Level Of Bone Research Articles

Variations of the ulnar nerve within the ulnar tunnel and palm in a select South African population

BackgroundUlnar tunnel syndrome (UTS) is a rare peripheral neuropathy associated with the entrapment of the distal portion of the ulnar nerve (UN) in its course through the fibro-osseous ulnar tunnel (eponymously known as Guyon's canal) at the wrist. The UN within the ulnar tunnel is prone to injury or compression resulting in an UTS. Therefore, it is of clinical importance to know the anatomical variations in the branching pattern of the UN within the ulnar tunnel. UTS is characterised by sensory deficits and muscular weakness, impaired sensation of the volar fingertips, and weakness in grasping with intrinsic hand muscles. This study aimed to examine the anatomical variations of the UN in the palm of the hand within a select South African cadaveric population. MethodsThe variations in the branching patterns of the UN were examined in 81 cadavers (n = 162) and described according to the classification system of Murata et al. (2004) [10]. Communicating branches were classified according to their description in previous literature. The length of the ulnar tunnel was measured from the level of the pisiform bone to the level of the hook of hamate. ResultsThe branching pattern was found as Type 1 (52.9 %), Type 2 (34 %), Type 3 (2.7), Type 4 (6.5 %), Type 5 (3.9 %). Berrettini, Riche-Cannieu and Kaplan anastomoses were found in 51.6 %, 2 % and 3.3 % of specimens, respectively. ConclusionIt is important for surgeons to be aware of these anatomical variations as they may lead to misdiagnosis and complications during surgical procedures during the treatment of UTS.

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study.

Background As part of preoperative patient evaluations, it is customary to estimate the likelihood of difficulties during laryngoscopy and intubation. A diverse array of predictors is frequently employed by anesthesiologists to anticipate difficult laryngoscopy (DL); however, no single predictor has been established as the gold standard. In the present study, we compared routine preoperative ultrasound-guided airway examination and clinical airway examination in predicting DL in patients coming for elective surgery. Methodology The present study is a single-blinded observational study that spanned 12 months, beginning in March 2018 and concluding in February 2019. The study took place at Kovai Medical Center and Hospital (KMCH), which is a tertiary-care facility in Coimbatore, India. The data were obtained through face-to-face interviews, with a sample size of 135 research participants. The questionnaire contained comprehensive data regarding the patient's age, weight, gender, comorbidities, planned surgery, and preoperative assessment, which encompassed a detailed examination of the airway. The clinical airway examination comprised assessing mouth opening, performing the modified Mallampati test, measuring thyromental height (TMH) and thyromental distance (TMD), evaluating neck circumference, and observing neck extension. Ultrasound-guided airway examination was performed during the immediate pre-operative period, focusing on specific parameters such as the pre-epiglottic space, anterior neck soft tissue at the level of vocal cords, thyrohyoid membrane, suprasternal notch, hyoid bone (single parameter measured at different levels), hyo-mental ratio, and tongue volume (TV). Results Among the ultrasound parameters, TV (72.15 cm3) is the best ultrasound parameter to predict DL (95%CI: 0.65 to 0.82), with a high sensitivity of 82% and specificity of 45.88%. Other parameters that are useful are anterior neck soft tissue at the level of the thyrohyoid membrane (0.67 cm), suprasternal notch (1.01 cm), and, lastly, pre-epiglottic space (0.57 cm). Among clinical parameters, modified Mallampati grade (grade 3 or more) is the best parameter to assess the airway clinically and predict DL, followed by neck circumference (>42 cm) and TMH (>5 cm). Based on the findings, we observed that both clinical and ultrasound parameters are comparable to predict DL. Conclusion We observed that routine clinical airway examination and ultrasound examination yielded comparable results in predicting DL. Therefore, the routine use of clinical airway examination still holds good in predicting DL.

The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome.MethodsIn this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm.ResultsIn this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05).ConclusionBased on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly.

