Cartilaginous Structures Research Articles

Usefulness of Intraoperative Arthrography for Postaxial Polysyndactyly of the Foot.

Surgery for polydactyly of the foot aims to achieve good cosmesis and improve shoe fitting. An accurate understanding of toe morphology will help to minimize the skin incision or optimize the surgical plan before incision. However, it is difficult to determine the shape of the articular surface using radiographs of children with immature bone. We performed arthrography during surgery for postaxial polydactyly of the foot to assess the cartilaginous structures. The purpose of this study was to investigate the usefulness of arthrography in postaxial polydactyly of the foot. We included 36 digits of 31 patients (16 males and 15 females), including 5 bilateral cases. The age at surgery ranged from 9 to 75 months (mean, 20mo). Intraoperative arthrography was performed and all radiographs and arthrograms were reviewed and classified by 3 observers using the Watanabe classification. The absolute percentage agreement between the observers was calculated. The senior author assigned the arthrograms as the reference. The types determined by the other 2 observers using radiographs and arthrograms were compared with the reference. Full agreement occurred in 66.7% of the radiographs and in 75% of arthrograms. The mean kappa coefficient was 0.58, indicating fair agreement, between the reference and the radiologic assessment, while it was 0.81, indicating excellent or almost perfect agreement, in the evaluation using arthrograms. Intraoperative arthrography is an easy and reliable diagnostic method that can be used to determine the detailed articular shape. Level III.

Frameworks for Total Ear Reconstruction: Past, Present and Future Directions

Total ear reconstruction describes surgical approaches aimed toward restoring the external ear to correct acquired or congenital deformities. Frameworks for auricular reconstruction have undergone substantial evolution over the past century and are broadly categorized as either autologous or alloplastic in nature. Recently, advances in tissue engineering, regenerative medicine and materials science have opened new avenues for recreating the cartilaginous and soft tissue structures of the ear through development of cutting-edge 3D constructs derived from a patient's own cells in a process known as bioprinting. This review outlines the historical approaches to frameworks for ear reconstruction and provides an updated synopsis and appraisal of current bioprinting efforts.

Scanning electron microscopic and histological features of the oral cavity of the Egyptian tortoise (Testudo kleinmanni).

This investigation was led to depict the structural and functional adaptations of the oral cavity of herbivorous Egyptian tortoises using scanning electron and light microscopes. The SEM showed that the triangular papillary tongue possessed three conical papillary subtypes: the rectangular conical on the tip, the round conical on the rest of the dorsal lingual surface and the elongated conical on the caudal portion of the lingual wing. The presence of the serrated lips with their valves compensated for the absence of the teeth. The rostral part had a vomeronasal opening while the middle part had the choana, but the caudal part had numerous openings of the salivary glands. There are three palatine folds: a single median palatine fold, two peripheral palatine folds and the choanal fold. The current histological results show the keratinized dorsal lingual surface, in which the keratinized layer extended to cover the papillae. Two types of lingual glands, according to their position, are papillary superficial and deep lingual glands. Papillary or superficial glands open in the interpapillary spaces via narrow openings, while the deep glands are surrounded by well-developed muscles and open via wide openings on the dorsal lingual surface. An entoglossal cartilaginous structure of hyaline cartilage was found in the mid- and hindtongue, with numerous chondrocytes lodged within the lacunae. Our results conclude that the oral cavity of the herbivorous Egyptian tortoise was adapted to the dietary and vigorous demands of the Egyptian fauna.

OA24 Airway obstruction in an adolescent: relapsing polychondritis

OA24 Airway obstruction in an adolescent: relapsing polychondritis

The diagnostic dilemma of congenital foot deformity in pediatrics: could adding ultrasound be problem solving?

