Multiligamentous knee injuries (MLKI) are rare orthopedic injuries with involvement of two or more ligaments in the knee. There are variety of combinations of MLKI and one such relatively common and important injury pattern is anterior cruciate ligament (ACL) plus medial collateral ligament (MCL) injury. Though MCL grade 1 and 2 does not warrant surgical management, grade 3 defintely needs reconstruction or repair according to past studies so as to avoid valgus instability. A retrospective study was conducted evaluating the outcomes of combined ACL and MCL injuries in 22 patients at our centre. Road traffic accidents (RTA) accounted for 45.5% of the total cases as the most common mechanism of injury. Out of 22 patients operated with simultaneous ACL and MCL reconstruction, 14 (63.6%) had good results based on Lyscholm scoring system, 5 (22.8%) had excellent results, and 3(13.6%) had fair result and none of our patients had poor results. Simultaneous single stage management of ACL and MCL injury has advantages like early rehabilitation, reduced number of hospital stay as well as absence of necessity for getting admitted and operated for each ligament separately which also brings down the cost to the patient. Keywords: Reconstruction, ACL, MCL, Lyscholm.

Tillaux fractures are the avulsion of the distal tibial physis caused by the stress placed on the anterior tibio-fibular ligament, which are very rare in case of an adult. Due to severe swelling and overlapping of bones they are often missed in an innocuous looking X ray. Our case includes a 40 year old presented with severe pain and swelling of the ankle joint following trauma on a background history of Becker’s muscular dystrophy .While, the patient had proximal muscle weakness in lower limbs due to the comorbidity, Investigations also revealed the tillaux fracture with fractures of posterior and medial malleolus, which roughly outlines the injury mechanism to be of Supination-external rotation type. The objective of this publication is to highlight this unusual injury, to avoid incorrect diagnosis and its management which focuses on different challenges in achieving absolute reduction with early rehabilitation of the patient keeping in view of the existing co-morbidity. Keywords: Ankle injury, Adult Tillaux fracture, Chaput fracture syndesmotic injury, Tibiofibular ligament, Becker muscular dystrophy.

Introduction: Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury is relatively a rare entity and it is extremely important to manage these injuries with great accuracy, as this may involve damage to neurovascular structures associated with knee dislocation and also carries the risk of accelerated joint degeneration if left untreated. There are many issues that are topic of debate even today like timing of surgery, graft of choice and single stage versus staged reconstruction. Materials and Methods: A prospective study for evaluating the outcomes of combined ACL and PCL injuries in 20 patients was conducted at our centre, who were managed arthroscopically. Preoperative and post-operative Lyscholm scores and IKDC scores were assessed to evaluate the patients outcomes. Results: Out of 20 patients operated for ACL and PCL injury, 14(70%) of them had excellent to good results and the rest 6(30%) had fair results with none of the patients reporting poor results. Conclusion: Simultaneous ACL and PCL reconstruction using arthroscopic technique is an effective and safe procedure irrespective of the time since injury and also this is more helpful to achieve early rehabilitation. Keywords: PCL, Lyscholm score, IKDC.

In vitro cytotoxic effects of different intracanal medicaments on the co-culture of dental mesenchymal stem cells using the MTT assay

