseo peri-implantar.

Influence of zoledronic acid and low-intensity laser on collagen fibers during the bone repair process

Purpose: To evaluate collagen fibers during the bone repair process in critical defects created in the tibias of rats, treated with zoledronic acid (AZ) associated with low-level laser therapy (LLLT). Methods: Ten rats were distributed according to treatment: group 1) saline solution; group 2) LLLT; group 3) AZ; group 4) AZ and LLLT. AZ was administered at the dose of 0.035 mg/kg at fortnightly intervals over eight weeks. Next, 2-mm bone defects were created in the tibias of all animals. The bone defects in groups 2 and 4 were irradiated LLLT in the immediate postoperative period. After periods 14 and 28 of application, the animals were euthanized, and birefringence analysis was performed. Results: Approximately 90% of the total area was occupied by collagen fibers within the red color spectrum, this area being statistically larger in relation to the area occupied by collagen fibers within the green and yellow spectrum, in the four groups. Over the 14-day period, there was no statistically significant difference between the groups. In the 28-day period, group 2 (14.02 ± 15.9%) was superior in quantifying green birefringent fibers compared to group 1 (3.06 ± 3.24%), with p = 0.009. Conclusions: LLLT associated with ZA is effective in stimulating the neoformation of collagen fibers. The LLLT group without the association with ZA showed a greater amount of immature and less organized matrix over a period of 28 days.

Characterization of the Masquelet Induced Membrane Technique in a Murine Segmental Bone Defect Model / Caracterização da membrana induzida pela técnica de Masquelet em modelo murino de defeito ósseo segmentar

Abstract Objective To reproduce in an animal model the surgical technique of Masquelet used in the treatment of critical bone defects and to analyze the characteristics of the membrane formed around the bone cement. Methods A 10mm critical defect was created in the femoral shaft of 21 Sprague-Dawley rats. After resection of the central portion of the diaphysis, the defect was stabilized with a Kirschner wire introduced through the medullary canal and with the interposition of a bone cement spacer. After 2, 4, and 6 weeks of the surgical procedure, the animals were euthanized and evaluated on radiographs of the posterior limb regarding the size of the defect, alignment and stability of the osteosynthesis. The membranes formed around the spacer were subjected to histological analysis to assess thickness, connective tissue maturation and vascular density. Results Over time, the membranes initially made up of loose connective tissue were replaced by membranes represented by dense connective tissue, rich in thick collagen fibers. At six weeks, membrane thickness was greater (565 ± 208μm) than at four (186.9 ± 70.21μm, p = 0.0002) and two weeks (252.2 ± 55.1μm, p = 0.001). All membranes from the initial time showed foci of osteogenic differentiation that progressively reduced over time. Conclusion In addition to the structural and protective function of the membrane, its intrinsic biological characteristics can actively contribute to bone regeneration. The biological activity attributed by the presence of foci of osteogenesis confers to the membrane the potential of osteoinduction that favors the local conditions for the integration of the bone graft.

Resumo Objetivo Reproduzir em modelo animal a técnica cirúrgica de Masquelet utilizada no tratamento de defeitos ósseos críticos e analisar as características da membrana formada em torno do cimento ósseo. Métodos Um defeito crítico de 10mm foi realizado na diáfise femoral de 21 ratos Sprague-Dawley. Após a ressecção da porção central da diáfise o defeito foi estabilizado com fio de Kirschner introduzido pelo canal medular e com a interposição de espaçador de cimento ósseo. Após 2, 4, e 6 semanas do procedimento cirúrgico os animais foram eutanasiados e avaliados em radiografias do membro posterior quanto ao tamanho do defeito, o alinhamento e a estabilidade da osteossíntese. As membranas formadas em torno do espaçador foram submetidas a análise histológica para avaliação da espessura, da maturação do tecido conjuntivo e da densidade vascular. Resultados Ao longo do tempo as membranas inicialmente constituídas por tecido conjuntivo frouxo foram substituídas por membranas representadas por tecido conjuntivo denso, rico em fibras colágenas espessas. Com seis semanas a espessura das membranas foi maior (565 ± 208μm) do que com quatro (186,9 ± 70,21μm, p = 0,0002) e duas semanas (252,2 ± 55,1μm, p = 0,001). Todas as membranas do tempo inicial apresentaram focos de diferenciação osteogênica que reduziram progressivamente ao longo do tempo. Conclusão Além da função estrutural e protetora da membrana, suas características biológicas intrínsecas podem contribuir ativamente para a regeneração óssea. A atividade biológica atribuída pela presença de focos de osteogênese confere à membrana potencial de osteoindução que favorece as condições locais para a integração do enxerto ósseo.

Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Review on the origin of knee valgus deformity / 中华骨科杂志

The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods, matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice, it is of great significance to establish a reasonable morphological classification of knee valgus deformity, in order to grasp the characteristics and patterns of the onset of valgus deformity. According to the origin of the deformity and the tension of the medial and lateral collateral ligaments, the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin. Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity, they are quite different. Traditional classification is based on femoral tibial angle, valgus angle, etc; The new classification is divided into mechanical angle, anatomical angle, distal condylar angle, etc. The origin of Genu valgum deformity is generally complex. The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue. The new classification, especially based on the classification of anatomical angle valgus deformity, can not only reflect the morphological and anatomical details of knee valgus deformity, but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint. At present, the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement. The former focuses on correcting extraarticular deformity without over repairing ligaments, and the latter focuses on force line correction, which is the final treatment for terminal valgus deformity. The application of digital technology in clinical orthopedics can improve the accuracy of implant placement. Implant placement needs to be based on the patient's bone characteristics and degree of deformity. For patients with severe deformity, the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.

Progress on correlation of maternal and neonatal serum bone metabolism biochemical indicators / 中华围产医学杂志

Bone metabolism biochemical indicators can reflect the state of bone transformation timely, which not only play an essential physiological role in individuals' normal growth and development but also are related to the development of many diseases. This paper reviews the progress on the correlation of serum bone metabolism biochemical indicators during pregnancy and the neonatal period to provide a reference for achieving adequate intrauterine nutritional reserves in the fetus and individualized nutritional guidance in the neonatal period.

Impact of a modified implant macrogeometry on biomechanical parameters and bone-related markers in rats

Abstract This study investigated the impact of a modified implant macrogeometry on peri-implant healing and its effect on bone-related molecules in rats. Eighteen rats received one implant in each tibia: the control group received implants with conventional macrogeometry and the test group received implants with modified macrogeometry. After 30 days, the implants were removed for biomechanical analysis and the bone tissue around them was collected for quantifying gene expression of OPN, Runx2, β-catenin, BMP-2, Dkk1, and RANKL/OPG. Calcein and tetracycline fluorescent markers were used for analyzing newly formed bone at undecalcified sections of the tibial implants. These fluorescent markers showed continuous bone formation at cortical bone width and sparse new bone formed along the medullary implant surface in both groups. However, higher counter-torque values and upregulation of OPN expression were achieved by test implants when compared to controls. The modified macrogeometry of implants optimized peri-implant healing, favoring the modulation of OPN expression in the osseous tissue around the implants.

Cuidados de enfermagem aos pacientes com metástases ósseas submetidos à radioterapia: revisão de escopo / Nursing care for patients with bone metastases undergoing radiotherapy: a scoping review

