ABSTRACT
Isolated cuneiform fractures are rare and account for only 1.7% of all midfoot fractures. Medial cuneiform fractures can be treated conservatively or surgically, with good clinical outcomes. However, nonunion is a rare complication of medial cuneiform fractures, and only a few cases have been reported in the literature. We report a case of a medial cuneiform fracture requiring surgical treatment that had a good clinical outcome. A 15-year-old boy presented to an orthopedic clinic with a complaint of pain in his right foot. The patient had landed on the foot during a handball game and was treated conservatively for several months. However, his symptoms persisted, and he was referred to our clinic for further evaluation, where he was diagnosed with medial cuneiform nonunion of the right foot. Open reduction and internal fixation surgery using a compression screw and staple and autologous bone grafting were performed. Postoperatively, bone union was observed, and the patient returned to full competition with no complaints of pain during exercise. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score at 21 months after surgery was 100.0 for the following subscales: Pain & Pain-Related; Physical Functioning & Daily Living; Social Functioning; Shoe-Related; General Health & Well-Being; and Sport (handball). We encountered a case of an isolated medial cuneiform fracture that required surgical treatment. During the surgical treatment, fixation with a combination of compression staples and screws may be considered simple and useful for achieving strong fixation because the medial cuneiform fracture has a small bone fragment.
ABSTRACT
Quality evaluation of mesenchymal stem cells (MSCs) based on efficacy would be helpful for their clinical application. In this study, we aimed to find the factors of human bone marrow MSCs relating to cartilage repair. The expression profiles of humoral factors, messenger RNAs (mRNAs), and microRNAs (miRNAs) were analyzed in human bone marrow MSCs from five different donors. We investigated the correlations of these expression profiles with the capacity of the MSCs for proliferation, chondrogenic differentiation, and cartilage repair in vivo. The mRNA expression of MYBL1 was positively correlated with proliferation and cartilage differentiation. By contrast, the mRNA expression of RCAN2 and the protein expression of TIMP-1 and VEGF were negatively correlated with proliferation and cartilage differentiation. However, MSCs from all five donors had the capacity to promote cartilage repair in vivo regardless of their capacity for proliferation and cartilage differentiation. The mRNA expression of HLA-DRB1 was positively correlated with cartilage repair in vivo. Meanwhile, the mRNA expression of TMEM155 and expression of miR-486-3p, miR-148b, miR-93, and miR-320B were negatively correlated with cartilage repair. The expression analysis of these factors might help to predict the ability of bone marrow MSCs to promote cartilage repair.
ABSTRACT
BACKGROUND: The purpose of this study was to evaluate the relationship of fatty infiltration in rotator cuff muscles and shoulder strength in rotator cuff tears and these changes during nonsurgical treatment. METHODS: Fifty-three shoulders from 47 patients (mean age: 69.9 years) diagnosed with rotator cuff tears by magnetic resonance imaging (MRI) were treated nonsurgically. The degrees of fatty infiltration in supraspinatus (SSP) and infraspinatus (ISP) muscles were graded by the modified Goutallier classification (grade 0-1, grade 2-3, or grade 4). The isometric strength of the abductors (Abd) and external rotators (ER) were examined with a hand dynamometer. We analyzed the correlation of the modified Goutallier classification in SSP and ISP muscles with the strength of Abd and ER at initial visit. In addition, MRI and strength tests were repeated after 24 ± 6 months, and changes in fatty infiltration and strength were examined. RESULTS: Fatty infiltration of SSP and ISP muscles had a negative correlation with the strengths of Abd and ER at initial visit, respectively. Six of 45 shoulders (SSP grade: 0-3) and 7 of 43 shoulders (ISP grade: 0-3) had progression of fatty infiltration. Predictive factor of a progression of fatty infiltration during follow-up was decreased initial strength of Abd. There was no significant change in the strength of Abd, and the strength of ER showed significant improvement between the initial and post-treatment measurements. Even in the subgroup that had progression of fatty infiltration at follow-up, the strength of Abd and ER did not decrease significantly. CONCLUSIONS: Although fatty infiltration of the rotator cuff muscles exhibited a negative correlation with muscle strength, fatty infiltration and muscle weakness did not progress at the same rate.
Subject(s)
Adipose Tissue , Muscle Strength , Rotator Cuff Injuries/pathology , Rotator Cuff Injuries/therapy , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Range of Motion, Articular , Rotator Cuff Injuries/diagnostic imaging , Treatment OutcomeABSTRACT
Ultrasound-guided subcostal transversus abdominis plane block (TAPB) is widely used for abdominal surgery; however, arterial plasma concentration of the anesthetic ropivacaine after the blockade is still unclear. We evaluated ropivacaine concentration after subcostal TAPB in adult patients undergoing upper abdominal surgery. Twelve patients with American Society of Anesthesiologists physical status 1-2 were enrolled. They received ultrasound-guided subcostal TAPB with 0.45 % ropivacaine at 3 mg/kg. Arterial plasma samples were collected at 15, 30, 45, 60, 90, and 120 min after the blockade and analyzed for total ropivacaine concentration using liquid chromatography and mass spectrometry. At every time point, the maximum concentrations (C(max)), and time to the C max (T(max)) were recorded. The mean C(max) and T(max) were 1.87 (0.78) µg/ml and 31.3 (16.7) min, respectively. No adverse events or clinical symptoms indicating systemic toxicity were observed during this study. The study demonstrated that administration of ropivacaine at 3 mg/kg during subcostal TAPB led to rapid increases in plasma concentration of the anesthetic during the first 2 h after the blockade. C(max) nearly reached the threshold for systemic toxicity.