MORPHOMETRIC CHARACTERISTICS OF NECK PARAMETERS IN THE PERINATAL PERIOD OF ONTOGENESIS

This study aims – to establish the normative morphometric parameters of the neckcircumference, anterior- posterior diameter, height, and width during the perinatal periodof ontogenesis, after which the parameters will be used to construct anatomical models. Material and Methods. The study was conducted on 63 human fetuses aged 4 to10 months and 7 newborns (including 5 isolated organ systems). To create anatomicalmodels, the well-known dimensions of the neck in all age groups were determined usinga centimeter tape and a caliper. The neck circumference was measured at the level of thehyoid bone. The anteroposterior neck diameter was defined as the distance between thebody of the hyoid bone and the VII spinous process of the cervical vertebra. Neck heightwas measured from the upper to the lower neck borders. Neck width was determined inthe frontal plane at the level of the hyoid bone between the lateral edges of the neck.Statistical analysis of the data was performed using the licensed program RStudio.Results. A morphometric analysis of the average values of the well-known neck parameters,namely its circumference, anterior- posterior diameter, height, and width, was conductedin the perinatal period of ontogenesis. The analysis revealed that these parameters exhibitnon-synchronous growth throughout the studied period of the development, with periodsof intensive and relative growth. A correlation analysis was conducted between allmorphometric parameters of the neck of fetuses and newborns. The results demonstratedthat the correlation coefficients between the values of all paired correlation coefficientswere positive and close to 1 (≥0.90), indicating a strong positive correlation between allstudied parameters. A statistical analysis of the data from the Conover- Iman test indicatesthat the median values of the morphometric parameters of the neck cannot be consideredreliable for the pairs «9 months – 10 months» and «10 months – Newborns». This isjustified by the fact that individual anatomical variability is inherent in each individual,and these periods of the development are critical for the neck area. The constructedstandard anatomical models of the morphometric parameters of the neck will serve asa norm for the subsequent determination of certain morphological deviations, which willthen be used to establish variants of the structure and developmental defects of the neck.Conclusions. 1. During the perinatal period of the development, the well-known parametersof the neck, namely its circumference, anterior- posterior diameter, height and width,increase asynchronously. 2. The average values of the morphometric parameters of the neckcircumference and anterior- posterior diameter during the perinatal period of ontogenesisindicate that one period of accelerated development is evident, occurring between the 7thand 9th month of intrauterine development for the neck circumference and between the 6thand 9th month of development for the anterior- posterior diameter of the neck. Two periods ofaccelerated development are observed for the parameters of neck height and width. For neckheight, these periods are from the 5th to the 7th month of development and from the 8th to the9th month of development. For neck width, the periods are from the 4th to the 5th month ofthe development and from the 7th to the 9th month of intrauterine development. In all otherperiods of development, the morphometric parameters of the neck exhibit a slight increase. 3.Based on the arithmetic mean data of the circumference, anterior- posterior diameter, height,and width of the neck, models for predicting the normative morphometric parameters of fetusesand newborns were constructed. The systematized data on the peculiarities of spatial andtemporal transformations of the morphometric parameters of the neck circumference, anteriorposterior diameter, neck height and width, followed by their construction of mathematicalmodels, will contribute to the individualization of the norm, improvement of early diagnosticmethods and development of new methods of surgical correction of congenital neck defects.

CBCT Evaluation of Alveolar Bone Change and Root Resorption after Orthodontic Treatment: A Retrospective Study.