RESUMO Objetivo mapear estudos sobre os cuidados de enfermagem aos pacientes com metástases ósseas submetidos à radioterapia. Métodos revisão de escopo realizada em nove bases de dados, segundo as diretrizes do Instituto Joanna Briggs. Foram incluídos artigos científicos disponíveis para acesso aberto na íntegra, em qualquer idioma, independentemente do método utilizado. Resultados foram analisados 13 estudos, com predomínio de revisões de literatura. As temáticas foram: educação em saúde a pacientes e a acompanhantes, sobre os eventos relacionados ao esqueleto; avaliação e manejo da dor; prevenção da fratura patológica; manejo da compressão medular; avaliação da hipercalcemia; garantia da segurança na administração de bifosfonatos orais; avaliação da qualidade de vida; e monitorização do progresso, eventos adversos e resultados terapêuticos. Conclusão os enfermeiros fornecem importante suporte contínuo aos pacientes, monitoram o progresso, os efeitos colaterais e os resultados terapêuticos, bem como previnem e manejam os eventos relacionados ao esqueleto. Contribuições para a prática: o estudo destacou os principais cuidados de enfermagem aos pacientes com metástases ósseas em tratamento radioterápico, sendo relevante para dar subsídio teórico aos profissionais direcionando sua assistência, especialmente na área da oncologia.

ABSTRACT Objective to map studies on nursing care for patients with bone metastases undergoing radiotherapy. Methods scoping review conducted in nine databases, according to the guidelines of the Joanna Briggs Institute. Scientific articles available for full open access, in any language, regardless of the method used, were included. Results 13 studies were analyzed, with a predominance of literature reviews. The themes were: health education to patients and companions about events related to the skeleton; pain assessment and management; prevention of pathological fractures; management of spinal cord compression; assessment of hypercalcemia; ensuring safety in the administration of oral bisphosphonates; quality of life assessment; and monitoring of progress, adverse events, and therapeutic outcomes. Conclusion nurses provide important ongoing support to patients, monitor progress, side effects, and therapeutic outcomes, and prevent and manage skeletal-related events. Contributions to practice: the study highlighted the main nursing care to patients with bone metastases in radiotherapy treatment, being relevant to give theoretical subsidy to professionals directing their assistance, especially in the oncology area.

Cortical microarchitecture and remodeling-associated gene expression related to oral cancer prognosis

Abstract The objective of this study was to assess the remodeling-associated gene expression in the mandible of patients diagnosed with oral squamous cell carcinoma (OSCC), investigating the cortical microarchitecture, and their influence on disease-free survival (DFS) and overall survival (OS) rates. A total of twenty-four patients who underwent mandibulectomy for OSCC treatment had two bone fragments harvested from the mandible for gene expression (RANK, RANKL, OPG, and SOST), and microarchitecture analysis, including bone volume, surface, mineral density, degree of anisotropy, and fractal dimension. The prognosis of the patients was assessed. The results revealed that RANK, RANKL, and SOST were predominantly downregulated, while OPG was completely downregulated. Tumors located adjacent to the posterior region of the mandible (p = 0.02), with a bone mineral density below 1.03 g/cm3 HA (p = 0.001), and a bone volume less than 86.47% (p = 0.03) were associated with poor outcomes. In conclusion, bone-remodeling-associated genes exhibited downregulation in the cortex of the mandible in OSCC patients. Additionally, the tumor's location within the mandible, bone volume, and cortical bone mineral density were identified as factors impacting DFS.

Effect of micro-CT acquisition parameters and individual analysis on the assessment of bone repair

Abstract This study aimed to investigate whether two acquisition parameters, voxel size and filter thickness, used in a micro-computed tomography (micro-CT) scan, together with the examiner's experience, influence the outcome of bone repair analysis in an experimental model. Bone defects were created in rat tibiae and scanned using two voxel sizes of 6- or 12-µm and two aluminum filter thickness of 0.5- or 1-mm. Then, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) were analyzed twice by two groups of operators: experienced and inexperienced examiners. For BV/TV, no significant differences were found between scanning voxel sizes of 6 and 12 µm for the experienced examiners; however, for the inexperienced examiners, the analysis performed using a 12-µm voxel size resulted in higher BV/TV values (32.4 and 32.9) than those acquired using a 6-µm voxel size (25.4 and 24.8) (p < 0.05). For Tb.Th, no significant differences between the analyses performed by experienced and inexperienced groups were observed when using the 6-µm voxel size. However, inexperienced examiners' analysis revealed higher Tb.Th values when using the 12-µm voxel size compared with 6 µm (0.05 vs. 0.03, p < 0.05). Filter thickness had no influence on the results of any group. In conclusion, voxel size and operator experience affected the measured Tb.Th and BV/TV of a region with new bone formation. Operator experience in micro-CT analysis is more critical for BV/TV than for Tb.Th, whereas voxel size significantly affects Tb.Th evaluation. Operators in the initial phases of research training should be calibrated for bone assessments.