BackgroundFoot deformity is one of the most common congenital musculoskeletal anomalies in the pediatric age group. Accurate diagnosis can be sometimes impossible to be established clinically. In the assessment of foot abnormalities, radiology plays a crucial role. Lack of ossification of the tarsal bones renders plain radiographs of the foot as of little diagnostic value in this age group. MRI apart from its cost requires anesthesia and sedation. In contrast, ultrasonography allows for the imaging of cartilaginous structures. As a result, newborn foot abnormalities can be thoroughly assessed. The whole anatomy of the foot is evaluated using several scanning views. Additional planes may be needed to show the pathologic features of a specific deformity. The purpose of this study was to demonstrate the additive value of ultrasound to plain radiographs in the assessment of foot deformities in the pediatric age group.ResultsThis case–control study was performed on sixty children, 30 of which were patients admitted from the pediatric orthopedic clinic, presenting with foot deformity, after being examined clinically. Antero-posterior and lateral radiographs of foot, tibiocalcaneal, antero-posterior talocalcaneal, and lateral talocalcaneal angles were measured. Sonographic examination was done in different projections of both feet, while the patient is lying supine with dynamic sonography. The sonographic parameters measured were as follows: medial malleolar–navicular distance and medial soft tissue thickness on medial projection, calcaneocuboid distance on lateral projection, talonavicular relation on dorsal projection, and tibiocalcaneal distance on posterior projection. There was a statistically significant difference between patients and controls in the medial malleolar–navicular distance and medial soft tissue thickness measured on the medial view, the calcaneocuboid distance recorded on the lateral view, and the tibiocalcaneal distance measured on the posterior view.ConclusionsUltrasonography has a growing and useful role as a complementary imaging modality in the evaluation and follow-up of pediatric patients with foot deformity.

Clinical Characteristics of Our Follow-Up Patients with the Rare Disease Relapsing Polychondritis: A Single-Center Study

Tekrarlayan polikondrit (TP), özellikle kulaklar, burun, gözler, eklemler ve solunum yolu olmak üzere vücuttaki kıkırdaklı yapıları ve diğer dokuları etkileyen, immun aracılı, sistemik inflamatuar, dejeneratif bir hastalıktır. TP'nin hedef dokuları sadece kıkırdak içeren yapılar olmayıp, deri, böbrek, kalp ve merkezi sinir sistemi gibi kıkırdak içermeyen yapılar da etkilenir. Nadir bir hastalık olması nedenli epidemiyolojisi konusunda veriler yetersizdir. Sıklıkla 40-60 yaşları arasında görülür. Erkekler ve kadınlar eşit olarak etkilenir. Klinik özellikleri hastalar arasında değişkenlik göstermektedir. Hastalığın nadir görülmesi ve geniş klinik yelpazesi sıklıkla yanlış tanıya veya tanıda gecikmeye yol açar. TP'nin erken teşhisi ve hızlı tedavisi, ilişkili komplikasyonları ve ölümü önlemek, prognozu iyileştirmek için kritik öneme sahiptir. Tedavi seçenekleri arasında glukokortikoidler, dapson, hastalık modifiye edici antiromatizmal ilaçlar (DMARDs) ve biyolojik ajanlar yer alır. Prognoz, organ hasarının ciddiyetine bağlı olarak klinik tablo kadar heterojendir. TP tanısı ile izlediğimiz 10 hastanın ortalama hastalık başlama yaşı 49,5±4,1 idi. Semptom başlangıcı ile tanı arası süre ortanca 3 aydı (2-60). Hastaların %80’i erkekti. En sık rastlanan klinik bulgu aurikuler kondritti (%100). Hastaların tümü tedavileri sırasında en az bir kez oral prednizolon aldı. İki hastaya intravenöz metilprednizolon uygulandı. Bir hastada DMARDs yanıtsız olması nedenli infliksimaba geçildi. Bir hasta pnömosepsis nedenli kaybedildi. Bu yazıda, TP'nin patogenezi, klinik seyri, teşhisi ve tedavisi ile ilgili mevcut bilgilere genel bir bakış sunarak nadir görülen ancak pek çok sistemi etkileyebilen bu hastalıkla ilgili hekimler arasındaki farkındalığı artırmayı amaçladık.