For years, there has been a long debate about the impact of orthodontic treatment on the periodontium of patients. Therefore, it is important to understand the effects of orthodontic forces on the periodontium. The objective of this study was to evaluate the height of the alveolar bone at the four surfaces of specific teeth and the root length of the central incisors before and after orthodontic treatment. CBCTs from a group of fifty patients were evaluated before (T0) and after orthodontic treatment (T1). Evaluations of the alveolar bone were performed by measuring the distance from the most apical point of the marginal portion to the CEJ at the buccal (B-ABL), lingual (L-ABL), mesial (M-ABL), and distal (D-ABL) surfaces of the central incisor (CI), first premolar (1st PM), and first molar (1st M). Meanwhile, root resorptions were evaluated by measuring the distance from the center of the tooth at the CEJ to the most apical point of the central incisor. The reduction in the alveolar bone level was highest at the buccal segment (75%) and lowest at the distal (42%) segment, although the decrease was not statistically significant. Root resorption, in terms of reduction in the total length, was detected in the upper central incisor. Fixed orthodontic treatment can produce a significant reduction in root length, but not at the level of the alveolar bone.

Healing patterns of alveolar bone following ridge preservation procedures.

Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.

Ultrasound-based airway assessment in obese patients as a valuable tool for predicting difficult airway: an observational study

BackgroundDifficult airway, characterized by difficult mask ventilation and intubation, is common in obese patients undergoing surgery. The purpose of this study was to evaluate and compare the prognostic efficiency of ultrasound-measured anterior cervical soft tissue parameters as an indicator of difficult airway during anesthesia induction in obese patients. MethodsThis prospective, double-blind, observational study was conducted at Balikesir University Faculty of Medicine Hospital between March 2020 and March 2022. A total of 157 patients age ≥ 18 (BMI ≥ 30 kg.m-2), without previous head and neck surgery were included in the study. Anterior cervical soft tissue measurements were performed at three levels; minimum distance between the hyoid bone and skin at the level of the hyoid bone; (DSHB), distance between the midpoint of the epiglottis and skin at the level of the thyrohyoid membrane; (DSE), distance between the anterior commissure of vocal cords and skin at the vocal cord level; (DSV). The Han scale was used to assess difficult mask ventilation and the Cormack-Lehane scale was used to assess difficult laryngoscopy. ResultsIn the difficult laryngoscopy group, the mean values of DSHB, DSE and DSV were 18.5 ± 3.5, 18.3 ± 3.8, and 18.6 ± 3.4, respectively. The AUC values for DSHB, DSE, and DSV were 0.845, 0.827, and 0.850, respectively. Anterior cervical measurements showed a better predictive value for difficult laryngoscopy compared to difficult mask ventilation. ConclusionUltrasonographic measurements were predictive for difficult laryngoscopy and ventilation with better correlation in laryngoscopy.

1011 A Rare Case of Left Sided Hemiparesis Following a Pneumatic Gun-Shot Injury to Left Anterior Chest Wall in a 13-Year-Old Boy

Abstract Introduction Even though pneumatic weapons rarely cause severe direct trauma, pellet embolisation can lead to unexpected, catastrophic events. Case Report A 13-year-old, previously healthy boy was injured by an accidentally fired pneumatic gun, while playing with his twin brother. He sustained a penetrating wound to left anterior chest wall and resultant bleeding was self-limiting. He was hospitalised within 15minutes. On admission, he was hemodynamically stable with normal Respiratory, Cardiovascular and Neurological system findings. Entry wound measuring 5*5 mm was present at 5th intercostal space just left to the sternum. No exit wound was detected. Initial chest radiograph and ultra-sound abdomen and chest were normal. 2D echocardiogram revealed only a very thin layer(3mm) of pericardial effusion. Four hours later, He developed a focal seizure followed by left sided hemiparesis. Urgent NCCT brain and carotid artery duplex showed a high dense pellet in right internal carotid artery at the level of petrous temporal bone and hypo-dense Middle Cerebral Artery (MCA) suggestive of right MCA thrombosis. He was transferred to a tertiary care centre. Interventional radiological and endo-vascular attempts of pellet retrieval have been failed. Ischemic stroke pursued with worsening cerebral oedema; thus decompression craniotomy was performed on day 3. He is currently being rehabilitated in a specialised centre. Conclusions High degree of suspicion should be maintained on the possibility of projectile embolisation, in pneumatic gun-shot injuries, especially in the absence of an exit wound. Extensive early investigations should be performed to localise the projectile and retrieval should be planned.

