Portion Of Cartilage Research Articles

Revisiting morphology of xiphoid process of the sternum in human: a comprehensive anatomical study.

The xiphoid process (XP) in animals such as sheep and rats are well known to have cartilage called xiphoidal cartilage (XC). In humans, the cartilage in the xiphoid process is considered an anatomical variant and is not well understood. The aim of this study was to investigate the morphology of the XP. A total of twenty embalmed European descendant cadaveric sterna (aged 52 to 98 years) were used. Transilluminated XPs and midsagittal sections of XPs were used to examine the bone and cartilage. Subsequently, a sagittally-sectioned XP was harvested for histology and stained with Masson's trichrome. The results of the transillumination and histological examinations were compared qualitatively. The dark area visible in transilluminated XPs was consistent with the bony part in the midsagittal XP sections, which contained bone marrow; the bright area was consistent with the cartilage part in the midsagittal XP sections. This was all demonstrated histologically. Most of the XPs (85%) had some portion of cartilage. The XP was classified into four types based on its proportions of bone and cartilage: Type I, no ossification (< 1/3 ossification) 45%; Type II, minor ossification (1/3 - 1/2 ossification) 20%; Type III, major ossification (1/2-2/3 ossification) 20%; Type IV, complete ossification (> 2/3 ossification) 15%. Most of the XPs (85%) had bone and cartilage, which could have been overlooked in studies using skeletons or CT. Previous studies probably underestimated or overestimated the size of the XP. The XC needs to be considered as normal anatomy.

Chondrocutaneous Custom-made Graft for Upper Lateral and Alar Cartilage Nose Reconstruction: The T Graft

AbstractUpper lateral cartilage and alar cartilage nose reconstruction secondary to failed aesthetic procedure or tumor excision, surely represents a reconstructive challenge for plastic surgeons, because of the support needed and for the function of the internal nasal valve (INV).Several scientific publications deal with internal nasal reconstructive techniques, including simple homologous or heterologous tissue grafts.We describe a new hybrid chondrocutaneous graft used for reconstruction of the upper lateral cartilage and a portion of the alar cartilage (cephalic part), excised with the adherent nasal mucosa (in correspondence with INV), included in the tumor mass.

Osteochondral fractures in childhood and adolescence

Osteochondral fractures (OCF) are traumatic shearing injuries to portions of cartilage and bone. The most common cause is patellar dislocation, with the main localisation being the medial patellar facet and the lateral femoral condyle. They can occur in all age groups. Clinically, there is apainful knee joint effusion (haemarthrosis) with a"dancing patella". This is usually accompanied by restricted movement and/or alocking phenomenon. In addition to the standard X‑ray of the knee in three planes (lateral, anterior-posterior and tangential patella), an MRI should be performed promptly in the case of haemarthrosis and suspicious symptoms, as concomitant injuries are present in up to 70% of cases. The aim of treatment is to restore joint congruence in order to prevent the risk of secondary osteoarthritis. Small chondral and stable osteochondral fractures can be treated conservatively. Surgery is indicated for all other OCFs. In addition to refixation with various materials (bioresorbable screws, bone plugs, suture material and Kirschner wires), cartilage regeneration procedures (AMIC, MACI, OAT, etc.) are available for late diagnosed or non-refixable fragments. However, the number of cases is small. Osteochondral fractures are rare injuries in children and adolescents. Prompt MRI is recommended for diagnosis in cases of suspected OCF. Refixation is the preferred treatment method, with bioresorbable implants showing promising results in reducing the need for additional surgery. The risk of secondary osteoarthritis can be reduced with regular treatment.

Outcomes of endoscopic modified cartilage-perichondrium tympanoplasty on different sized perforations

ObjectivesTo evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique. MethodsIn our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around. ResultsAt 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05). ConclusionsCompared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification.

Evaluation of articular cartilage degeneration in patients with osteonecrosis of the femoral head using T2 mapping magnetic resonance imaging.

