Damage To Blood Supply Research Articles

The impact of Cortexin on cytokine levels in the treatment of moderate chronic generalized periodontitis in young and middle-aged people

Relevance. Chronic generalized periodontitis is one of the most common dental diseases in Russia and worldwide. Periodontitis causes changes in the immune system, cytokines, antioxidant protection, hemostasis and other systems, leading to periodontal microcirculatory and blood supply damage. Interleukins are regulatory molecules that play a part in specific immune reactions: inflammation, regeneration, and microcirculation. They are produced by immune system cells in response to an activating stimulus and regulate the strength and duration of immune and inflammatory reactions. Our study revealed an imbalance of pro- and anti-inflammatory cytokines in patients with moderate chronic generalized periodontitis of different ages.Material and Methods. The study involved 130 patients with moderate chronic generalized periodontitis aged 25 to 60. The control group consisted of 15 practically healthy individuals aged 18 to 24 years without acute and chronic periodontal diseases at the time of the study. The concentration of cytokines in blood serum and oral fluid (IL-1ß, IL-4, IL-8, IL-10) was evaluated in all patients before and after the standard comprehensive treatment and with the inclusion of Cortexin.Results. After the moderate chronic generalized periodontitis treatment, pro-inflammatory and anti-inflammatory cytokines in the blood decreased in the group of 25-44-year-olds. In standard treatment, IL-1ß level decreased by 30%, IL-4 – by two times, IL-8 – by 1.5 times, and IL-10 – by three times; but with Cortexin, IL-1ß became normal, IL-4 decreased by 3.5 times, IL-8 – by 2.5 times, IL-10 became normal. In the oral fluid of patients aged 25-44 years, IL-1ß decreased by 20% after the standard treatment, IL-4 decreased by six times, IL-8 decreased by two times, and the addition of Cortexin to the comprehensive therapy caused a 70% decrease, IL–4 reduced by ten times, IL-8 – by nine times, the concentration of IL-10 remained the same. IL-22 decreased by 1.5 and 2 times based on the treatment methods. The after-treatment assessment of changes in the interleukin content in blood serum in 45-60-year-old patients with chronic generalized periodontitis revealed the same levels of IL-4 after the standard treatment, a decrease of IL-1ß by 1.5 times, IL-8 - by 1.5 times; and the use of Cortexin in the treatment normalized the concentration of IL-4, led to a decrease in IL-1ß by two times, IL-8 - by three times. After the therapy, in the oral fluid of patients aged 45-60 years, IL-1ß decreased by 1.5 times with standard treatment, IL-4 and IL-8 decreased by two times, and IL-10 did not change, IL-22 - by 1.5 times; and using Cortexin, the concentration of IL-1ß decreased by 70%, IL-4 decreased by three times, IL-8 - by four times, IL-10 and IL-22 - by two times.Conclusion. Before treatment, the concentration of cytokines was higher in all groups of patients compared to the control values in blood serum and oral fluid. With standard therapy, the content of interleukins decreases in biological fluids, and the effect is more pronounced if standard treatment and Cortexin are combined. The correlation analysis detects that clinical manifestations of gingival inflammation are directly related to the concentration of pro- and anti-inflammatory interleukins in the blood and oral fluid.

Anatomical characterization of the intraosseous arteries of the porcine tibia

IntroductionTibial fractures have a high rate of post-fracture complications. Blood supply is recognized as a positive factor in tibial fracture healing. However, it’s difficult to assess blood supply damage after tibial fracture because of the lack of understanding of the tibial intraosseous arteries. This study aimed to delineate and anatomically characterize porcine tibial intraosseous arteries, as a model for the human system. MethodsTwenty right calf specimens with popliteal vessels were prepared from ordinary Landrace pigs. Epoxy resin was perfused into the vasculature from the popliteal artery. After 24 h, casts of the intraosseous arteries of the tibia were exposed through acid and alkali corrosion. The distribution and anatomy of the exposed intraosseous arteries were observed and measured under a microscope, and the data were statistically analyzed. ResultsSixteen complete specimens were obtained. The medullary artery bifurcated into the main ascending and descending branches, which each split into two upward primary branches that further divided into 1–3 secondary branches. Among all specimens, 56 ascending and 42 descending secondary branches, which were all ≥0.3 mm in diameter. Furthermore, the horizontal plane was divided into three zones—safety, buffer, and danger zones—according to the probability of the presence of intraosseous artery. DiscussionThe cast perfusion and corrosion approach was successfully applied for anatomical characterization of the intraosseous arteries of the porcine tibia. These observations provide a theoretical basis for understanding the tibial vasculature in humans and will facilitate the establishment of novel “safe corridor” in the tibia for the protection of the blood supply during surgery.