Detection of morphometrical, histological and histochemical characteristics of lung and trachea in adult local squirrel (Sciurus anomalus)

The present study aimed to identify the topography, morphology, histochemistry and histology of lung structures, bronchial divisions and trachea in adult local Squirrel (Sciurus anomalus) as a species inhabited in Iraqi environments. This work was conducted on thirty local Squirrel of both sexes (15) males and (15) females were divided into three equal groups, first for http://wsx5customurl.comanatomical perceptions, second to resin cast technique and the third for histological study. Anatomically, in both sexes, the trachea appeared as a cartilaginous structure consisting of flexible cartilaginous rings, C-like, connected by annular ligaments. It begins at the end of the cricoid cartilage from the level of the second cervical vertebra to the fourth thoracic vertebral plane; eventually, it splits into the right and left main bronchi. Count tracheal rings, the entire weight of the lung, full length, the diameter of the trachea and right and left bronchi. The trachea in females was slightly less than in males but not significantly. The bronchial tree was detected in resin cast, which was constructed of the trachea divided into left and right primary bronchi (Main bronchi), the right one was split into four secondary bronchi to enter the right lobes and two secondary bronchi to the left one. The left lung contains one lobe, whereas four lobes were observed in the right. Histologically, the wall of the trachea consists of four layers. Epithelial cells of ciliated pseudostratified columnar and goblet cells that reacted positively with PAS were covered in the mucosa. Submucosa was devoid of the tracheal glands. The Trachealis muscle is connected from the outer aspect of rings. Similarly to the trachea, the primary bronchi are structured but smaller in diameter; they break up within the lung into primary, secondary and tertiary bronchi, then it terminates in respiratory bronchioles that contain Clara cells and open at the end in the sacs of alveoli. Two types of pneumocystis were observed lining the alveoli. The current study concluded anatomically and histologically that there were no significant differences between males and females of local squirrels. The lobulation of the lung in squirrels is different from other animals. The trachea and lung histologically resembled numerous animals, however, the wall had micro morphometric changes. But, the surface lining cells of the tracheal and bronchi mucosa secrete neutral mucin, with no submucosal glands in the tracheal wall. Keywords: Trachea, Local Squirrel, Bronchial Tree, Histochemical, Lung.

Issue Information

Deformational external ear anomalies in neonates. Conchal crus (A); a leg extending from the middle part of the cavity of concha to its vertical wall, Stahl ear (B); cartilaginous structure starting from the superior crus of antihelix and passing through the fossa scaphoid towards the edge of the helix, Lop ear (C); abnormal downward curving of the upper part of the auricle and absence of the superior crus of antihelix, Rim kink (D); vertical depression in the helix, Prominent ear (E); prominent ear. Further details can be seen in the article by Erdem et al. in this issue. image

Ontogeny of the paraphalanges and derived phalanges of Hemidactylus turcicus (Squamata: Gekkonidae).

Gekkotan lizards of the genus Hemidactylus exhibit derived digital morphologies. These include heavily reduced antepenultimate phalanges of digits III and IV of the manus and digits III-V of the pes, as well as enigmatic cartilaginous structures called paraphalanges. Despite this well-known morphological derivation, no studies have investigated the development of these structures. We aimed to determine if heterochrony underlies the derived antepenultimate phalanges of Hemidactylus. Furthermore, we aimed to determine if convergently evolved paraphalanges exhibit similar or divergent developmental patterns. Herein we describe embryonic skeletal development in the hands and feet of four gekkonid species, exhibiting a range of digital morphologies. We determined that the derived antepenultimate phalanges of Hemidactylus are the products of paedomorphosis. Furthermore, we found divergent developmental patterns between convergently evolved paraphalanges.

A FoxA2+ long-term stem cell population is necessary for growth plate cartilage regeneration after injury.

Longitudinal bone growth, achieved through endochondral ossification, is accomplished by a cartilaginous structure, the physis or growth plate, comprised of morphologically distinct zones related to chondrocyte function: resting, proliferating and hypertrophic zones. The resting zone is a stem cell-rich region that gives rise to the growth plate, and exhibits regenerative capabilities in response to injury. We discovered a FoxA2+group of long-term skeletal stem cells, situated at the top of resting zone, adjacent the secondary ossification center, distinct from the previously characterized PTHrP+ stem cells. Compared to PTHrP+ cells, FoxA2+ cells exhibit higher clonogenicity and longevity. FoxA2+ cells exhibit dual osteo-chondro-progenitor activity during early postnatal development (P0-P28) and chondrogenic potential beyond P28. When the growth plate is injured, FoxA2+ cells expand in response to trauma, and produce physeal cartilage for growth plate tissue regeneration.