To evaluate and characterise articular cartilage degeneration in patients with osteonecrosis of the femoral head (ONFH) using T2 mapping magnetic resonance imaging. We reviewed 35 patients with ONFH (20 males and 15 females, mean age: 45.7 ± 12.9 years) without obvious cartilage abnormalities on plain magnetic resonance imaging (ONFH group) and 25 healthy volunteers (9 males and 16 females, mean age: 42.9 ± 5.8 years) (control group). All patients underwent T2 mapping magnetic resonance imaging after ONFH onset. The region of interest was defined as the weight-bearing portion of the articular cartilage in the femoral head and acetabulum in the coronal view. The T2 values of the articular cartilage of the acetabulum and femoral head, including necrotic and normal regions, were significantly higher in the ONFH group than those in the control group. These T2 values of the acetabulum and femoral head in Stages 3A and 2 were significantly higher in the ONFH group than those in the control group. The articular cartilage of the acetabulum and femoral head can deteriorate after the onset of ONFH, which may affect the natural history of ONFH and ONFH treatment. Our findings suggest the need for early intervention in joint preservation surgery.

CT features of abnormally whole-course wide eustachian tubes with microtia and atresia

Objective: To study the clinical and CT features of the abnormal whole-course wide of eustachian tube (AWWET) with microtia and atresia(MA). Methods: The clinical and CT data of 19 patients (20 ears) from January 2017 to December 2021 with AWWET with MA were retrospectively analyzed, including 15 males and 4 females. The age ranged from 5 to 16 years, with an average of 9.5 years. 50 patients with common MA without wide eustachian tube(ET) as a case control group, including 32 males and 18 females.The age ranged from 5 to 16 years, with an average of 9.2 years. 20 patients (40 ears) who had normal ear CT for tinnitus, otalgia as a normal control group, including 12 males and 8 females. The age ranged from 5 to 16 years, with an average of 12.5 years. We measured the dimension and length of the bony portion of the ET, the total length, the angle between the bony portion and the cartilage portion, and the horizontal angle of ET on CT imagings, and compared with 40 normal ears by SPSS 27.0 software. Results: According to the relationship between AWWET and tympanum, patients were divided into the communicated group and the blocked group. A male predominance, left ear predominance, with high incidence of hemifacial microsomia exhibited in both groups. AWWET was presented as a widened lumen on CT. In 11 ears (4 ears in the communicated group, 7 ears in the blocked group), ETs bifurcated, the upper bony tube extended to the sphenoid body, the lower part continued down to cartilaginous ET and opened onto the nasopharynx, with"mastoid-like"pneumatization of the sphenoid body in 6 ears. The middle ear deformity in case group was more serious than MA control group, especially the blocked group. The incidence of otitis media in the communicated group was lower than that in the MA control group, and 4 cases in the blocked group had effusion in the ET. Compaired with normal ear, the bony ET elongated significantly in the AWWET groups, and the whole course of ET was significantly shortened, specially in the blocked group. The angle between the bony ET and the cartilaginous ET was decreased and the horizontal angle of the ET increased in the AWWET groups, the difference was considered to indicate statistical significance(P<0.05). Conclusions: AWWET with MA is rare, a male predominance, left ear predominance, and with high incidence of hemifacial microsomia. The middle ear deformity is more serious than common MA, especially in the blocked group. The incidence of otitis media in the communicated group is significantly lower than that in the common MA, and the blocked group may be accompanied by ET inflammation.

Symmetrization in primary tip rhinoplasty after resection of the cephalic portion of the lower-lateral cartilage

The cephalic trim allows the remodeling of the alar cartilages by removing the cranial portion of the lower-lateral cartilages; this resection determines raising the tip of the nose through its rotation. The objective of this study is to demonstrate how a greater symmetry of the lower-lateral cartilages after resection of the cephalic portion is obtainable by introducing a specific additional surgical time into the procedure. Between June 2016 and December 2021, forty-six patients underwent primary rhinoplasty with the cephalic portion of the alar cartilage resection. After the cephalic trim symmetry of the nose tip was then assessed through a specific additional surgical maneuver in 23 patients (Group A), whereas in 23 patients, the evaluation of symmetry was performed according only to the surgeon's personal judgment (Group B). Preoperative and postoperative pictures were evaluated in the symmetry of the two sides of the faces considering anthropometric measurements and the judgment by ten plastic surgeons uninvolved in this study. None of the patients had completely symmetric values. Objectively, the degree of asymmetry in Frankfurt's plane, considering RMLLA (midline-lateral alar margin ratio), was significantly decreased in Group A. Subjectively, more patients in Group A who were judged with asymmetrical face before rhinoplasty were evaluated with a symmetrical face after rhinoplasty than those in GroupB. We believe that in closed rhinoplasty, the symmetry of the postoperative sides of the face is increased by performing an easily replicable intraoperative maneuver as described.

