Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo / Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty

Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)

Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 44–77 years) and mean follow up was 7 years (range of 5–9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)

Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty / Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo

Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 44–77 years) and mean follow up was 7 years (range of 5–9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)

Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)

Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty. / Resultados funcionales e imagenológicos de la reparación artroscópica de lesiones parciales bursales del manguito rotador sin acromioplastia. Seguimiento a mediano plazo.

BACKGROUND AND PURPOSE: The purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty. MATERIALS AND METHODS: Sixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity. RESULTS: Mean age was 57.2 years (range, 44-77 years) and mean follow up was 7 years (range of 5-9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears. CONCLUSIONS: In the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.

Serum klotho concentrations inversely correlate with the severity of nailfold capillaroscopic patterns in patients with systemic sclerosis.

Klotho is a transmembrane and soluble glycoprotein that governs vascular integrity. Previous studies have demonstrated reduced serum klotho concentrations in patients with systemic sclerosis (SSc), and it is known that klotho deficiency can impair the healing of digital ulcers related to microvessel damage. The aim of this study was to evaluate the association between serum klotho levels and nailfold capillaroscopic abnormalities in SSc patients. We retrospectively enrolled 54 consecutive patients with SSc diagnosed on the basis of the 2013 EULAR/ACR criteria [11 with diffuse SSc; 47 females; median age 68.0 years (IQ 18); median disease duration 11.0 years (IQ 7)]. Serum klotho concentrations were determined by means of an enzyme-linked immunosorbent assay. On the basis of the 2000 classification of Cutolo et al., 14 patients had normal nailfold capillaroscopic findings, 8 had an early scleroderma pattern, 21 an active scleroderma pattern, and 11 a late scleroderma pattern. The median serum klotho concentration was 0.29 ng/mL (IQ 1). Regression analysis of variation showed an inverse correlation between serum klotho concentrations and the severity of the capillaroscopic pattern (p=0.02; t -2.2284), which was not influenced by concomitant treatment. Logistic regression did not reveal any significant association between the risk of developing digital ulcers and nailfold capillaroscopic patterns, serum klotho levels, or concomitant medications. The presence of avascular areas significantly correlated with calcinosis (p=0.006). In line with previous studies, our findings confirm that klotho plays a role in preventing microvascular damage detected with nailfold capillaroscopy.

Resultados de la artroplastia parcial de superficie para el tratamiento de pacientes con necrosis ósea avascular del húmero proximal / Results of partial resurfacing of humeral head in patients with avascular necrosis

Objetivo: El objetivo de este trabajo es reportar los resultados a corto plazo y las complicaciones de la artroplastia de superficie del húmero proximal (HemiCup(R)) en pacientes tratados por necrosis ósea avascular. Material y métodos: Entre 2010 y 2014 fueron evaluados 9 pacientes a los que se les realizó una artroplastia de superficie del húmero proximal. Todos los pacientes fueron tratados por necrosis ósea avascular. El seguimiento promedio fue de 44 meses (mínimo 24 meses). La edad promedio fue de 47 años (rango 32-57 años). Los pacientes fueron evaluados cínica y radiológicamente. Se reportaron las complicaciones. Resultados: Los pacientes presentaron una mejoría significativa en los scores funcionales y la movilidad entre el preoperatorio y el último control en el seguimiento. El score de Constant mejoró de 35 a 79 puntos (p<0,001), el score de ASES mejoró de 31 a 76 puntos (p<0,001), la flexión anterior y la rotación externa mejoraron de 101 a 150° (p<0,001) y de 24 a 45° (p<0,001), respectivamente. Un paciente presentó desgaste sintomático en la glena durante el seguimiento, requiriendo una cirugía de revisión. Conclusión: En nuestra serie, la artroplastia parcial de superficie del húmero proximal (HemiCup(R)) demostró una mejoría significativa en los scores funcionales y la movilidad en pacientes tratados por necrosis ósea avascular, con un seguimiento promedio de 44 meses

Objective: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup(R)) in patients treated by avascular necrosis. Material and methods: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. Results: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. Conclusion: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup(R)) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months

Results of partial resurfacing of humeral head in patients with avascular necrosis. / Resultados de la artroplastia parcial de superficie para el tratamiento de pacientes con necrosis ósea avascular del húmero proximal.

OBJECTIVE: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup®) in patients treated by avascular necrosis. MATERIAL AND METHODS: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. RESULTS: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. CONCLUSION: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup®) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months.

The role of klotho in systemic sclerosis.

The aim was to evaluate the role of klotho in the pathogenesis of systemic sclerosis (SSc), through the measurement of its serum concentration in SSc patients compared to healthy controls, and to assess the association with cutaneous and visceral involvement. Blood samples obtained from both SSc patients and healthy controls were analysed by an ELISA assay for the detection of human klotho. SSc patients were globally evaluated for disease activity and assessed through the modified Rodnan's Skin Score, Medsger's scale, pulmonary function tests, 2D-echocardiography, nailfold capillaroscopy and laboratory tests. Our cohort consisted of 69 SSc patients (61 females, mean age 64.5±12.5 years, median disease duration 9.0 (IQR 8) years) and 77 healthy controls (28 females, mean age 49.7±10.2 years). In the group of SSc patients, 19 (27.5%) suffered from a diffuse form of SSc. All patients were receiving IV prostanoids, and some of them were concomitantly treated with immunosuppressive drugs (prednisone, hydroxychloroquine, mofetil mycophenolate, methotrexate, cyclosporin A and azathioprine). The median serum concentration of klotho was significantly lower in patients compared to controls (0.23 ng/mL vs 0.60 ng/mL; p<0.001). However, Spearman's test showed no significant association between klotho serum levels and disease activity, concerning either clinical, laboratory or instrumental findings. Our data show a significant deficit of klotho in SSc patients although any significant association was detected between klotho serum concentration and the clinical, laboratory or instrumental features of the disease. However, due to the limits of the study, further investigations are required.

Gene expression is differently affected by pimecrolimus and betamethasone in lesional skin of atopic dermatitis.

BACKGROUND: Topical corticosteroids and calcineurin inhibitors are well-known treatments of atopic dermatitis (AD) but differ in their efficacy and side effects. We recently showed that betamethasone valerate (BM) although clinically more efficient impaired skin barrier repair in contrast to pimecrolimus in AD. OBJECTIVE: This study elucidates the mode of action of topical BM and pimecrolimus cream in AD. METHODS: Lesional AD skin samples after topical treatment with either BM or pimecrolimus were subjected to gene expression profile analysis. RESULTS: Betamethasone valerate resulted in a significant reduction in mRNA levels of genes encoding markers of immune cells and inflammation, dendritic cells, T cells, cytokines, chemokines, and serine proteases, whereas pimecrolimus exerted minor effects only. This corroborates the clinical finding that BM reduces inflammation more effectively than pimecrolimus. Genes encoding molecules important for skin barrier function were differently affected. Both BM and pimecrolimus normalized the expression of filaggrin and loricrin. BM, but not pimecrolimus, significantly reduced the expression of rate-limiting enzymes for lipid synthesis and the expression of involucrin and small proline-rich proteins, which covalently bind ceramides. This may explain the lack of restoration of functional stratum corneum layers observed after BM treatment. CONCLUSION: The gene expression profiles are consistent with our previous findings that corticosteroids may exert a more potent anti-inflammatory effect but may impair the restoration of the skin barrier. Corticosteroids are still the main treatment for severe and acutely exacerbated AD; pimecrolimus may be preferable for long-term treatment and stabilization.