Biologic therapy in relapsing polychondritis: navigating between options

Introduction Relapsing polychondritis (RP) is a rare systemic inflammatory disease of unknown etiology, primarily affecting cartilaginous tissue and proteoglycan-rich structures. Clinical manifestations vary from mild symptoms to occasional organ or life-threatening complications. Treatment can be challenging and is mostly based on experience or case reports/series. Areas covered There is growing literature investigating the role of biologics in the management of RP. TNFα antagonists, abatacept, tocilizumab, rituximab, anakinra and tofacitinib have been prescribed in several RP patients, mainly as second-line treatment, after conventional immunosuppressive agents’ failure. Expert opinion : Glucocorticoids represent the gold standard treatment of RP. Conventional immunosuppressants should be administered in refractory patients or when a glucocorticoid-sparing effect is needed. Biologic therapy should be used after failure of conventional treatments or in severe manifestations. TNFα inhibitors are the most prescribed biologic agent, with partial or complete response in several cases; but loss of efficacy may occur over time. Infliximab and adalimumab should be preferred among TNFα antagonists. Abatacept and tocilizumab proved to be effective as second-line biologic agents, but frequent infections are reported with the former. Data on anakinra and rituximab are controversial, therefore they are not recommended as first-line biologic drugs. The use of JAK inhibitors is still anecdotal.

Recommendations of diagnosis and treatment of relapsing polychondritis in China

Relapsing polychondritis is an immune mediated systemic inflammatory disease, involving the cartilaginous and proteoglycan rich structures. The characteristic manifestations were inflammation and deformity of ear and nasal cartilage. Here, Chinese Rheumatology Association summarized manifestations, diagnosis and disease activity index evaluation of relapsing polychondritis, standardized treatment regimens, to improve disease prognosis.

Metabolic Bone Disease of Prematurity.

Metabolic Bone Disease of Prematurity.

Mineralized belemnoid cephalic cartilage from the late Triassic Polzberg Konservat-Lagerstätte (Austria).

Although hyaline cartilage is widely distributed in various invertebrate groups such as sabellid polychaetes, molluscs (cephalopods, gastropods) and a chelicerate arthropod group (horseshoe crabs), the enigmatic relationship and distribution of cartilage in taxonomic groups remains to be explained. It can be interpreted as a convergent trait in animal evolution and thus does not seem to be a vertebrate invention. Due to the poor fossil record of cartilaginous structures, occurrences of mineralized fossil cartilages are important for evolutionary biology and paleontology. Although the biochemical composition of recent cephalopod cartilage differs from vertebrate cartilage, histologically the cartilages of these animal groups resemble one another remarkably. In this study we present fossil material from the late Triassic Polzberg Konservat-Lagerstätte near Lunz am See (Lower Austria, Northern Calcareous Alps). A rich Carnian fauna is preserved here, whereby a morphogroup (often associated with belemnoid remains) of black, amorphous appearing fossils still remained undetermined. These multi-elemental, symmetrical fossils show remarkable similarities to recent cartilage. We examined the conspicuous micro- and ultrastructure of these enigmatic fossils by thin-sectioning and Scanning Electron Microscopy (SEM). The geochemical composition analyzed by Microprobe and Energy Dispersive X-ray Spectroscopy (SEM-EDX) revealed carbonization as the taphonomic pathway for this fossil group. Mineralization of soft tissues permits the 3D preservation of otherwise degraded soft tissues such as cartilage. We examined eighty-one specimens from the Polzberg locality and seven specimens from Cave del Predil (formerly Raibl, Julian Alps, Italy). The study included morphological examinations of these multi-elemental fossils and a focus on noticeable structures like grooves and ridges. The detected grooves are interpreted to be muscular attachment areas, and the preserved branched system of canaliculi is comparable to a channel system that is also present in recent coleoid cartilage. The new findings on these long-known enigmatic structures strongly point to the preservation of cephalic cartilage belonging to the belemnoid Phragmoteuthis bisinuata and its homologization to the cephalic cartilage of modern coleoids.