Advantages of the Cartilage-Sparing Technique in Prominent Ear Deformity Surgery: Comparison of a New Technique.

Ear cartilage, crucial for maintaining ear shape and function, can sometimes undergo damage or deformation, requiring surgical intervention. This study aimed to compare the efficacy of a novel, less invasive cartilage-protective method with the traditional, more invasive cartilage-removal technique. Our study included 64 patients (128 ears). The first group of 32 patients (64 ears) received the new cartilage-protective technique, while the second group of an equal number of patients and ears underwent the traditional method. The newer technique endeavors to retain as much healthy cartilage as possible, addressing only the issue at hand, while the traditional technique requires the removal of a substantial portion of cartilage. The cartilage-protective method demonstrated several notable advantages over the traditional one. First, it significantly reduced the operation duration due to its less invasive nature. Second, it caused less pain to the patients by minimizing trauma to surrounding tissues. Furthermore, this technique significantly lowered the risk of complications, probably due to the minimal disturbance or removal of healthy cartilage, hence reducing the likelihood of post-operative complications such as infections or deformities. The findings of our study propose the cartilage-protective method as a superior treatment option when surgical intervention becomes necessary to repair or restore the function of ear cartilage. This technique, being less invasive, not only results in less pain for the patients but also reduces the risk of complications. It promotes quicker patient recovery without any loss of sensation in the ear. Thus, it could potentially revolutionize the approach to dealing with ear cartilage issues. Level four.

Development of machine learning models aiming at knee osteoarthritis diagnosing: an MRI radiomics analysis

BackgroundTo develop and assess the performance of machine learning (ML) models based on magnetic resonance imaging (MRI) radiomics analysis for knee osteoarthritis (KOA) diagnosis.MethodsThis retrospective study analysed 148 consecutive patients (72 with KOA and 76 without) with available MRI image data, where radiomics features in cartilage portions were extracted and then filtered. Intraclass correlation coefficient (ICC) was calculated to quantify the reproducibility of features, and a threshold of 0.8 was set. The training and validation cohorts consisted of 117 and 31 cases, respectively. Least absolute shrinkage and selection operator (LASSO) regression method was employed for feature selection. The ML classifiers were logistic regression (LR), K-nearest neighbour (KNN) and support vector machine (SVM). In each algorithm, ten models derived from all available planes of three joint compartments and their various combinations were, respectively, constructed for comparative analysis. The performance of classifiers was mainly evaluated and compared by receiver operating characteristic (ROC) analysis.ResultsAll models achieved satisfying performances, especially the Final model, where accuracy and area under ROC curve (AUC) of LR classifier were 0.968, 0.983 (0.957–1.000, 95% CI) in the validation cohort, and 0.940, 0.984 (0.969–0.995, 95% CI) in the training cohort, respectively.ConclusionThe MRI radiomics analysis represented promising performance in noninvasive and preoperative KOA diagnosis, especially when considering all available planes of all three compartments of knee joints.

Using Microphysiological System for the Development of Treatments for Joint Inflammation and Associated Cartilage Loss-A Pilot Study.

Osteoarthritis (OA) is a painful and disabling joint disease affecting millions worldwide. The lack of clinically relevant models limits our ability to predict therapeutic outcomes prior to clinical trials, where most drugs fail. Therefore, there is a need for a model that accurately recapitulates the whole-joint disease nature of OA in humans. Emerging microphysiological systems provide a new opportunity. We recently established a miniature knee joint system, known as the miniJoint, in which human bone-marrow-derived mesenchymal stem cells (hBMSCs) were used to create an osteochondral complex, synovial-like fibrous tissue, and adipose tissue analogs. In this study, we explored the potential of the miniJoint in developing novel treatments for OA by testing the hypothesis that co-treatment with anti-inflammation and chondroinducing agents can suppress joint inflammation and associated cartilage degradation. Specifically, we created a "synovitis"-relevant OA model in the miniJoint by treating synovial-like tissues with interleukin-1β (IL-1β), and then a combined treatment of oligodeoxynucleotides (ODNs) suppressing the nuclear factor kappa beta (NF-κB) genetic pathway and bone morphogenic protein-7 (BMP-7) was introduced. The combined treatment with BMP-7 and ODNs reduced inflammation in the synovial-like fibrous tissue and showed an increase in glycosaminoglycan formation in the cartilage portion of the osteochondral complex. For the first time, this study demonstrated the potential of the miniJoint in developing disease-modifying OA drugs. The therapeutic efficacy of co-treatment with NF-κB ODNs and BMP-7 can be further validated in future clinical studies.