Tumour necrosis factor α regulates the miR-27a-3p-Sfrp1 axis in a mouse model of osteoporosis.

Osteoporosis is a metabolic bone disease that involves gradual loss of bone density and mass, thus resulting in increased fragility and risk of fracture. Inflammatory cytokines, such as tumour necrosis factor α (TNF-α), inhibit osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), and several microRNAs are implicated in osteoporosis development. This study aimed to explore the correlation between TNF-α treatment and miR-27a-3p expression in BMSC osteogenesis and further understand their roles in osteoporosis. An osteoporosis animal model was established using ovariectomized (OVX) mice. Compared with Sham mice, the OVX mice had a significantly elevated level of serum TNF-α and decreased level of bone miR-27a-3p, and in vitro TNF-α treatment inhibited miR-27a-3p expression in BMSCs. In addition, miR-27a-3p promoted osteogenic differentiation of mouse BMSCs in vitro, as evidenced by alkaline phosphatase staining and Alizarin Red-S staining, as well as enhanced expression of the osteogenic markers Runx2 and Osterix. Subsequent bioinformatics analysis combined with experimental validation identified secreted frizzled-related protein 1 (Sfrp1) as a downstream target of miR-27a-3p. Sfrp1 overexpression significantly inhibited the osteogenic differentiation of BMSCs in vitro and additional TNF-α treatment augmented this inhibition. Moreover, Sfrp1 overexpression abrogated the promotive effect of miR-27a-3p on the osteogenic differentiation of BMSCs. Furthermore, the miR-27a-3p-Sfrp1 axis was found to exert its regulatory function in BMSC osteogenic differentiation via regulating Wnt3a-β-catenin signalling. In summary, this study revealed that TNF-α regulated a novel miR-27a-3p-Sfrp1 axis in osteogenic differentiation of BMSCs. The data provide new insights into the development of novel therapeutic strategies for osteoporosis.

Analysis of the correlation between peri-implant probing depth and radiographic bone level

Objective: To evaluate the correlation between peri-implant probing depth (PPD) and radiographic bone level (rBL) in implants with peri-implantitis. Methods: From January 2019 to December 2022, 24 patients with 30 implants who suffered from peri-implantitis at the Department of Periodontology, Peking University School and Hospital of Stomatology were included in the present research. SPSS 26.0 software was used to simple random sampling select 30 healthy implants from which with electronic examination records in Department of Periodontology, Peking University School and Hospital of Stomatology from January 2007 to June 2023 as the control group. On the premise of retaining the implant prosthesis, PPD (distance between pocket bottom and peri-implant soft tissue margin) was examined using a Williams periodontal probe with a light force (about 0.2 N), and a total of 4 sites were recorded for each implant. Periapical radiography and cone beam CT were applied to measure the rBL (distance between the reference point at the neck of the implant and the apical point of the bone defect) and the width of the bone defect (DW), and the type of the bone defect was recorded. The correlation and consistency between the diagnosis of PPD and rBL were analyzed. Results: PPD was significantly correlated with rBL in a total of 60 implants in 180 sites (r=0.64, P<0.001). The chi-square test showed an 8.15-fold increase in the detection rate of PD≥6 mm at sites with rBL≥1 mm (P<0.001). Multivariate logistic regression analysis showed that rBL was still statistically associated with PPD after adjustment for jaw position and examination position of implants. Take rBL <1 mm as reference, the odds ratios (OR) of 1 mm≤rBL<2 mm, 2 mm≤rBL<3 mm and rBL≥3 mm group with PPD were 6.23 (P=0.014), 2.77 (P=0.183) and 10.87 (P=0.001), respectively. Conclusions: There is a positive correlation between PPD and rBL in implants with peri-implantitis. PPD can be used as a clinical examination index to assist in estimating the level of peri-implant bone under the premise of retaining the prosthesis.