The host immune response, specifically macrophage function, is a critical determinant of biomaterial success or failure post-implantation. Extracellular matrix (ECM) derived scaffolds have been shown to promote a pro-regenerative macrophage phenotype and a more constructive remodelling outcome. Here we demonstrate that macrophages adopt distinct phenotypes when exposed to articular cartilage (AC), ligament (LIG) and growth plate (GP) derived ECM scaffolds. Macrophages were generally unresponsive to LIG-derived ECM, adopted an M2-like phenotype when exposed to AC-derived ECM, and a hybrid M1-M2 phenotype when exposed to GP-ECM. Furthermore, macrophages expressed higher levels of pro-chondrogenic factors, such as FGF2, when exposed to AC-ECM, and higher levels of angiogenic and pro-osteogenic factors, such as VEGF, IL-6 and TNF, when exposed to GP-ECM. In addition, we observed that they can differentially direct the differentiation of skeletal stem cells, whereby AC-ECM promotes the chondrogenic differentiation and GP-ECM the osteogenic differentiation of multipotent stem/stromal cells (MSCs). In vivo characterisation of immune cell subsets following scaffold implantation into a large bone defect demonstrated that AC-ECM drives an M2 macrophage phenotype, while GP-ECM containing scaffolds promoted a hybrid M1-M2 phenotype and enhanced vascularisation and vessel maturation. This distinct response to the implantation of GP-ECM containing scaffolds was associated with increased CD45+ leukocyte and CD3+ T cell infiltration, accompanied by elevated concentrations of IFN-γ and IL-17. Taken together this work demonstrates that the source tissue of ECM scaffolds plays a key role in regulating the phenotype of both macrophages and skeletal stem cells. Furthermore, these ECMs can direct the cellular differentiation and production of growth factors essential for the regeneration of their source tissue. This work highlights the need for a more thorough characterisation of innate immune cell subsets post-biomaterial implantation.

Autotransplantation is a viable option for immediate rehabilitation of missing teeth in young patients. It aims to preserve pulp vitality and proprioception, aiding complete root formation and osseous development, resulting in esthetic outcomes. A 20-year-old healthy female patient presented with pain in relation to a grossly mutilated nonrestorable right upper second molar tooth. Due to the young age of the patient, the proposed treatment was autotransplantation of upper third molar with incompletely formed roots to rehabilitate the second molar. Following precise diagnosis and application of strictly standardized treatment protocols, the strategically chosen donor tooth was atraumatically extracted and transplanted into the recipient site causing minimal damage to the periodontal ligament cells (PDLs). Clinical and radiographic findings over the 4-year follow-up period demonstrated normal gingival healing along with gradual bone regeneration. There was continued root formation and pulp revascularization with subsequent partial pulp canal obliteration. Higher survival rates of transplanted teeth are significantly associated with strict case selection criteria and protection of PDL. An analysis of pertinent prognostic factors with a long-term follow-up is required to predict and improve the outcome of tooth transplantation.

Amaç: Bu çalışmanın amacı, ıslah programlarında kullanılmak üzere doğrusal tip özellikleri, verim özellikleri ve birinci laktasyon karlılığı arasındaki genetik korelasyonların tespitini yapmaktır.Materyal ve Metot: Araştırma 2012-2017 yılları arasında Hatay ilinde yürütülmüştür. Araştırmada toplam 810 baş birinci laktasyonda olan inek kullanılmıştır. Genetik parametrelerinin varyans ve kovaryanslarının analizi ise Multivariate Limited Maximum Likelihood testi ile gerçekleştirilmiştir.Bulgular: Ortalama inek başına birinci laktasyon net kar, 305-gün süt verimi, ilk buzağılama yaşı, ilk tohumlamada gebe kalma oranı ve kolay doğum oranı 540 US$, 6008 kg, 793 gün, %61.6 ve %91.7 olarak belirlenmiştir. Doğrusal tip özellikleri ile verim özelliklerinin kalıtım dereceleri sırasıyla; 0.10-0.42 ve 0.04-0.39 arasında tahmin edilmiştir. Birinci laktasyon karlılığı ile doğrusal tip özellikleri arasındaki genetik korelasyonlar -0.08 ve 0.42 arasında, birinci laktasyon karlılığı ile verim özellikleri arasındaki korelasyonlar 0.06 ve 0.34. arasında tahmin edilmiştir. Birinci laktasyon karlılığı ile en yüksek korelasyonu meme merkez bağı (0.42) gösterirken, en düşük korelasyonu meme derinliği (-0.08) göstermiştir. Yine birinci laktasyon karlılığı ile en yüksek korelasyonu süt proteini verimi (0.34) gösterirken, en düşük korelasyonu ilk tohumlamada gebe kalma oranı (0.09) göstermiştir. Doğrusal tip özellikleri ile verim özellikleri arasındaki genetik korelasyonlar -0.42 (Ayak açısı ve ilk tohumlamada gebe kalma oranı) ile 0.49 (Sütçü tip özelliği ve 305-gün süt verimi) arasında değişiklik göstermiştir.Sonuç: Araştırma sonuçları, birinci laktasyondaki daha fazla sütçü tipe sahip, ön meme bağlantısı güçlü, güçlü ayak ve bacak yapısına sahip ineklerin, birinci laktasyonda daha karlı olduklarını ve süt sığırı ıslah programlarında doğrusal tip özellikleri ile verim özellikleri arasındaki bu genetik korelasyonlardan yararlanılarak, daha isabetli seleksiyon yapılabileceğini ortaya koymuştur.