Bone marrow stem cells incubated with ellipticine regenerate articular cartilage by attenuating inflammation and cartilage degradation in rabbit model.

Ellipticine (Ellip.) was recently reported to have beneficial effects on the differentiation of adipose-derived stem cells into mature chondrocyte-like cells. On the other hand, no practical results have been derived from the transplantation of bone marrow stem cells (BMSCs) in a rabbit osteoarthritis (OA) model. This study examined whether autologous BMSCs incubated with ellipticine (Ellip.+BMSCs) could regenerate articular cartilage in rabbit OA, a model similar to degenerative arthritis in human beings. A portion of rabbit articular cartilage was surgically removed, and Ellip.+BMSCs were transplanted into the lesion area. After two and four weeks of treatment, the serum levels of proinflammatory cytokines, i.e., tumor necrosis factor α (TNF-α) and prostaglandin E2 (PGE2), were analyzed, while macroscopic and micro-computed tomography (CT) evaluations were conducted to determine the intensity of cartilage degeneration. Furthermore, immuno-blotting was performed to evaluate the mitogen-activated protein kinases, PI3K/Akt, and nuclear factor-κB (NF-κB) signaling in rabbit OA models. Histological staining was used to confirm the change in the pattern of collagen and proteoglycan in the articular cartilage matrix. The transplantation of Ellip.+BMSCs elicited a chondroprotective effect by reducing the inflammatory factors (TNF-α, PGE2) in a time-dependent manner. Macroscopic observations, micro-CT, and histological staining revealed articular cartilage regeneration with the downregulation of matrix-metallo proteinases (MMPs), preventing articular cartilage degradation. Furthermore, histological observations confirmed a significant boost in the production of chondrocytes, collagen, and proteoglycan compared to the control group. Western blotting data revealed the downregulation of the p38, PI3K-Akt, and NF-κB inflammatory pathways to attenuate inflammation. The transplantation of Ellip.+BMSCs normalized the OA condition by boosting the recovery of degenerated articular cartilage and inhibiting the catabolic signaling pathway.

Surgical Treatment of Nictitans Membrane Eversion in Dogs

The presented study is the first retrospective evaluation of the scrolling of the third eyelid in a total of 44 dogs referred to the Istanbul University-Cerrahpaşa, Faculty of Veterinary, Department of Surgery between 2012 and 2021 with a sudden onset of an ocular mass in the medial canthus with epiphora and conjunctival hyperemia. The clinical appearance of the patients, the treatment procedures applied, and the results were examined. A complete ophthalmological inspection revealed the cartilage eversion of the nictitating membrane in sixteen patients (24 eyes) due to the scrolling of the third eyelid and cartilage eversion accompanied by a prolapsed gland in twenty-eight patients (32 eyes). Cartilage eversion was treated by the resection of the defected cartilage portion. In cases with prolapse of the nictitans gland accompanying cartilage eversion, the Morgan pocket method was applied to reposition the prolapsed gland by resectioning the rotating cartilage. In conclusion, -taking into account the potential effect of breed, age, and gender predispositions- the therapeutic approach followed revealed satisfactory results in maintaining the functional capacity of the third eyelid in dogs with cartilage eversion of the nictitating membrane and hyperplasia of the nictitans gland.

The ethmoid bone is the ideal graft to strengthen nasal septum L-strut among different grafts: An evaluation based on finite element analysis.