Osteomielitis hematógena del fémur en el adulto

Introducción: Las infecciones del tejido óseo por gérmenes patógenos por la vía hematógena son frecuentes en el niño en las zonas metafisarias y columna vertebral en el adulto. Objetivo: Presentar el caso de una paciente adulta con osteomielitis del fémur por vía hematógena. Caso clínico: Paciente de 38 años de edad, blanca, femenina sin comorbilidad conocida, la cual acude a la consulta de Ortopedia y Traumatología por referir dolor intenso a nivel del muslo derecho que no remite al tratamiento ambulatorio con analgésicos. Mediante la exploración física se observó ligero aumento de volumen a nivel del muslo distal. A la palpación se detectó hiperestesia cutánea en especial hacia la cara lateral. La tomografía axial computarizada detectó a nivel de la diáfisis distal del fémur derecho, lesión osteolítica con presencia de una hiperdensidad en su interior con densidad ósea. Al tener en cuenta todos los elementos anteriores, se decide llevar la paciente al quirófano, para tratamiento de tipo quirúrgico, donde se realizó incisión quirúrgica lateral en la zona distal del muslo derecho, se avanzó por planos quirúrgicos y se realizó punción ósea con trocar de ocho milímetros donde se observó salida de pus espeso. Conclusiones: La osteomielitis hematógena es una enfermedad típica del paciente con epífisis abiertas y en la columna vertebral del adulto. La invasión al tejido óseo por la vía hematógena en el adulto que no sea en la columna es muy infrecuente.

Introduction: Infections of the bone tissue by pathogenic germs by hematogenous route are frequent in the child in the metaphyseal zones and in the spine in the adult. Objective: To present an adult patient with osteomyelitis of the femur by hematogenous route. Clinical case: A 38-year-old white female patient with no known morbidity, clinical record 253853, named MRA, who went to the Orthopedics and Traumatology clinic for reporting severe pain at the level of the right thigh that did not respond to treatment with ambulatory pain relievers. Physical examination revealed a slight increase in volume at the level of the distal thigh. On palpation, skin hyperesthesia was detected, especially towards the lateral aspect of the knee. A computed tomography scan detected an osteolytic lesion at the distal diaphysis of the right femur with the presence of hyperdensity with bone density. Taking all the above elements into account, it was decided to take the patient to the operating room for surgical treatment, where a lateral surgical incision was made in the distal area of the right thigh, surgical plans were performed, and an eight millimeters trocar bone puncture was used to open the bone where thick pus was observed. Conclusions: Hematogenous osteomyelitis is a typical entity of the patient with open epiphyses and in the adult spine. Invasion of bone tissue by the hematogenous route in adults other than in the spine is very rare.

Synchronous jawbone diseases: a multicenter retrospective study

Abstract The aim of this study is to report an original case series of synchronous jawbone diseases. Data of patients seen over 13 years were extracted from the files of three Oral Radiology and Pathology diagnostic centers in Brazil. The clinical, radiographic, and laboratory characteristics were tabulated and analyzed by the authors; the patients were described according to lesion type. Seventy-two synchronous jawbone diseases were included in this study. Florid osseous dysplasia, Gorlin-Goltz syndrome, and cherubism were the most frequent disorders reported in this case series. In addition, the posterior mandible area was the main site of manifestation. Florid osseous dysplasia and Gorlin-Goltz syndrome represented two-thirds of our samples. With the utilization of adequate demographic, clinical, and radiologic information, it is possible to diagnose most of the synchronous lesions of jawbones. Sometimes, however, we need complementary exams, such as histopathologic and biochemical analysis or dosing of calcium, phosphorus, and alkaline phosphatase.

