Irregular Cartilage Research Articles

Histopathology of Idiopathic Condylar Resorption Differs From Temporomandibular Joint-Only Juvenile Idiopathic Arthritis

BackgroundIdiopathic condylar resorption (ICR) is a rare condition of unknown etiology characterized by progressive decrease in volume and pathologic remodeling of a previously normal mandibular condyle. Juvenile Idiopathic Arthritis (JIA) affecting only the temporomandibular joint (TMJ-only JIA) is characterized by synovitis and destruction of TMJ tissues without involvement of other joints. It is often difficult to differentiate the two conditions because they exhibit similar phenotypes. PurposeTo compare histology of resected condylar specimens from patients with ICR and TMJ-only JIA. Specific aims were: 1) To correlate longitudinal clinical data with histopathology of resected condyle specimens, 2) To compare resorption patterns between the two disease processes. Study design, setting, sampleThis was a retrospective cohort study of patients treated at Massachusetts General Hospital (MGH) from 1999 through 2023. Predictor/exposure/independent variablePrimary predictor variable was the diagnosis (ICR or JIA). Secondary predictor variables included age, gender, race, putative contributing factors, and laboratory studies. Main outcome variable(s)Primary outcome variable was presence or absence of inflammatory infiltrates in bone and synovial specimens. Secondary outcome variables were structural integrity and morphologic characteristics of the condylar cartilage and bone. AnalysesSpearman correlation was used to assess the relationship between histological scores and age, gender, and possible associated contributing factors. A p-value < 0.05 was considered statistically significant. ResultsThirty-five subjects (67 specimens) were included in Group 1 (ICR). Eight subjects (15 specimens) were included in Group 2 (TMJ-only JIA). The histopathologic findings in ICR consisted of severe and irregular cartilage surface disruption, fibrocartilage degeneration, and subchondral bone with no inflammatory infiltrate. Degeneration was observed to begin at the anterior pole of the condyle and progress eventually to total resorption to the sigmoid notch. TMJ-only JIA was notable for more severe condylar degeneration and inflammation in the bone and synovia. There was no specific pattern of degeneration. For both groups, the subject’s age, gender, or putative contributing factors did not correlate with the histopathologic scores. Conclusions and RelevanceThese results support the hypothesis that “ICR” and TMJ-only JIA are distinct clinical entities and can be distinguished by histopathologic findings in the mandibular condyles and synovia.

Effect of moxibustion on plasma amino acid metabolism in rats with knee osteoarthritis.

To observe the effect of moxibustion at "Zusanli "(ST36) on the plasma amino acid metabolism in rats with knee osteoarthritis (KOA), and to explore the amino acid metabolism mechanism of moxibustion in repairing cartilage injury in KOA. A total of 30 SD rats were randomly divided into normal, model and moxibustion groups, with 10 rats in each group. Rats in the model and moxibustion groups were injected with the mixture of L-cysteine and papain into bilateral knee joint cavity to make the KOA model. The moxibustion group received moxibustion at bilateral ST36 for 30 min, once daily for 30 days. At the end of the experiment, the swelling degree of knee joint was calculated, the mechanical pain threshold was measured by the Von Frey filament, the cartilage tissue injury was observed by HE staining, the matrix metalloproteinase-13 (MMP-13) content in the synovial tissue was detected by enzyme-linked immunosorbent assay (ELISA), and the differential amino acid metabolites in plasma were detected and screened by liquid chromatography-mass spectrometry (LC-MS). Compared with the normal group, the model group showed irregular cartilage surface, decreased number of chondrocytes, uneven distribution, and local clusters of chondrocytes；the contour of the tide line was blurred. The degree of joint swelling in the model group was higher than that in the normal group (P<0.01), the mechanical pain threshold was lower (P<0.01), and the content of MMP-13 in synovial tissue was higher (P<0.01). The contents of proline and tryptophan in the model group were down-regulated (P<0.01, P<0.05). Compared with the model group, the cartilage tissue damage and knee joint swelling were decreased(P<0.05), mechanical pain threshold was increased(P<0.05), MMP-13 content in synovial tissue and levels of glutamate and histidine expression were decreased (P<0.01, P<0.05). Moxibustion at ST36 significantly alleviated arthritis-related swelling and pain in KOA model rats, attenuated cartilage damage, and regulated levels of certain plasma amino acid metabolites. Moxibustion may regulate KOA cartilage synthesis and degradation through amino acid metabolic pathways such as proline, tryptophan, glutamate and histidine, exerting anti-inflammatory, analgesic, and protection of cartilage injury effects.