Imaging of Complications of Chemoradiation.

Chemoradiation for head and neck cancer is associated with a variety of early and late complications. Toxicities may affect the aero-digestive tract (mucositis, salivary gland injury), regional osseous and cartilaginous structures (osteoradionecrosis (ORN) and chondronecrosis), vasculature (progressive radiation vasculopathy and carotid blow out syndromes), and neural structures (optic neuritis, myelitis, and brain injury). These may be difficult to distinguish from tumor recurrence on imaging, and may necessitate the use of advanced MRI and molecular imaging techniques to reach the correct diagnosis. Secondary radiation-induced malignancies include thyroid cancer and a variety of sarcomas that may manifest several years after treatment. Checkpoint inhibitors can cause a variety of adverse immune events, including autoimmune hypophysitis and encephalitis.

MR Imaging Provides Practical Information for Preoperative Assessment of Radial Polydactyly with Bifurcation at the Metacarpophalangeal Joint Level.

PurposeWe aimed to evaluate the use of magnetic resonance imaging (MRI) to visualize unossified bone sites that are often not visible with radiography in pediatric radial polydactyly patients with bifurcation at the metacarpophalangeal (MP) joint level. The MRI validation could help in planning for surgical procedures.Patients and MethodsA total of 141 thumbs in 139 pediatric patients with bifurcation at the MP joint on radiography were included in this study. All the patients had undergone MRI with proton density-weighted fat-suppressed fast spin-echo (FS PDWI) sequence and fast fat-suppressed 3D spoiled gradient-recalled echo (FS 3D SPGR) sequence. The MR images of the cartilaginous structure and joint characteristics at the MP joint were evaluated and categorized by two experienced radiologists.ResultsOur analysis demonstrated that MR imaging, especially the FS 3D SPGR sequence, yields better visibility of the cartilaginous structure and shows clearer joint characteristics that could not be detected by radiography. The abnormalities included a cartilaginous connection on the base of duplicated proximal phalanx, cartilaginous joint connection and the shape of articular cartilage on the head of metacarpal and soft tissue band. Radiologically encountered duplications at the MP joint level were successfully classified into six types based on the MRI-detected structural changes. The distribution of the six types was 17.7% (25/141) in type 1, 53.9% (76/141) in type 2, 2.8% (4/141) in type 3, 9.9% (14/141) in type 4, and 13.5% (19/141) in type 5.ConclusionThis data showed that MR imaging provides practical information on the anatomic characteristics in radial polydactyly with bifurcation at the MP joint level that could aid surgical decision-making processes. Thus, the FS 3D SPGR sequence could be used as a MR imaging technique in radial polydactyly.

Larval Development in Tropical Gar (Atractosteus tropicus) Is Dependent on the Embryonic Thermal Regime: Ecological Implications under a Climate Change Context

In ectotherm species, environmental temperature plays a key role in development, growth, and survival. Thus, determining how temperature affects fish populations is of utmost importance to accurately predict the risk of climate change over fisheries and aquaculture, critical to warrant nutrition and food security in the coming years. Here, the potential effects of abnormal thermal regimes (24, 28 and 32 °C; TR24, TR28, and TR32, respectively) exclusively applied during embryogenesis in tropical gar (Atractosteus tropicus) has been explored to decipher the potential consequences on hatching and growth from fertilization to 16 days post-fertilization (dpf), while effects on skeletal development and body morphology were explored at fertilization and 16 dpf. Egg incubation at higher temperatures induced an early hatching and mouth opening. A higher hatching rate was obtained in eggs incubated at 28 °C when compared to those at 24 °C. No differences were found in fish survival at 16 dpf, with values ranging from 84.89 to 88.86%, but increased wet body weight and standard length were found in larvae from TR24 and TR32 groups. Thermal regime during embryogenesis also altered the rate at which the skeletal development occurs. Larvae from the TR32 group showed an advanced skeletal development, with a higher development of cartilaginous structures at hatching but reduced at 16 dpf when compared with the TR24 and TR28 groups. Furthermore, this advanced skeletal development seemed to determine the fish body morphology. Based on biometric measures, a principal component analysis showed how along development, larvae from each thermal regime were clustered together, but with each population remaining clearly separated from each other. The current study shows how changes in temperature may induce craniofacial and morphological alterations in fish during early stages and contribute to understanding the possible effects of global warming in early development of fish and its ecological implications.