In the rhinoplasty of Asian short nose deformity, the surgeon cuts a portion of septal cartilage and retains the nasal septum L-strut, but a deviated nasal septum is formed after the surgery under forces of soft tissue contracture. Although various autologous grafts are used to reinforce the L-strut, there is a lack of objective "mechanical theory" to support the clinical findings in other studies at the present time. A simplified and geometrical finite element model of L-strut reinforced with clinically common materials, including auricular cartilage, nasal septal cartilage, and perpendicular plate of ethmoid, was established. Simulating the mechanical environment of nasal tip in reality, when the force was loaded, the von Mises stress and directional deformation of the L-strut were observed under different widths. Kruskal-Wallis test was used to examine the significance of intergroup differences of L-strut, and P<0.05 indicated statistical significance. All autologous grafts decreased the maximum directional deformation of L-strut, and the variance of nasal tip displacement was reduced; the perpendicular plate of ethmoid showed a distinct effect. The increasing width of the L-strut reduced the maximum displacement of the nasal tip, but the influence of using grafts as a reinforcement to the L-strut was much greater than the residual width (p=0.003). The graft reinforcement significantly increased the stability of the L-strut, which enhanced the resistance to deformation in the long-term action of tension, and the effect of the perpendicular plate of ethmoid to reinforce was significantly better than that of auricular and nasal septal cartilage.

Improving Safety in Chondrolaryngoplasty.

Improving Safety in Chondrolaryngoplasty.

Cricotracheostomy in a patient with severe kyphosis: A case report.

Cricotracheostomy is a useful surgical procedure for opening the airway in cases where conventional tracheotomy is difficult. This is a safe and easy technique involving removal of the anterior portion of the cricoid cartilage. Herein, we report the case of a patient with difficulty in neck extension due to severe kyphosis, who underwent cricotracheostomy. A 65-year-old woman developed dyspnea and was transported to our hospital. SpO2 was 60% (room air) and endotracheal intubation was performed. She was managed on ventilator. However, weaning off the ventilator was difficult, and endotracheal intubation was prolonged. Subsequently, the patient was referred to us for a tracheostomy. The patient was unable to maintain the supine position due to severe kyphosis, and computed tomography revealed that the brachiocephalic artery was running just below the thyroid gland. Therefore, conventional tracheostomy was difficult to perform, and we performed cricotracheostomy instead. After the cricotracheostomy, there were no tracheal problems, such as tracheal stenosis and stomal hemorrhage. Cricotracheostomy can be performed in cases where multiple anatomical difficulties may be faced in the tracheostomy site, as in this case. Furthermore, cricotracheostomy is beneficial for long-term airway management because it causes fewer complications compared to conventional tracheotomy.

Calcification and resorption of mouse Meckel's cartilage analyzed by von Kossa and tartrate-resistant acid phosphatase histochemistry and scanning electron microscopy/energy-dispersive X-ray spectrometry.

Meckel's cartilage is essential for the normal development of the mandible. The fate of the intermediate portion of Meckel's cartilage is unique as most of it disappears soon after birth except for the part that forms the sphenomandibular ligament. The mechanism of the disappearance of Meckel's cartilage is unknown; therefore, this study was designed to investigate the process of Meckel's cartilage degradation, focusing on cartilage matrix calcification and the appearance of chondroclasts. Developing mouse mandibles at embryonic days 15, 16, 17, and 18, and postnatal day 2 were processed for whole-mount staining with alcian blue and alizarin red. The mandibles on embryonic days 15, 16, 17, and 18 were fixed and embedded in paraffin. Adjacent sections were processed for von Kossa and tartrate-resistant acid phosphatase (TRAP) histochemistry and scanning electron microscopy/energy-dispersive X-ray spectrometry (SEM/EDS). Calcification and the element concentrations of calcium, phosphorus, and carbon were examined with von Kossa histochemistry and SEM/EDS. The involvement of chondroclasts was investigated using TRAP histochemistry. The results demonstrated that the intermediate portion of Meckel's cartilage is resorbed by chondroclasts after chondrocyte hypertrophy and cartilage matrix calcification and that the mineral concentration of calcified Meckel's cartilage is comparable to that of the surrounding bone. This study contributes to the understanding of the mechanism of Meckel's cartilage resorption and provides useful insights into the development of the mandible.

Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

Potential Value of Matrix Metalloproteinase-13 as a Biomarker for Osteoarthritis.