Glucosamine sulfate-loaded nanofiber reinforced carboxymethyl chitosan sponge for articular cartilage restoration

Cartilage is severely limited in self-repair after damage, and tissue engineering scaffold transplantation is considered the most promising strategy for cartilage regeneration. However, scaffolds without cells and growth factors, which can effectively avoid long cell culture times, high risk of infection, and susceptibility to contamination, remain scarce. Hence, we developed a cell- and growth factor-dual free hierarchically structured nanofibrous sponge to mimic the extracellular matrix, in which the encapsulated core–shell nanofibers served both as mechanical supports and as long-lasting carriers for bioactive biomass molecules (glucosamine sulfate). Under the protection of the nanofibers in this designed sponge, glucosamine sulfate could be released continuously for at least 30 days, which significantly accelerated the repair of cartilage tissue in a rat cartilage defect model. Moreover, the nanofibrous sponge based on carboxymethyl chitosan as the framework could effectively fill irregular cartilage defects, adapt to the dynamic changes during cartilage movement, and maintain almost 100 % elasticity even after multiple compression cycles. This strategy, which combines fiber freeze-shaping technology with a controlled-release method for encapsulating bioactivity, allows for the assembly of porous bionic scaffolds with hierarchical nanofiber structure, providing a novel and safe approach to tissue repair.

Correlations of characteristics with tissue involvement in knee gouty arthritis: Magnetic resonance imaging analysis

ObjectiveThis study investigates the MRI features of knee gouty arthritis (KGA), examines its relationship with the extent of tissue involvement, and assesses whether risk factors can predict KGA. Materials and methodsPatients diagnosed with KGA underwent MRI examinations, and two independent observers retrospectively analyzed data from 44 patients (49 knees). These patients were divided into mild and severe groups based on tissue involvement observed during arthroscopy. MRI features were summarized, and the intraclass correlation coefficient evaluated interobserver reproducibility. Single-factor analysis compared clinical indicators and MRI features between groups, while Cramer's V coefficient assessed correlations. Multivariate logistic regression identified predictors of tissue involvement extent, and a ROC curve evaluated diagnostic performance. ResultsAmong 49 knees, 18 had mild and 31 had severe tissue involvement. Key MRI features included ligament sketch-like changes, meniscal urate deposition, irregularly serrated cartilage changes, low-signal signs within joint effusion, synovial proliferation, Hoffa's fat pad synovitis, gouty tophi, bone erosion, and bone marrow edema. The interobserver reliability of the MRI features was good. Significant differences (P < 0.05) were observed between the groups for anterior cruciate ligament (ACL) sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi. ACL sketch-like changes (r = 0.309), Hoffa's fat pad synovitis (r = 0.309), and gouty tophi (r = 0.408) were positively correlated with the extent of tissue involvement (P < 0.05). ACL sketch-like changes (OR = 9.019, 95 % CI: 1.364–61.880), Hoffa's fat pad synovitis (OR = 6.472, 95 % CI: 1.041–40.229), and gouty tophi (OR = 5.972, 95 % CI: 1.218–29.276) were identified as independent predictors of tissue involvement extent (P < 0.05). The area under the ROC curve was 0.862, with a sensitivity of 67.70 %, specificity of 94.40 %, and accuracy of 79.14 %. ConclusionThis comprehensive analysis of MRI features identifies ligament sketch-like changes, meniscal urate deposition, and low-signal signs within joint effusion as characteristic MRI manifestations of KGA. Irregular cartilage changes are valuable for differential diagnosis in young and middle-aged patients. ACL sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi correlate with tissue involvement severity and are critical in predicting and assessing the extent of tissue involvement in KGA.

Continuous Low-Intensity Ultrasound Improves Cartilage Repair in Rabbit Model of Subchondral Injury.