Influence of bFGF on in vitro expansion and chondrogenic construction of articular cartilage-derived progenitor cells.

BackgroundArticular cartilage-derived progenitor cells (ACPCs) possess the properties of both chondrocytes and bone marrow mesenchymal stem cells (BMSCs). However, the number of ACPCs in articular cartilage is low, and an effective culture system is needed for their expansion. Basic fibroblast growth factor (bFGF) promotes the expansion of chondrocytes and BMSCs, as well as the chondrogenic differentiation of BMSCs. Therefore, the aim of this study was to clarify whether bFGF could be used for in vitro expansion of ACPCs and whether bFGF promoted chondrogenic construction of ACPCs.MethodsWe applied the fibronectin adhesion method to sort mice ACPCs and compared the proliferative, osteogenic, and chondrogenic abilities of ACPCs by adding various concentration of bFGF (0, 2, and 5 ng/mL) to the cell culture medium. Then used the best system to construct cartilage with ACPCs in vitro and in vivo.ResultsThe results indicated that bFGF promoted ACPCs proliferation, inhibited osteogenesis, and promoted chondrogenesis, and that a cell culture system containing 2 ng/mL bFGF was optimal for these effects. ACPCs constructed cartilage using the filtered culture system presented homogeneous cartilaginous histological structure in vitro and in vivo.ConclusionsBy applying this cell culture system, homogenous cartilage tissue was constructed in vitro and in vivo by chondrogenic induction, which provides a stable cell expansion culture method for the application of ACPCs in cartilage repair.

Комплексное лечение пациентов с протяженным рубцовым стенозом гортани и шейного отдела трахеи

Improving the methods of reconstructive plastic surgery, the emergence of new algorithms for managing patients, the development of pharmacology have significantly improved the results of treatment of patients with cicatricial stenosis of the larynx and cervical trachea; however, the problem continues to be relevant since the outcome of treatment is not always satisfactory. The presence of chronic respiratory failure (which often accompanies cicatricial stenosis of the respiratory tract) as well as the lack of supporting viable cartilaginous structures of the larynx and trachea aggravates the course of the disease and requires a differentiated approach to the treatment of extended cicatricial laryngotracheal stenosis. The article analyzes the effectiveness of an integrated approach to the treatment of patients with extended laryngotracheal cicatricial deformity of the lumen using allogeneic graft as well as the correction of respiratory disorders and post-hypoxic tissue changes using inhalations of a heated helium-oxygen mixture in the perioperative period. The study included 20 patients with an age interval of 20–65 years and a disease duration of 1–12 years. At the outpatient stage, the necessary clinical and radiological, endoscopic, and functional examination was carried out. To detect chronic respiratory failure, the gas and acid-base composition of the blood was studied. In the hospital, all patients underwent reconstructive plastic surgery using allogeneic graft. All patients at the pre- and postoperative stage received inhalations with a heated helium-oxygen mixture according to the developed algorithm. The study showed that an integrated approach to the treatment of patients with extended laryngotracheal cicatricial stenoses is an effective method leading to good functional results of surgical treatment, reducing the time of postoperative wound regeneration and improving the quality of life of patients.

Transposition Flaps in the Reconstruction of Auricular Defects after MOHS Micrographic Surgery.

Background: Closing of ear defects can be a significant surgical challenge, due to the complex three-dimensional cartilaginous structure of this region. Patients and Results: We present a series of 5 retrospective cases of defects on the ear, left after Mohs micrographic surgery for skin cancer, that were repaired with transposition flaps and their Discussions and Conclusion: There are various surgical procedures described for the reconstruction of an ear defect, including local flaps, skin grafts, and even healing by secondary intention. In our opinion, transposition flaps can be a good option when dealing with defects of the tragus, chonca, triangular fossa, superior part of the helix, or even the medial part of the ear. It allows for reconstruction in a single surgical step with decreased morbidity and favorable cosmetic results.