Comparison of the zonal distribution of calcium salt density and fat marrow in bone-healthy and osteoporotic sacra: an image data analysis using quantitative computed tomography and magnetic resonance imaging.

Pathogenesis of sacral fragility fractures is not fully understood. This study investigates zonal distribution of calcium salt and fat marrow in intact bone-healthy and osteoporotic pelvis. In addition, in unilateral sacral fractures, the fracture side was compared with the intact side. CT and MRI images of 37 pelves were analyzed. Zonal calcium salt distribution by Hounsfield units (HU) was recorded for each CT dataset. Fat marrow content was measured in MRI mDixon-Quant sequence. The cohort was divided: intact pelves with (PEO, HU < 100, n = 8) and without osteoporosis (PE, HU ≥ 100, n = 14) based on the mean HU value in LWK5. A third group consisted of patients with osteoporosis and unilateral fractures (PEOFx, n = 10). The results suggest that in PEO sacral alae experience disproportionate skeletal rarefaction. This concerns the sacral ala at the S1 level (- 25 ± 55), whereby the calcium salt content is so low that it corresponds to the S3 level of healthy bone (- 20 ± 21 HU). This explains the occurrence of transalar fractures in the load-transmitting zone S1. In PEOFx, the calcium salt density was higher and the fat content was lower on the fractured side than on the intact side, indicating bony compacting due to lateral compression and fat displacement due to hematoma in the accident mechanism. This study makes an important contribution to the understanding of the development of sacral fragility fractures. Furthermore, impaction of the cancellous bone within the fracture can be demonstrated.

Influence of Mechanical Properties of Dental Implants on Biomechanical Behavior: A Three-Dimensional Finite Element Analysis

In the context of this numerical study is particularly to analyze and observe the effect of mechanical properties and masticatory efforts on the intensity and distribution of biomechanical stresses induced in the mandibular bone (the cortical bone, the spongy bone) and in the elements which constitute the structure of the dental bridge (abutments, implants, bridge). The 3D model studied is subjected to loading in the three directions of space (corrono-apical, disto-medial, bucolingual). The numerical analysis allowed us to highlight the localization of the stress concentration zones, on the one hand, at the level of the regions of contact between the elements of the dental bridge structure and on the other hand, at the level of the mandibular bone. This parametric approach for the mechanical properties of bridges is used to better visualize and quantify the biomechanical behavior of dental bridges.

Crestal Bone Remodeling in Polished Collar Implants

OBJECTIVE: This study aimed to evaluate the amount of crestal bone remodeling in polished collar implants. METHODOLOGY: Thirty patients with a missing maxillary or mandibular 1st or 2nd premolar tooth requiring simultaneous bone grafting were recruited and implant placed at the level of crest with polished collar placed 1mm apical to the level of bone and bone augmentation was performed to graft the buccal threads. Buccal bone thickness was measure at crestal level as well as 1mm apical to polished collar. The implants were uncovered at 6 months and restored and patients followed up for 12 months from the time of implant placement. Cone beam computed tomography scans were taken at two time points, immediately after implant placement and at 12-month time point. RESULTS: At clinical re-entry (6 months), there was significant difference in mean buccal bone thickness found between crestal level and 1mm apical to polished collar (p&lt;0.05). Radiographically (at 12 months), the mean buccal bone change was -1.82mm 0.57mm at crest and -0.94mm 0.31mm at 1mm apical to crest. CONCLUSION: Bone regenerative techniques were unable to prevent biologic bone remodeling around the implant platform; therefore, the outcomes of bone augmentation might be affected by the polished collar of implant. KEY WORDS: Dental implants, polished collar, bone augmentation, bone remodeling, cone beam computed tomography