Subchondral drilling (SD), a bone marrow stimulation technique, is used to repair cartilage lesions that lack regenerative potential. Cartilage repair outcomes upon SD are typically fibrocartilaginous in nature with inferior functionality. The lack of cues to foster the chondrogenic differentiation of egressed mesenchymal stromal cells upon SD can be attributed for the poor outcomes. Continuous low-intensity ultrasound (cLIUS) at 3.8 MHz is proposed as a treatment modality for improving cartilage repair outcomes upon marrow stimulation. Bilateral defects were created by SD on the femoral medial condyle of female New Zealand white rabbits (n = 12), and the left joint received cLIUS treatment (3.8 MHz, 3.5 Vpp, 8 min/application/day) and the contralateral right joint served as the control. On day 7 postsurgery, synovial fluid was aspirated, and the cytokine levels were assessed by Quantibody™ assay. Rabbits were euthanized at 8 weeks and outcomes were assessed macroscopically and histologically. Defect areas in the right joints exhibited boundaries, incomplete fill, irregular cartilage surfaces, loss of glycosaminoglycan (GAG), and absence of chondrocytes. In contrast, the repaired defect area in the joints that received cLIUS showed complete fill, positive staining for GAG with rounded chondrocyte morphology, COL2A1 staining, and columnar organization. Synovial fluid collected from cLIUS-treated left knee joints had lower levels of IL1, TNFα, and IFNγ when compared to untreated right knee joints, alluding to the potential of cLIUS to mitigate early inflammation. Further at 8 weeks, left knee joints (n = 12) consistently scored higher on the O'Driscoll scale, with a higher percent hyaline cartilage score. No adverse impact on bone or change in the joint space was noted. Upon a single exposure of cLIUS to TNFα-treated cells, nuclear localization of pNFκB and SOX9 was visualized by double immunofluorescence and the expression of markers associated with the NFκB pathway was assayed by quantitative real-time polymerase chain reaction. cLIUS extends its chondroprotective effects by titrating pNFκB levels, preventing its nuclear translocation, while maintaining the expression of SOX9, the collagen II transcription factor. Our combined results demonstrate that healing of chondral defects treated with marrow stimulation by SD can be accelerated by employing cLIUS regimen that possesses chondroinductive and chondroprotective properties. Impact statement Repair of cartilage represents an unsolved biomedical burden. In vitro, continuous low-intensity ultrasound (cLIUS) has been demonstrated to possess chondroinductive and chondroprotective potential. To our best knowledge, the use of cLIUS to improve cartilage repair outcomes upon marrow stimulation, in vivo, has not been reported and our work reported here fills that gap. Our results demonstrated enhanced cartilage repair outcomes under cLIUS (3.8 MHz) in a rabbit model of subchondral injury by subchondral drilling. Enhanced repair stemmed from mesenchymal stem cell differentiation in vivo and the subsequent synthesis of articular cartilage-specific matrix.

MRI identification of pseudolesions in the distal tibia articular surface: Frequency and diagnostic criteria