Background: Emerging knowledge has highlighted the role of matrix metalloproteinase (MMP)-13 in osteoarthritis (OA); however, the suitability of MMP-13 as a biomarker for OA remains unclear. Therefore, this study aimed to assess the potential value of MMP-13 as a biomarker for OA.Methods: The study enrolled 51 patients, of which 33 had advanced varus OA and 18 did not have OA. Immunohistochemistry and western blotting analyses were performed to measure MMP-13 activity in the cartilage and subchondral bone of patients with OA. Enzyme-linked immunosorbent assay was used to measure serum MMP-13 levels in patients with or without OA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess the association between serum MMP-13 levels and clinical symptoms. Furthermore, the association between serum MMP-13 levels and radiological severity of OA was evaluated using the Kellgren–Lawrence (KL) grading system. Finally, we built the proportional odds logistic regression models to evaluate serum MMP-13 levels as a potential predictor for OA.Results: MMP-13 levels were significantly higher in the severe-worn cartilage of the medial tibial plateau than in the relatively intact portion of the lateral cartilage (p < 0.05). This was contrary to the findings for MMP-13 differential expression in the subchondral bone in knee OA (p < 0.05). Patients with OA had significantly higher serum MMP-13 levels compared with patients without OA. Additionally, remarkable associations among serum MMP-13 levels, WOMAC scores, and KL grading scores were found in the end-stage OA. Furthermore, the subsequent analysis suggested that serum MMP-13 level was a significant predictor for OA.Conclusion: MMP-13 is valuable for diagnosing, measuring disease severity, and predicting OA in the advanced period of the disease, suggesting that it has potential possibility as a biomarker for OA. However, the underlying mechanisms and clinical application of MMP-13 as a biomarker for OA require to be further investigated.

A rapid prototyping approach for custom training of autologous ear reconstruction

Autologous ear reconstruction is the preferred treatment in case of partial or total absence of the patient external ear. This kind of surgery can be really challenging since precise replication of complex three-dimensional structure of the ear is crucial to provide the patients with aesthetically consistent reconstructed anatomy. Therefore, the results strongly depends on the “artistic skills” of the surgeon who is in charge to carry out a three-dimensional sculpture, which resembles the shape of a normal ear. In this context, the definition of a preoperative planning and simulation process based on the patient's specific anatomy may help the surgeon in speeding up the ear reconstruction process and, at the same time, to obtain better results, thus allowing a superior surgical outcome. In the present work the main required features for performing an effective simulation of the ear reconstruction are identified and a strategy for their interactive design and customization is devised with the perspective of a semi-automatization of the procedure. In detail, the paper provides a framework which start from the acquisition of 3D data from both a healthy ear of the patient (or, if not available e.g. due to bilateral microtia of the ear of one of his parents or from a template) and of costal cartilage. Acquired 3D data are properly processed to define the anatomical elements of the ear and to find, using nesting-based algorithms, the costal cartilage portions to be used for carving the ear itself. Finally, 3D printing is used to create a mockup of the ear elements and a prototype of the ear to be reconstructed is created. Validated on a test case, the devised procedure demonstrate its effectiveness.

Pignat's vertical partial laryngectomy with crico-hyoido-epiglotto-plasty.

Pignat's partial laryngectomy with crico-hyoido-epiglotto-plasty (CHEPL) is a vertical laryngectomy with resection of the anterior portion of the thyroid cartilage and reconstruction with a wires net and the subhyoid muscles. The aim of this retrospective study was to evaluate and analyze oncologic and functional outcomes in patients affected by laryngeal squamous cell carcinoma and treated with Pignat's partial laryngectomy. Seventy patients with cT1-cT3 glottic cancer were surgically treated with Pignat's technique. invasion of posterior cricoid arch, more than 3 mm under glottis, of more than one arytenoid, of posterior portion of thyroid cartilage, of the suprahyoid epiglottis. Overall survival, disease free survival, rates of decannulation and enteral feeding were analyzed. 23 (32.9%) pT1, 37 (52.9%) pT2, 5 (7.1%) pT3, 5 (7.1%) pT4a, 64 (91.5%) pN0, 5 (7.1%) pN1, 1 (1.4%) pN2. Adjuvant treatment was administered to 13 patients (18.6%). All patients had tracheotomy. Five year OS and DFS were 81.66 and 77.95%, respectively. A statistically significant DFS difference was observed between early and late stages. Five year local control was 81.16%. Five year larynx preservation rate was 89.16%. Median decannulation time was 12 days. Median duration of enteral nutrition was 16 days. All patients achieved efficient phonation. Pignat's partial laryngectomy with CHEPL can represent an alternative to horizontal supracricoid laryngectomy to achieve laryngeal preservation. Good oncologic and functional outcomes are possible as long as indications are followed.