Worldwide research trends on femur head necrosis (2000-2021): a bibliometrics analysis and suggestions for researchers.

Osteonecrosis of the femoral head (ONFH) is a common and stubborn disease. The main causes are venous stasis of the femoral head, arterial blood supply damage, bone cell and bone marrow death, and bone tissue necrosis and subsequent repair obstacles. Over the past 22 years, the number of papers on ONFH has, overall, continued to increase. Using bibliometrics, we investigated the trends, frontiers, and hotspots of global scientific output in the past 22 years. We searched Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC) and retrieved information associated with papers and records published between 2000 and 2021. We used VOSviewer and CiteSpace to conduct bibliometric analysis and visual analysis on the overall distribution of annual output, major countries, active institutions, journals, authors, commonly cited literature, and keywords. The impact and quality of the papers were assessed using the global citation score (GCS). We retrieved a total of 2006 articles and reviews. Over the past 22 years, the number of publications (NP) increased. China ranked first in terms of NP, while the United States had the highest h-index and the highest number of citations (NC). Shanghai Jiao Tong University and International Orthopaedics were the institution and periodical, respectively. The paper written by Mont et al. in 2006 had the highest total GCS score, at 379. The top three keywords were "ischemic necrosis", "osteonecrosis", and "hip joint". Although there was a fluctuation in publications associated with ONFH, overall, the NP increased. China was the most prolific in this area, while the United States was the most influential country. The top 3 authors in terms of NP were Zhang, Motomura, and Zhao. Areas of focus in ONFH over recent years include signal pathway, genetic differentiation, glucocorticoid-induced osteogenesis, induced ischemic necrosis and osteogenesis. Our bibliometrics analysis revealed the research hotspots and rapid development trends of ONFH research in the past 22 years. The most critical indicators [researchers, countries, research institutions, and journals publishing osteonecrosis of the femoral head (ONFH) research] relevant to the research hotspots in the field of ONFH research were analyzed.

A New Potential Complication in 2-Level Anterior Cervical Discectomy and Fusion with Zero-Profile Devices: Collapse of the Middle Cervical Vertebra

The objective of this study was to describe a new potential complication, collapse in the middle cervical vertebra of consecutive 2-level anterior cervical discectomy and fusion (ACDF), and discuss its possible mechanism. Clinical and radiologic outcome data from 27 consecutive 2-level ACDF patients using zero-profile devices were collected at 1, 3, 6, and 12months postoperatively, as well as the last follow-up. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the neck disability index and Japanese Orthopaedic Association score. Radiographic evaluation included measurements of the overall and surgical segment curvature, identification of collapse, and assessment of the ratio of anterior height and wedge of the upper, middle, and lower vertebrae in the surgical segment. The application of zero-profile devices to treat consecutive 2-level cervical spondylosis mostly resulted in good midterm clinical outcomes. Surprisingly, as evidenced by the significantly decreased anterior height and wedge ratio of the middle cervical vertebra, collapse was noted immediately in the middle vertebra in 4 patients at 1month (n=3) and 3months (n=1). The collapse increased for no more than 6months, and there was no deterioration of clinical and radiological outcomes at the last follow-up. Collapse in the middle cervical vertebra of consecutive 2-level ACDF with the application of zero-profile devices can occur in the early postoperative period, which may be due to axial stress concentration and blood supply damage in the middle cervical vertebral body.

Uncemented Total Hip Arthroplasty For Osteonecrosis of The Femoral Head in Late Diagnosed Developmental Dysplasia of The Hip: A Case Report

Background: Osteonecrosis of the femoral head (ONFH) is a disease in which local death of osteocytes and the component of the bone marrow occurs owing to venous stasis or arterial blood supply damage or interruption in the femoral head. Developmental dysplasia of the hip (DDH) is characterized by an abnormal anatomical relationship between the femoral head and acetabulum, and includes acetabular dysplasia, subluxation and in the most severe cases, development dislocation of the hip joint. Total Hip Arthroplasty (THA) is among the most successful orthopedic procedures worldwide. For acute and chronic hip diseases, THA can relieve joint pain, correct deformities, and restore and improve hip function. This study aims to understand the efficacy of Uncemented Total Hip Arthroplasty as the treatment of choice for osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in young adult patient. Case Report: We present a case of osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in a 32 years old active male. He had a history of falling trauma from a height of about 1.5 meters at the age of 12 years (20 years ago), and at that period the patient was diagnosed with right femoral head fracture and had a special condition, namely developmental dysplasia of the hip, since that incident the patient had not been looking for any treatment and was unable to walk normally and always had a limping gait. Uncemented Total Hip Replacement procedure is chosen and performed successfully with good outcomes within 16 weeks after the procedure. Discussion: Uncemented and cemented replacement had satisfactory long-term survival but they differed in their modes of failure. Patients who undergo total hip arthroplasty for osteonecrosis of the femoral head are younger and more active compared to those with osteoarthritis, showing a high likelihood of future revision procedures. Therefore, cementless applications is more appropriate alternative in young adult patient with osteonecrosis of femoral head. Conclusion: Uncemented Total Hip Arthroplasty in young adult male patients with osteonecrosis of the femoral head and late diagnosis of DDH is a suitable option and has a high level of the functional effectiveness and good material durability.