ObjectivePseudolesions of joints are known as focal irregularities of chondral or subchondral bone in typical joint areas and occur frequent but without clinical relevance. This study aims to report the prevalence and describe MRI findings of a previously unreported chondral, mostly posterior located pseudolesion of the distal tibia, and to define criteria to distinguish it from pathologic osteochondral lesions, as well as from another known pseudolesion of this area - the so called “Notch of Harty”. Material and methodsA tri-centric retrospective case-control study included a total of 2,428 patients with ankle MRI examinations performed over a period of 6 years. MRI scans were evaluated by three radiologists in consensus for any cartilage irregularity of the distal tibial articular surface. For this purpose, the tibial articular surface was divided into 9 topographic regions. Proton-density weighted, fat-suppressed sequences in sagittal and coronal acquisition were used to assess the postero-medial articular surface of the tibia.Imaging features such as size and localization of cartilage irregularity and/or a cortical mould as well as presence of associated edema and/or subchondral cysts were reported. Demographic data (sex, age, and weight) was also recorded. Clinical data comprised presence of pain, movement impairment, and concomitant pathologies. ResultsA total of 68 patients (34 male, 34 female) with a lesion of the distal tibia were identified that had a new pseudolesion (prevalence of 3%). These lesions occurred most frequently (50 out of 68, 74%) in the postero-medial distal tibia plafond and were more commonly detected in the age group of 9–30 years (47%).In 13 of these 68 cases, the cartilage irregularity was the sole lesion without subchondral abnormalities. By defining these cases as definite pseudolesions, the prevalence was 1% and their age distribution was similar to that of the 55 other lesions with subchondral changes.Here with 11 of the 13 cases the majority (85%) were seen in the posterior part, especially in the postero-medial part (55%) of the distal tibia. The size of the cartilage defect ranged from 1 to 7 mm, and the majority (69%) sized from 2 to 3 mm.In 36 of 68 patients, we have seen subchondral alterations such as edema and/or cysts in addition to cartilage irregularity. 66% (n = 45) of these changes were edema and 37% (n = 25) were cysts.None of these 68 new pseudolesions with or without subchondral changes needed surgical or arthroscopic intervention. In the radiological and orthopaedic reports, clinical symptoms such as pain or instability were never associated with our observed lesions and there was no significant correlation between the presence of motion-related pain and imaging findings of cartilage irregularity, subchondral edema, and subchondral cysts. Thirteen patients had MRI follow-up examinations. Here the lesions did not show any MR morphological changes or clinical deterioration.Besides the new pseudolesion, which occured mainly in the posterior part of the tibia surface, we observed the “Notch of Harty” with a higher prevalence (25%) in our patient cohort. The typical localization was in the antero-medial tibial articular surface, without any edema or cysts. There were no coincidences of patients with both a new pseudolesion and the “Notch of Harty” ConclusionA new pseudolesion is typically seen in the postero-central and postero-medial tibial articular surface with a prevalence of 3% and may be associated with only a small cartilage irregularity. In many cases, however, additional findings such as bone edema and/or an adjacent bone cysts were found, which impairs differentiation of these lesions from pathologic osteochondral lesions. The latter are obviously often associated with a larger cartilage defect and clinical symptoms. Due to the balanced age distribution between those pseudolesions with and without subchondral changes and the lack of clinical symptoms, we conclude that the here reported pseudolesions are not a predilection for a clinically manifest osteochondral lesion (OCL). At the very least, the apparent lack of clinical relevance increases the likelihood that we are dealing with a new true pseudolesion.

Platelet-rich plasma for treatment of rheumatoid arthritis

Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune ailment which involves joint pathogenesis, bone and cartilage irregularities, together with systemic comorbidities, impacting over 75 million people worldwide. At present there is no remedy for RA and the existing treatment modalities utilized have shortcomings and side effects. Recently, there has been an increased interest in use of biologics, such as platelet-rich plasma (PRP), for regenerative medicine applications, including for musculoskeletal ailments. This prompted consideration of use of PRP in patients suffering with RA. In this editorial, we highlighted the safety and efficacy of PRP to treat RA based on recently published clinical studies. These studies, despite preliminary, demonstrated that use of PRP is safe and laid the foundation for multi-center prospective open-label non-randomized trials and double-blinded randomized controlled trials with larger sample size to further evaluate the efficacy of PRP to alleviate symptoms of RA for potential clinical usage.

Benefits of Combined Surgical Techniques in Otoplasty.

Prominent ear deformity is one of the aesthetic problems that should be treated due to the psychosocial problems it causes. We aimed to present our results in which we used the combination of Mustarde suture to create an antihelix, conchal resection, and concomastoid suture combination to reduce conchal excess in the light of literature. A total of 28 cases in which the same otoplasty method was used in 2 separate centers between 2014 and 2020 were included in the study. Elliptic skin excision, antihelix reconstruction with Mustarde suture, and in cases with large conchal cartilage, cartilage excision and reconstruction with concomastoid suture were performed in all of our cases. After the skin was closed, a bandage was applied to the ear. In the early postoperative period, hematoma developed in 4 cases. There was superficial erosion of the skin in 4 cases. In the late period, hypertrophic scar developed in both ears and resolved with medical treatment. There was minimal asymmetry in 4 cases, but intervention was not required in cases with asymmetry. Skin necrosis, infection, and visible cartilage irregularity on the anterior side were not observed in any case. The aim of otoplasty is to create symmetrical ears with smooth contours, so combined techniques should be used instead of a single technique. In otoplasty, we used Mustarde suture to create antihelix, conchal resection, and concomastoid suture combination to reduce cavum. Our results were satisfactory.