Exposure to endocrine disruptors and alterations in mineralized tissues: a narrative review / Exposición a disruptores endocrinos y alteraciones en tejidos mineralizados: revisión narrativa

Background: Endocrine Disrupting Chemicals (EDCs) would cause alterations in organs/systems of exposed individuals or their progeny. Objetive: To identify and analyze the main published findings on the effects of exposure to EDCs on teeth, cartilage, and bone. Material and Methods: Two databases were analyzed: Medline and Web of Science. Only observational studies analyzing the effect of EDCs on mineralized tissues published since 2006 were included in the study. Results: 25 articles were selected, most of them involving EDCs pesticides, plasticizers, or personal care products, highlighting organochlorine compounds, bisphenols, phthalates, dioxins, parabens, and perfluoroalkyls. Thirty-six per cent of the studies reported an accumulation of EDCs in teeth or bones, while 64% reported alterations in their development or morphology, mainly at the bone level, primarily affecting their mineral density and size, as well as that of the bones of exposed individuals or their progeny. The type of effect observed was related to the EDCs analyzed, and it seemed to depend on variables such as age, sex, ethnicity/race, and even the metabolic status of the individuals in the different species analyzed. No evidence associated with effects on cartilage was found. Conclusion: EDCs in the environment, at work, or at home, under different exposure routes, are capable of accumulating in teeth and bone, particularly affecting the latter. It is necessary to study the effect of EDCs on mineralized tissues in agro-industrial areas, especially on teeth.

Antecedentes: Los Químicos Disruptores Endocrinos (EDCs) causarían alteraciones en órganos/sistemas de individuos expuestos, o su progenie. Objetivo: Identificar y analizar los principales hallazgos publicados sobre el efecto de la exposición a EDCs en dientes, cartílago y hueso. Material y Métodos: Se analizaron dos bases de datos: Medline y Web of Science, incluyendo solo estudios observacionales publicados desde el 2006, analizando el efecto de los EDCs sobre tejidos mineralizados. Resultados:25 artículos fueron seleccionados, siendo la mayoría de los EDCs pesticidas, plastificantes o productos de cuidado personal, destacando los compuestos Organo-clorados, Bisfenoles, Ftalatos, Dioxinas, Parabenos y los Perfluoroalquilos. Un 36% de los estudios reportaron un acúmulo de EDCs en dientes o huesos, mientras que un 64% informaron de alteraciones en su desarrollo o morfología, particularmente a nivel de huesos, afectando principalmente su densidad mineral y su tamaño, así como el de los individuos expuestos o su progenie. El tipo de efecto observado tuvo relación con el EDCs analizado, pareciendo depender de variables tales como edad, sexo, etnia/raza e incluso el estado metabólico de los individuos, en las diferentes especies analizadas. No se encontraron evidencias asociadas a efectos en el cartílago. Conclusión: Los EDCs en el medio ambiente, ámbito laboral o doméstico, bajo distintas rutas de exposición, son capaces de acumularse en diente y hueso, afectando particularmente a este último. Es necesario estudiar el efecto de los EDCs en los tejidos mineralizados en zonas agroindustriales, particularmente a nivel de dientes.

Fraturas do esqueleto apendicular e critérios de manejo cirúrgico: ensaio iconográfico / Fractures of the appendicular skeleton and criteria for their surgical management: pictorial essay

Resumo A elevada prevalência de fraturas e o importante papel dos exames de imagem nesse contexto requerem que o radiologista esteja familiarizado com seus principais padrões, especialmente as fraturas com manejo essencialmente cirúrgico. Este estudo apresenta uma série de casos ilustrativos e uma breve revisão da literatura, com o objetivo de demonstrar algumas das principais fraturas do esqueleto apendicular com manejo cirúrgico, agrupadas didaticamente por articulação. Foram selecionadas radiografias e tomografias computadorizadas de casos didáticos ilustrativos do arquivo de imagens do nosso serviço.