Arthroscopic treatment for nonunion of the scaphoid.

Scaphoid nonunion has traditionally been treated by open surgery where the pseudarthrosis has been cleaned while either a structural wedged bone graft, or chips of cancellous bone has been used to fill the defect. K-wires or a screw has been used to stabilize the bone. Using the arthroscopic technique for treatment of nonunion of the scaphoid gives us small exposure to the joint, however with an excellent view of the bones, the articular surfaces and the intraarticular ligaments. The results from arthroscopic treatment for scaphoid nonunion with bone grafting using chips of cancellous bone are as good as from the open technique. The arthroscopic treatment, though, helps us to diagnose and treat concomitant lesions. There is less damage of blood supply, nerves and capsule, which might lead to a faster recovery and rehabilitation. The technique will be described and discussed.

Therapeutic Efficacy Analysis of Talar Fracture Internal Fixation with Lateral Malleolar Osteotomy.

BackgroundThere are many surgical treatment approaches for talar fractures. However, due to the unique anatomical and blood supply characteristics of the talus, the traditional approaches tend to lead to blood supply damage. In order to best preserve the blood supply of the talus, we proposed a surgical approach of internal fixation of the talar fracture with lateral malleolar osteotomy and analyzed its efficacy.Material/MethodsTwenty-six patients with talar fractures underwent open reduction surgery between January 2010 and December 2016. Following the lateral malleolar osteotomy, the talus was fully exposed. After anatomical reduction, the talus was fixed with 2 screws, and the lateral malleolus was fixed with distending wires. The treatment effects were assessed in the follow-up.ResultsAll patients were followed for 7 to 22 months, for an average of 14.34 months. According to the Maryland Foot Score, 19 cases were excellent (90–100 points), 4 cases were good (85–90 points), and 3 cases were moderate (50–74 points).ConclusionsInternal fixation of talar fractures with lateral malleolar osteotomy is a viable surgical approach to reduce injury to blood supply and maximize surgical exposure.

A case of avascular necrosis of capitate bone in an air compressor jack hammer worker

Introduction: Avascular necrosis (AVN) is very rare in capitate bone. It mostly occurs due to direct trauma to wrist. However, it could also occur as the result of disturbed blood supply due to repetitive micro-trauma in rare cases. Case Report: In this report, a 30-year-old man who was an air compressor jack hammer worker with chronic wrist pain was presented. Imaging revealed a low-signal intensity lesion on T1-weighted which supported AVN of capitate. Blood supply damage was due to continuous stress to palmar hand as the consequence of working with air compressor jack hammer which led to AVN of capitate. Conclusion: AVN of capitate could occur as the result of repetitive micro-trauma. It has a high correlation with the job of patients. Radiography does not help in the first stages. Magnetic resonance imaging (MRI) has high diagnostic sensitivity. In the primary stages in patients with occupation-induced AVN, it could be improved by changing the job and temporary immobilization.

Treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint by modified dynamic traction external fixator

Objective To study the application of modified dynamic Kirschner wire-rubber traction external fixator in the treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint. Methods From January 2014 to June 2017, 23 patients (32 fingers) with intra-articular fracture or dislocation of the proximal interphalangeal joints were treated by modified dynamic Kirschner wire-rubber traction external fixator after closed reduction under C arm X ray machine guidance. Results After 8 to 12 weeks, the fractures healed and the joint function recovered to the greatest extent. All the patients were follow-up for 3 to 15 months. No obvious complications such as adhesion and joint stiffness occurred. According to TAM functional evaluation, the results were graded as excellent in 19 cases and good in 4 cases. Conclusion The modified dynamic Kirschner wire-rubber traction external fixator is exquisite and simple. It does not produce iatrogenic blood supply damage during the treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint. It is conducive to fracture healing, supports early functional exercise, protects joint function to the greatest extent, and closed reduction can promote early fracture healing. Key words: Fractures,bone; Dislocations; Proximal interphalangeal joint; Dynamic Kirschner wire-rubber traction external fixator

Observation of the effect of external fixator combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysis

Objective To evaluate the clinical indications, complications and curative effects of external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysis. Methods From February 2013 to June 2017, 18 adolescent patients of distal tibial fracture involving stem epiphyseal in Luzhong Hospital of Beida Care were treated with external fixator combined with limited internal fixation.All 18 cases were closed fractures, according to Salter-Harris classification: type Ⅱ 8 cases, type Ⅲ 8 cases, type Ⅳ 2 cases.The fracture healing time, postoperative patients with limb full weight-bearing time, postoperative ankle function grading, postoperative incision of the skin, deep tissue and nail complications such as infection were observed. Results All patients received postoperative 12 to 24 months follow-up, with average of 16 months, the average postoperative fracture healing time was (8.4±3.2)weeks, the full load time of affected limb after operation was average (8.8±2.2)weeks, the ankle joint function score according to Kofoed score: 6 weeks after operation, Kofoed score was (86.6±6.8)points, excellent in 15 cases, good in 3 cases, and the excellent and good rate was 100%, 1 case with nail way out at postoperative 1 week, after the demolition of external fixator nail healed, no other blade and deep infection and other complications occurred. Conclusion The external fixation combined with limited internal fixation in the treatment of adolescents distal tibial fracture involving the metaphysic can avoid fracture end blood supply damage caused by open surgery, it is quick with small incision, fracture healing, fewer complications, and the advantages of ankle joint function restore is good, has good clinical therapeutic effect. Key words: Tibial fractures; Epiphyses; Fracture fixation, internal; External fixators; Adolescent

A Simple and Easy Intramedullary Lavage Method to Prevent Embolism During and After Reamed Long Bone Nailing.

Reaming of the long bones is widely practiced because it allows for improved healing and early mobilization in patients needing surgical debridement of bone tissue. The insertion of reamed intramedullary nails can cause complications such as bone necrosis, cortical blood supply damage, and fat or bone marrow embolism. We describe a novel way to limit the amount of material in the canal before nail insertion to limit the chances of embolism.

Transverse Testicular Ectopia: A Three-Case Report and Review of the Literature

To describe the embryologic, clinical, and therapeutic features of transverse testicular ectopia (TTE) and to review the literature on similar cases. Three cases of TTE were discovered accidentally during surgery for inguinal hernia and undescended testes; a persistent Müllerian duct syndrome (PMDS) was associated in 1 case. We also performed a literature search for other reports of TTE. A conservative surgical approach was chosen: transseptal orchiopexy was preferred in 2 cases and the Müllerian remnant was preserved in the first case. TTE is a rare anomaly that usually presents as a unilateral cryptorchidism and a contralateral descendent testis with an associated hernia. In suspected cases, laparoscopy and ultrasonographic evaluation may be helpful in diagnosing this condition before surgery. Surgery, transseptal orchiopexy, is highly recommended to manage TTE especially when vasa deferentia are fused. In case of PMDS, the authors preferred preserving Müllerian remnants because of the risk of vas deferens and testicular blood supply damage. Recently, laparoscopy is useful for both diagnosing and management of TTE and associated anomalies.

大腿骨転子間骨折術後に大腿骨頭壊死を来たした１例

Femoral head necrosis after extracapsular fracture is a rare complication.Until now, we have experienced only one case of femoral head necrosis after CHS operation. Three months later, the patient complained of hip pain when walking, and radiograph 10 months after operation showed a penetrated rag screw. The cause of fracture was simple fall that was not high energy accident. The vascural anastomotic ring at the base of the femoral neck plays an important role in the circulation of the femoral head. In this case, a possible etiology was the iatrogenic damage of blood supply to the femoral head (due to rotational force applied to the femoral head during reaming). It is therefore important to use a dase pin during operations.

Kapandji intramedullary wire osteosynthesis in proximal humeral fractures

For operative treatment of proximal humeral fractures minimal invasive techniques reduce the risk of iatrogenic damage of blood supply and periarticular scarring. Reported preliminary results are encouraging. We present our experience achieved with an intramedullary wire fixation adapted from a report of Kapandji in 1989. Between 3/95 and 6/00 29 patients were treated with this technique at our institution. All received early functional treatment. 14 patients (average mean age 56 years at time of trauma) who had a minimum follow up of 24 months (mean 36.4 months) and therefore allowed a preliminary conclusion regarding avascular head necrosis (AVN) were reexamined by use of the Constant Score and x-ray. We examined three unstable 2-part, four 3-part and seven 4-part fractures (5 of them valgus-impacted). The mean Constant Score at follow up was 70 points (31-86 points). We saw one total collapse of the humeral head because of AVN. In one patient the distal end of the wires led to a skin irritation and had to be shortened. We observed no secondary fragment displacement or non-unions. In our hands, this technique offers good results, even in valgus-impacted 4-part fractures of the elderly and allows internal fixation in little displaced but unstable fractures with the benefit of early functional treatment instead of longer immobilization. Based on the experience with intramedullary wiring the previously performed technique using threading wires was abandoned and the indication for primary arthroplasty considerably influenced.