Advanced injectable hydrogels for cartilage tissue engineering.

The rapid development of tissue engineering makes it an effective strategy for repairing cartilage defects. The significant advantages of injectable hydrogels for cartilage injury include the properties of natural extracellular matrix (ECM), good biocompatibility, and strong plasticity to adapt to irregular cartilage defect surfaces. These inherent properties make injectable hydrogels a promising tool for cartilage tissue engineering. This paper reviews the research progress on advanced injectable hydrogels. The cross-linking method and structure of injectable hydrogels are thoroughly discussed. Furthermore, polymers, cells, and stimulators commonly used in the preparation of injectable hydrogels are thoroughly reviewed. Finally, we summarize the research progress of the latest advanced hydrogels for cartilage repair and the future challenges for injectable hydrogels.

3D Contour Printing of Anatomically Mimetic Cartilage Grafts with Microfiber-Reinforced Double-Network Bioink.

Bioprinting is an emerging technology for fabricating cell-laden scaffolds with custom shapes that resemble the complex architecture of human tissues, however, construction of mechanically competent tissue grafts which mimic irregular cartilage defect is still a big challenge. Here, 3D printing of short fiber-reinforced double-network bioink to generate anatomically accurate and mechanical tunable scaffold for cartilage regeneration is reported. Poly(lactic acid) (PLLA) short fibers are first prepared by electrospinning and then fragmented through aminolysis reaction. Composite inks are constructed with an incorporation of fragmented microfibers with varied amounts and lengths into oxidized alginate bioink. The results show that incorporation of PLLA short fibers not only improves the printing fidelity but also facilitates in generating mechanically strong constructs. By incorporating gelatin methacryloyl (GelMA) and optimizing the bioink composition, the fabricated constructs with a compressive stress of ≈150 kPa even after 100 cyclical compression loading (up to 40% of strain) are achieved. In addition, this mechanically reinforced alginate/GelMA double-network bioink displays good biocompatibility and supports bone marrow-derived stromal cell chondrogenesis in vitro. Collectively, these findings demonstrate this approach is capable of printing engineered grafts which resemble the irregular size and mechanical properties of cartilage and thus hold potential for functional tissue regeneration.

Rekonstruksi Ruptur Kartilago Aurikula

Auricular cartilage rupture is one of the most common defects caused by trauma on head region. This is due to the protruding position of the ears on the sides of the head which is only covered by a thin skin structure. A 17 years old male patient, came to the Emergency Department of Andalas University Hospital due to a torn wound on his left ear 30 minutes before admitted to the hospital due to hit by a motorcycle handlebar. On physical examination, we found a laceration with skin avulsion around 2 cm square on the tragus auricular area to the lobules with irregular cartilage rupture. Based on the results of the inner ear examination, no abnormalities were found. We performed wound cleansing, wound edge repair, cartilage repair, and local flaps to cover the cartilage tissue, then we applied pressure bandages to prevent hematomas. The result after seven days after the procedure showed no signs of inflammation nor infection, the shape of the ear looked close to normal structure, and the inconspicuous and fine-line scar were achieved.

A novel protocol for injectable artificial cartilage constructs based on programmed shape-morphing hydrogels for cartilage regeneration

Direct contact between cells is of great significance to the formation of natural tissues, especially in regard to cartilage differentiation, which begins with the biological process of cell aggregation. Herein, based on the preparation of microspheres via microwells, we prepared functional hydrogel-based microwells by using cobalt ionic crosslinking. The preparation of functional microwells can not only induce the upregulation of genes and proteins related to cartilage differentiation but also greatly reduce markers related to hypertrophy and mineralization, which play a significant role in the formation of hyaline cartilage. Importantly, we combined microwell cultures with the later preparation of injectable artificial cartilage grafts. In vitro, microwell culture and cartilage differentiation induction can be achieved through the preparation of microwells crosslinked by ions. Via the partial removal of ions, the hydrogel and microtissues can be injected into the defect through the shape recovery of the gel in the later stage and through the stable gel formed by covalent crosslinking to repair irregular cartilage defects. This study not only broadens the application of microwells but also promotes the progress of material-based tissue engineering strategies through the design of intelligent materials.