The Effect of Apis dorsata Honey Treatment on Calcium Levels of Mandibular Bone in Ovariohysterectomized Wistar Rats

This study aimed to evaluate the efficacy of Apis dorsata honey on calcium levels in the mandibular bone of Wistar rats after ovariohysterectomy as an animal osteoporosis model for treating cases of osteoporosis. This study used 20 female rats, which were divided into five treatment groups with four replications. SHAM was the negative control group; OH was the ovariohysterectomized group without treatment as a positive control; the AD1, AD2, and AD3 groups were ovariohysterectomized rats with A. dorsata honey at doses of 1 g/kg bw, 2 g/kg bw, and 4 g/kg bw for 84 days. After 84 days of treatment, the left mandibular bones of the rats were collected, weighed, and stored in 10% neutral buffered formalin. Calcium levels were calculated using proximate analysis. The results showed a decrease in bone calcium levels in the ovariohysterectomy group, the highest results were in the SHAM group, and the lowest results were in the AD3 group. It can be concluded that the administration of A. dorsata honey could not maintain the calcium level of the mandibular bone in the ovariohysterectomized Wistar rats.

A Case Report Highlighting Uncommon Histopathological Finding of Papillary Thyroid Cancer within a Thyroglossal Duct Cyst

This study discusses a case involving a 30-year-old male presented in ENT OPD with complaints of painless swelling in front of his neck. Papillary thyroid carcinoma originating from a thyroglossal duct cyst is an infrequent and atypical form of cancer. Typically, it remains undetected until surgical intervention and the optimal approach to its management is a subject of ongoing debate. Here, we present the case of a 30-year-old male who initially presented with a thyroglossal duct cyst but was subsequently diagnosed with papillary thyroid carcinoma. This case report focuses on suspecting having a Thyroglossal duct cyst, presented with painless swelling in front of the neck at the level of the hyoid bone. The mass moved when the tongue protruded but did not move when the patient swallowed. It exhibited a soft consistency during palpation, was not tender, movable, non-compressible, non-reducible, lacked fluctuation, and did not expand on the valsula while showing no changes in overlying skin temperature. TGD carcinoma can sometimes go undetected because it is a rare condition. When dealing with rapidly expanding neck masses in the midline, it's essential to conduct appropriate examinations, including neck imaging and fine-needle aspiration cytology. While the Sistrunk procedure is adequate for squamous carcinoma, differentiated thyroid carcinoma typically necessitates total thyroidectomy as the recommended course of action.

Cross-Disciplinary Approach of Adrenal Tumors: Insights into Primary Aldosteronism-Related Mineral Metabolism Status and Osteoporotic Fracture Risk.