Abstract The high prevalence of fractures and the essential role that imaging examinations play in this scenario require the radiologist to be familiar with their main patterns, especially those of fractures for which the management is essentially surgical. This pictorial essay presents a series of illustrative cases and a brief review of the literature, the aim being to demonstrate some of the main fractures of the appendicular skeleton that require surgical management, grouped, didactically, by the joint affected. Radiographic and computed tomography studies of illustrative cases were selected from the imaging archives of our facility.

Comparative analysis of bone mineral content measured by bioelectrical impedance analysis and dual energy X ray absorption among children and adolescents / 中国学校卫生

Objective@#To compare bioelectrical impedance analysis (BIA) and dual energy X ray absorptiometry (DXA) for measuring body mineral content (BMC) of children and adolescents, and to provide a basis for BIA to accurately measure BMC in children and adolescents.@*Methods@#By using the convenience sampling method, among 1 469 children and adolescents aged 7-17 were recruited in Guangzhou from April to May 2019, the BMC was measured by DXA and BIA. The intraclass correlation coefficient ( ICC ) and Bland Altman analysis were used to evaluate the agreement between BIA and DXA. Bland Altman analysis was performed on log transformed data. The BMC was categorized into age and specific tertiles, and the agreement between methods was evaluated based on the kappa coefficients. Treating the BMC with DXA as the dependent variable, a prediction model was constructed for correcting the BIA measure.@*Results@#The ICC s were 0.93 and 0.94 for boys and girls, respectively. In Bland Altman analysis, the limits of agreements for the BIA to DXA ratio were wide in boys and girls, ranging from 0.27-0.76 and 0.17-0.72, respectively. The kappa coefficients for categorized BMC levels were 0.57 and 0.45 for boys and girls, respectively, showing a fair to good degree of agreement. When sub grouped by BMI, the kappa coefficients for all BMI groups of boys and overweight girls were all >0.75 , with an excellent agreement. The prediction models for boys and girls were as follows: BMC DXA =-0.51+0.44× BMC BIA + 0.06× Age +0.02× BMI ; and BMC DXA =-0.55+0.43× BMC BIA +0.06× Age +0.02× BMI , respectively. The R 2 for models of boys and girls were 0.87 and 0.87, respectively.@*Conclusion@#The agreement between BIA and DXA was poor for measuring BMC, but acceptable when evaluating the categorized BMC levels, suggesting the BIA may be applied in assessment of the BMC levels when compared to the age and gender specific population. Additionally, the prediction model for correcting BMC by BIA fis well to the measurement by DXA.

Relationship between prognosis and different surgical treatments of zygomatic defects: A retrospective study / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effect and summarize the characteristics of different treatment methods in repairing zygomatic defect.@*METHODS@#A total of 37 patients with zygomatic defect were reviewed in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from August 2012 to August 2019. According to the anatomical scope of defect, the zygomatic defects were divided into four categories: Class 0, the defect did not involve changes in zygomatic structure or continuity, only deficiency in thickness or projection; Class Ⅰ, defect was located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involved two processes; Class Ⅲa, referred to a single defect involving three processes and above; Class Ⅲb, referred to zygomatic defects associated with large maxillary defects. The etiology, defect time, defect size and characteristics of zygomatic defects, the repair and reconstruction methods, and postoperative complications were collected and analyzed. Postoperative computed tomography (CT) data were collected to evaluate the outcome of zygomatic protrusion. Chromatographic analysis was used to assess the postoperative stability.@*RESULTS@#Among the causes of defects, 25 cases (67.57%) were caused by trauma, and 11 cases (29.73%) were of surgical defects following tumor resection. We performed autologous bone grafts in 19 cases, 6 cases underwent vascularized tissue flap, 5 cases underwent external implants alone, and 7 cases underwent vascularized tissue flap combined with external implants. After the recovery of the affected side, the average difference of the zygomatic projection between the navigation group and the non-navigation group was 0.45 mm (0.20-2.50 mm) and 1.60 mm (0.10-2.90 mm), with a significant difference (P=0.045). Two patients repaired with titanium mesh combined with anterolateral thigh flap had obvious deformation or fracture of titanium mesh; 2 patients with customized casting prosthesis had infection after surgery and fetched out the prosthesis finally.@*CONCLUSION@#Autologous free grafts or alloplastic materials may be used in cases without significant structural changes. Pedicle skull flap or vascularized bone tissue flap is recommended for zygomatic bone defects with bone pillar destruction, chronic inflammation, oral and nasal communication or significant soft tissue insufficiency. Titanium mesh can be used to repair a large defect of zygomatic bone, and it is suggested to combine with vascularized bone flap transplantation.