Congenital Lobar Emphysema in a Kitten with Concomitant Hiatal Hernia and Nutritional Secondary Hyperparathyroidism.

A 2 mo old domestic shorthair kitten was presented for acute respiratory distress and severe ambulatory difficulties. Thoracic radiography revealed hyperinflation of the left cranial lung lobe and a mass with soft-tissue/gas opacity in the caudal mediastinum, leading to the suspicion of congenital lung lobe emphysema and hiatal hernia. Decreased bone radiopacity and suspected pathological fractures were also present. Complete clinicopathological analyses showed significant ionized hypocalcemia and suspicion of secondary hyperparathyroidism related to an inadequate diet. Lung lobectomy and reduction of the hiatal hernia following a median sternotomy and a cranial laparotomy were performed. IV and oral supplementation of calcium led to a full recovery and improvement in the kitten's walking. A histopathological analysis revealed pulmonary emphysema associated with hypoplastic and irregular bronchial cartilage. Congenital lobar emphysema is a rare disease in both humans and animals. This is the first veterinary report describing a kitten affected by congenital lobar emphysema combined with a hiatal hernia and additionally complicated by secondary nutritional hyperparathyroidism with a good long-term outcome.

An Injectable Platform of Engineered Cartilage Gel and Gelatin Methacrylate to Promote Cartilage Regeneration.

Cell–hydrogel constructs are frequently used as injectable platforms for irregular cartilage regeneration. However, cell–hydrogel constructs have obvious disadvantages, such as long culture times, high probability of infection, and poor cartilage formation capacity, significantly limiting their clinical translation. In this study, we aimed to develop a novel injectable platform comprising engineered cartilage gel (ECG) and gelatin methacrylate (GelMA) to improve cartilage regeneration. We first prepared an ECG by cutting the in vitro engineered cartilage sheet into pieces. The chondrocytes and ECG were evenly encapsulated into GelMA to form Cell-GelMA and ECG-GelMA constructs. The ECG-GelMA construct exhibited preferred gel characteristics and superior biocompatibility compared with the Cell-GelMA construct counterpart. After subcutaneous implantation in nude mice and goat, both gross views and histological evaluations showed that the ECG-GelMA construct achieved more homogenous, stable, and mature cartilage regeneration than the Cell-GelMA construct. Immunological evaluations showed that ECG-GelMA had a mitigatory immunologic reaction than the Cell-GelMA construct. Overall, the results suggest that the ECG-GelMA is a promising injectable platform for cartilage regeneration that may advance clinical translation.

Prolotherapy Injection for Severe Knee Osteoarthritis

Osteoarthritis (OA) is a progressive degenerative disease characterized by the abrasion of joint cartilage with the formation of new, irregular cartilage on the joint surface. Pain that occurs in osteoarthritis is induced by activities and relieved by rest. Degenerative processes, including age and genetics, have been associated with the development of osteoarthritis. Various problems emerge from knee OA patients, such as chronic pain, limitation in mobility, limitation in transferability, Activities of Daily Living (ADLs) dependency, limitation in social and leisure participation, and hence reduced Quality of Life (QoL). Prolotherapy stands for “proliferation therapy,” a regenerative medicine on interventional pain management in rehabilitation medicine. The primary purpose of prolotherapy injection is pain reduction and function improvement. Prolotherapy with hypertonic dextrose, as effective as hyaluronic acid or less effective than the Platelet-rich Plasma (PRP) and erythropoietin, has a beneficial effect in the short, medium, and long term 5 . In addition, no side effects or severe adverse reactions were reported in patients treated with hypertonic dextrose. This case reported a 77-year-old female having severe knee osteoarthritis for more than 5 (five) years and was relieved by prolotherapy injection. Keywords: Knee osteoarthritis, prolotherapy, interventional pain management, functional activity,rehabilitation. DOI: 10.7176/JHMN/98-03 Publication date: March 31 st 2022