Our objective was to overview the novel aspects in the field of adrenal gland neoplasms, namely, the management of bone status with respect to primary aldosteronism (PA). In the current narrative review, a PubMed study was conducted from inception until June 2023. The inclusion criteria were: human (clinically relevant) studies of any study design (at least 10 patients per study); English papers; and the following combination of key words within the title and/or abstract: "aldosterone" AND "bone", "skeleton", "osteoporosis", "fracture", "calcium", "parathyroid", "DXA", "osteocalcin", "P1NP", "alkaline phosphatase", "bone marker", "trabecular bone score", or "FRAX". The exclusion criteria were in vitro or animal studies, reviews, and case reports/series. We screened 1027 articles and finally included 23 studies (13 of case-control type, 3 cross-sectional, 5 prospective, 1 observational cohort, and 1 retrospective study). The assessments provided in these studies were as follows: nine studies addressed Dual-Energy X-ray Absorptiometry (DXA), another study pointed out a bone microarchitecture evaluation underlying trabecular bone score (TBS), and seven studies investigated the bone turnover markers (BTMs) profile. Moreover, 14 studies followed the subjects after adrenalectomy versus medical treatment, and 21 studies addressed secondary hyperparathyroidism in PA patients. According to our study on published data during a period of almost 40 years (n = 23, N = 3965 subjects aged between 38 and 64, with a mean age 56.75, and a female-to-male ratio of 1.05), a higher PTH in PA versus controls (healthy persons or subjects with essential hypertension) is expected, secondary hyperparathyroidism being associated in almost half of the adults diagnosed with PA. Additionally, mineral metabolism anomalies in PA may include lower serum calcium and higher urinary calcium output, all these three parameters being reversible under specific therapy for PA, regardless medical or surgical. The PA subgroup with high PTH seems at higher cardiovascular risk, while unilateral rather than bilateral disease was prone to this PTH anomaly. Moreover, bone mineral density (BMD) according to central DXA might show a higher fracture risk only in certain adults, TBS being a promising alternative (with a still unknown perspective of diabetes' influence on DXA-TBS results in PA). However, an overall increased fracture prevalence in PA is described in most studies, especially with respect to the vertebral site, the fracture risk that seems correctable upon aldosterone excess remission. These data recommend PA as a cause of secondary osteoporosis, a treatable one via PA intervention. There is still an area of debate the way to address BMTs profile in PA, the case's selection toward specific bone evaluation in every day practice, and further on, the understanding of the potential genetic influence at the level of bone and mineral complications in PA patients.

Critical-size defects reconstruction with four different bone grafts associated with e-PTFE membrane: Ahistomorphometric experimental invivo study.

The goal of this study was to assess the newly formed bone and the remnant biomaterial by comparing four different bone grafts used to treat critical-size defects, associated or not with the non-resorbable membrane. Two calvaria critical-size bone defects were created in 50 male Wistar rats. They were divided into blood (G1), autogenous (G2), bioglass (G3), hydroxyapatite (G4), and xenograft (G5) groups, associated or not with e-PTFE. The experimental periods were 15 and 45 days. Sections were prepared for histomorphometric assessment. All data were analyzed by the mixed-effects model with multiple comparisons (significance level, p < .05). A similar level of new bone was observed for all groups, associated with a high level of vascularization. G1 and G2 ensured sovereignty over the greater quantity of new bone. A non-significant result was reported comparing groups with and without membranes. No significant result was found between the experimental synthetic biomaterials (G3 and G4). G5L achieved 22.0% of new bone after 45 days (p > .05). All groups had a stable volume of biomaterial kept in the short term (p > .05). G2 was the best material for new bone formation and final volume of biomaterial, followed by G4 < G5 < G3. Thus, it is possible that G4 had a better degradation profile among the experimental groups. The best results were found in the autogenous group, with higher resorption and integration; non-significative new bone was found among the experimental groups; and the regeneration of critical bone defects using an e-PTFE barrier did not present significant results on new bone formation.

Histomorphometric evaluation, SEM, and synchrotron analysis of the biological response of biodegradable and ceramic hydroxyapatite-based grafts: from the synthesis to the bed application.