Implant site preparation-related bone microdamage: An alternative ex vivo analysis of drilling speed protocols / Microdanos ósseos gerados na preparação do sítio de instalação de implantes: uma alternativa para análise ex vivo de diferentes protocolos de velocidade de perfuração

ABSTRACT Objective: The aim of this study was to evaluate bone microdamage in sites prepared for implant placement by using an ex vivo model with three drilling rotation speeds. Methods: Bovine bone ribs were used for the creation of 18 osteotomy sites at different rotation speeds: 1200 rpm, 800 rpm, and 400 rpm. Specimens were stained with xylenol orange and prepared for histological analysis by using fluorescence and polarized light microscopies. Bone microdamage was evaluated by number and based on total bone area, as follows: microfracture density (Fr.D = n/mm2), microcrack morphology (diffuse or linear), and density (Cr.D = n/mm2), and presence of bone chips. To complement the analysis, linear microcracks were assessed by using confocal microscopy for three-dimensional visualization. Results: Bone microdamage on the osteotomy sites included microcracks, diffuse damages, microfracture, and bone chip formation. There was an association between bone microdamage and cancellous bone (p 0.0016), as well as a positive correlation between Fr.D and Cr.D (p 0.05, r 0.54). BM occurrence was not different between the three rotation speeds. In 3D, the height of the microcrack depth was 60.81 µm. Conclusion: Bone microdamage occurs during osteotomy, and the ex vivo model used was effective for the assessment of these biomechanical parameters. In addition, microdamage was not influenced by the drilling rotation speed in this experimental condition.

RESUMO Objetivo: O objetivo desse estudo foi avaliar os microdanos ósseos em locais preparados para a instalação de implantes utilizando um modelo ex vivo acessando três velocidades de rotação de perfuração. Métodos: Fragmentos ósseos de costela bovina foram utilizados para a criação de 18 sítios de osteotomia em diferentes velocidades de rotação: 1200 rpm, 800 rpm e 400 rpm. As amostras foram coradas com Alaranjado de Xilenol e preparadas para análise microscópica em fluorescência e luz polarizada. Os microdanos ósseos foram avaliados em número e calibrados com base na área total óssea: densidade de microfraturas (Fr.D = n/mm2), morfologia (difusa ou linear) e densidade de microtrincas (Cr.D = n / mm2) e presença de espículas ósseas. Para complementar a análise, microtrincas lineares foram avaliadas por meio de microscopia confocal para visualização tridimensional. Resultados: Os microdanos ósseos incluíram microtrincas, danos difusos, microfraturas e formação de espículas. Houve uma associação entre MO e localização em osso esponjoso (p=0,0016), bem como uma correlação positiva entre Fr.D e Cr.D (p=0,05, r = 0,54). A ocorrência de microdanos ósseos não foi diferente entre as três velocidades de rotação utilizadas. Em 3D, a profundidade maior da microfissura atingiu 60,81 µm. Conclusão: Microdanos ósseos ocorrem durante a osteotomia e podem ser acessados em um modelo ex vivo na condução de experimentos em biomecânica. Sugere-se que a presença de microdanos não é influenciada pela velocidade de rotação durante a perfuração.