Hydrogel composite scaffolds achieve recruitment and chondrogenesis in cartilage tissue engineering applications

BackgroundThe regeneration and repair of articular cartilage remains a major challenge for clinicians and scientists due to the poor intrinsic healing of this tissue. Since cartilage injuries are often clinically irregular, tissue-engineered scaffolds that can be easily molded to fill cartilage defects of any shape that fit tightly into the host cartilage are needed.MethodIn this study, bone marrow mesenchymal stem cell (BMSC) affinity peptide sequence PFSSTKT (PFS)-modified chondrocyte extracellular matrix (ECM) particles combined with GelMA hydrogel were constructed.ResultsIn vitro experiments showed that the pore size and porosity of the solid-supported composite scaffolds were appropriate and that the scaffolds provided a three-dimensional microenvironment supporting cell adhesion, proliferation and chondrogenic differentiation. In vitro experiments also showed that GelMA/ECM-PFS could regulate the migration of rabbit BMSCs. Two weeks after implantation in vivo, the GelMA/ECM-PFS functional scaffold system promoted the recruitment of endogenous mesenchymal stem cells from the defect site. GelMA/ECM-PFS achieved successful hyaline cartilage repair in rabbits in vivo, while the control treatment mostly resulted in fibrous tissue repair.ConclusionThis combination of endogenous cell recruitment and chondrogenesis is an ideal strategy for repairing irregular cartilage defects.Graphical

Comparison study between separation of helix from antihelix and mustarde techniques in the management of prominent ear

ObjectiveThis study aimed to assess the outcome of separating the helix from the antihelix as a new concept in the management of protruding ear and compare its result with the Mustarde technique.BackgroundThe Mustarde technique is one of the most popular approaches to correcting the prominent ear. However, the Mustarde technique is criticized for its temporary results, high rates of recurrences, and the likelihood of suture extrusion.Patients and methodsThe present prospective comparative study was carried out on 40 patients with protruding ears planned to be operated on and managed. The patients were divided into two groups: the first group (group A) included 20 patients, who were managed using separation of the helix from the antihelix technique. The second group (group B) included 20 patients, who were managed with the Mustarde technique.ResultsIn the present study, 42.5% of parents were very satisfied, 7.5% were satisfied, and 2.5% were very dissatisfied. Notably, parents of the patients in the Valente group had a significantly higher rate of satisfaction than those in the Mustarde group. All parents were satisfied in the Valente group, except for one parent (5%). In terms of complications, 12.5% of patients had a hematoma and no one had an infection, while 15% of patients had antihelix irregularity, 7.5% had suture extrusion, and 20% had cartilage irregularity. Patients in the Valente group had a significantly lower rate of hematoma and suture extrusion.ConclusionsSeparating the helix from the antihelix technique is a simple, reliable, and good option for correction of a prominent ear.

Frequency of Knee Joint Pathologies on Magnetic Resonance Imaging (MRI) In Lahore, Pakistan

Background: The knee is the body's largest joint, and it can be affected by a variety of conditions including meniscal tears, ligament and bone damage, ulcerations, ruptures, and dislocations. Magnetic resonance imaging (MRI) is defined as a screening tool for identifying Knee Pathologies without the need for arthroscopy. Objective: To determine the frequency of knee joint pathologies on Magnetic Resonance Imaging (MRI) in Lahore, Pakistan. Material and Methods: Data was collected following inclusion criteria using convenient sampling technique. A total of 140 Patients undergone Knee MRI scans on MRI Machine 1.5T Phillips. Data was collected from Radiology Department of Sharif Medical city and analyzed on SPSS version 22. Frequencies of Knee pathologies were mentioned. For Categorical Data like Age Groups and Gender Mean, Median and Standard Deviation was applied. Results: Results were based on 140 Participants who had Knee Scan. In which the Male Patients were 57.1% and 42.9% Females. The highest frequency was in 36-45 among four Age groups having 54.3%. In Knee Pathologies the common Meniscal Injuries in Medial &amp; Lateral have Longitudinal Tear as 18.6% &amp; Horizontal tear as 12.9%. In Collateral Ligaments MCL have 7% Mesniscofemoral and LCL has 5.7% Mesniscofemoral Ligament Injuries. In ACL injuries 21.4% have complete rupture and 10% Partial Rupture in PCL. Patella has 27.1% chondromalacia while popliteal tendon has complete rupture of 8.6%. 15.7 Patients have Irregular Cartilage and 12.9% Ulceration. General and Local Synovitis in Synovia was 8.6%. Conclusion: In conclusion MRI diagnosis will enable patients to avoid arthroscopic interventional contrast procedures. The finding of this research supports the use of magnetic resonance imaging (MRI) in the diagnosis of internal knee diseases.