This study aimed to analyze the physicochemical and histological properties of nanostructured hydroxyapatite and alginate composites produced at different temperatures with and without sintering, and implanted in rabbit tibiae. Hydroxyapatite-alginate (HA) microspheres (425-600µm) produced at 90 and 5 ºC without (HA90 and HA5) or with sintering at 1000ºC (HA90S and HA5S) were characterized by XRD, FT-IR, SEM, and in vitro degradation assay; also were implanted in bone defects on rabbit's tibiae (n=12). The animals were randomly divided into five groups (blood clot, HA90S, HA5S, HA90, and HA5) and euthanized after 7 and 28 days. The samples were assessed by light (histomorphometry) and polarized light microscopy, SEM-BSE microscopy, EDS-SEM elemental analysis, and synchrotron radiation X-ray microfluorescence. The non-sintered biomaterials had a lower crystallinity than sintered materials, being more degradable in vitro and in vivo. However, the sinterization of HA5 led to the apatite phase's decomposition into tricalcium phosphate (TCP). Histomorphometric analysis showed the highest (p<0.01) bone density in the blood clot group, similar bone levels among HA90S, HA90, and HA5, and significantly less bone in the HA5S. HA90 and HA5 groups presented higher degradation and homogeneous distribution of the new bone formation onto the surface of biomaterials fragments, compared to HA90S, presenting bone only around intact microspheres (p<0.01). EDS-SEM and μXRF-SR mapping techniques showed the elemental distribution of Ca, P, and Zn in the newly formed bone similar to the cortical bone indicating the bone maturity at 28 days. The synthesized biomaterials are biocompatible and osteoconductive. The heat treatment directly influenced the material's behavior, where non-sintered HA90 and HA5 showed higher degradation allowing a better distribution of the new bone onto the surface of the biomaterials fragments compared to HA90S presenting the same level of new bone, but only on the surface of the intact microspheres, potentially reducing the bone-biomaterial interface.

Gorham-Stout disease

Gorham-Stout disease (GSD), also called vanishing bone disease, is an extremely rare skeletal disorder characterized by destruction of osseous matrix due to a massive process of osteolysis and proliferation of blood and lymph vessels, followed by a lack of deposition of new bone matrix. GSD can occur either at the level of a single bone or affect several bones, although the bones of the upper part of the skeletal system, especially at maxillofacial level, seem to be preferentially involved. To date, the diagnosis of GSD, mainly based on radiographic and histological analyses, is often made by excluding the presence of other diseases. Unfortunately, despite the several studies on GSD that have been carried out since its discovery, the pathogenesis of this disease is still unknown. Consequently, the therapies currently used are mainly aimed at keeping the disease under control, trying to avoid its progression, but they are not decisive, and this is in fact due to the lack of knowledge of its pathogenetic and pathophysiological bases. This concise review aims to provide a brief overview of the state of the art of current research regarding the etiopathogenesis of GSD and the discovery and development of new and different diagnostic and therapeutic methods. KEY WORDS: GSD, lymph vessel, blood vessel, bone cells

Associations among computed tomographic measures of bone and muscle quality and biomechanical measures of tibiotarsal bone quality in laying hens.

The objectives of the current study were to quantify laying hen sternal carina (keel) and tibiotarsal bone and muscle quality using clinical CT, tissue level, and biomechanical measures; test associations among muscle transverse sectional area, bone mineral density, and biomechanical measures of bone quality; and determine whether CT measures of bone and muscle quality would be predictive of biomechanical measures of tibiotarsal bone quality. 60 40-week-old Hy-Line brown laying hens were used. Associations among CT imaging, tissue level, and biomechanical measures of tibiotarsal and keel bone and muscle quality were tested using multivariate correlational analyses. Bivariate and generalized regressions were performed to determine whether CT measures were predictive of biomechanical measures of tibiotarsal bone quality. Low positive correlations were identified between tibiotarsal muscle transverse-sectional area (cross-sectional area [CSA]) and bone mineral density (BMD) in the proximal location of the bone (r = -0.11 to 0.31). Tibiotarsal muscle CSA was also low to moderately correlated with biomechanical measures of bone quality (r = 0.20 to 0.41). Keel muscle CSA values were not correlated with keel BMD values, but they were correlated with biomechanical measures of tibiotarsal bone quality (r = 0.18 to 0.40). Keel CT measures of bone quality were not correlated with tibiotarsal CT measures of bone quality. At the proximal location, muscle CSA and tibiotarsal BMD were predictive of biomechanical failure load (F = 9.68, P = .0003muscle CSA; F = 9.13, P = .004tibiotarsal BMD). Findings supported using noninvasive CT measures of muscle and bone quality in longitudinal research studies evaluating the effects of interventions on laying hen welfare.