Cartilage-Sparing Otoplasty: A Systematic Review.

Objective: Cartilage-sparing techniques have continued to play a large role in modern otoplasty. Without invasion of the cartilage, the approach has been associated with less risk of skin necrosis, cartilage irregularities, hematoma, and infection. However, refinements are often needed to decrease the incidence of recurrence and suture extrusion. The objective of this systematic review is to assess the current evidence for cartilage-sparing otoplasty. Data Sources: PubMed and EMBASE databases. Study Selection: Search terms utilized were "cartilage" and "sparing" and "otoplasty." Exclusion criteria include book chapters, technical reviews, and non-English language articles. Data Extraction: On August 1, 2019, two independent authors performed a literature query with the aforementioned key words and databases. Data Synthesis: The initial search yielded 80 results, of which 20 final articles remained for final analysis. Sample sizes ranged from 17 to 565 patients, with 14 (70%) of the studies being case series with and without adjunctive techniques. Four (20%) studies compared outcomes between cartilage-invasive and cartilage-sparing techniques. Five (25%) studies were retrospective cohort studies and only one (5%) study was prospective in nature. However, according to the Oxford Centre for Evidence-Based Medicine scale, all of the studies were of low quality. Conclusions: Since the inception of cartilage-sparing otoplasty, various modifications of the approach have been described. Recent studies demonstrated superior outcomes compared with cartilage-invasive techniques; however, a personalized approach to each patient remains necessary and often may require a combination of both to achieve the most satisfying aesthetic result. Question: Is there a preferred method for otoplasty based on outcomes? Findings: Studies on otoplasty have low quality. Cartilage-sparing otoplasty outcomes seem to be superior to cartilage-scoring otoplasty. Meaning: Provide systematic review to surgeons who perform otoplasty with outcomes in order for a personalized approach to be implemented.

Cellulose Nanocrystal Reinforced Collagen-Based Nanocomposite Hydrogel with Self-Healing and Stress-Relaxation Properties for Cell Delivery.

While injectable in situ cross-linking collagen hydrogels offer great potential for applying stem cell therapy to regenerate articular cartilage via minimally invasive procedures, the encapsulated cells experience high shear stress during injection, which results in limited cell survival. In this study, surface-modified cellulose nanocrystals (CNCs) have been investigated as green and biocompatible reinforcing agents for collagen hydrogel. Aldehyde-functionalized CNCs (a-CNCs) were produced through a facile one-pot oxidation. A nanocomposite a-CNC/collagen hydrogel cross-linked rapidly by dynamic Schiff base bonds based on a-CNCs and collagen under physiological conditions. The a-CNC/collagen hydrogel exhibited fast shear-thinning, self-healing characteristics, and improved elastic modulus compared with CNC/collagen hydrogel without Schiff base bonds. The a-CNC/collagen hydrogel was then investigated for mesenchymal stem cell (MSC) delivery. MSCs encapsulated in the a-CNC/collagen hydrogel showed high cell viability after extrusion in vitro. Subcutaneous injection of MSCs encapsulated in the a-CNC/collagen hydrogel showed improved implant integrity and higher cell retention. The proposed self-healing collagen-based hydrogel would not only protect cells during injection but also fit into the irregular cartilage defect, thus holding promise in delivering MSCs for cartilage regeneration through minimally invasive procedures.