The article's abstract is not available.

تأثیر حرکت برش جانبی با و بدون پیشبینی در افزایش عوامل خطرزای آسیب لیگامنت صلیبی قدامی: تجزیه و تحلیل کینماتیکی اندام تحتانی

The invention relates to an apparatus used in the separation of the Symphysis pubis joint from its posterior aspect. This process medically named as Symphysiotomy. The apparatus consists of 3 parts: (1). Size 14G cannula which is 14cm in length, made of stainless steel and has a sharp bevel and thickened posterior part to enable the user to have a good grip on it during usage. (2). A stylet 14cm long made of stainless steel to fit in the inside of the cannula to prevent coring of the tissues during the introduction of the cannula. It has a vertical end to stop the advancement inside the cannula. (3). A cutter which is 14cm long and made of stainless steel and fits inside the cannula when the stylet is removed. Its front part is sharp on one side to cut through the ligament and cartilage of the symphysis pubis from its posterior aspect. Its back has a half-circle end to prevent the cutter from advancing beyond the bevel of the cannula inside the tissues. This is a life-saving operation and used to widen the diameter of the pelvis during certain situations of obstructed delivery of the baby. The design of the apparatus and instructions of its use enable doctors and midwives to perform the symphysiotomy procedure once they are trained on its use. The use of the invention avoids bleeding, injury to urethra and bladder, and avoids the formation of skin scar. The symphysiotomy scalpel obtained patent status from the King Abdulaziz City for Science & Technology (5910 dated 20 May 2018).

Las fracturas del escafoides son comunes y presentan una incidencia que viene en aumento. Se requiere de una alta sospecha clínica y de estudios complementarios para llegar al diagnóstico, donde el examen físico tiene alta sensibilidad pero baja especificidad. Las radiografías presentan un bajo valor predictivo negativo y una alta tasa de falsos negativos, mientras que la resonancia magnética es el estudio de elección por su alta sensibilidad y efectividad, además de que detecta lesiones ligamentarias y presenta una relación costo-beneficio favorable. La sensibilidad de la tomografía axial computarizada es similar, y tiene gran utilidad en el planeamiento quirúrgico. La clasificación de Herbert es la más utilizada y tiene utilidad para definir el tratamiento, el cual depende del momento del diagnóstico, la localización y la estabilidad de la fractura. Como indicaciones quirúrgicas destacan la inestabilidad, el desplazamiento mayor a 1mm, las fracturas del polo proximal y las oblicuas. El manejo quirúrgico puede ser tanto volar como dorsal, con técnica abierta o percutánea dependiendo de las características de cada caso. En términos generales, se presenta consolidación en la gran mayoría de los casos; siendo menor en: aquellas fracturas desplazadas, en fracturas del polo proximal, en fracturas de diagnóstico tardío y en pacientes fumadores. El manejo quirúrgico condiciona mayor tasa de complicaciones, sin embargo las mismas se consideran menores. Se expone el caso de un paciente con antecedente de trauma de muñeca. En la valoración inicial, presentó datos clínicos poco específicos, se realizó una radiografía de muñeca y no se evidenció ninguna lesión ósea. Sin embargo, el paciente persistió con dolor, por lo que se realizó una tomografía axial computarizada, y se diagnosticó una fractura del polo proximal del escafoides. Se procedió con un manejo quirúrgico.

Aim To evaluate tunnel positioning on radiographs in singlebundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction, to evaluate if measurement is accurate and reproducible. Methods Radiographs of 30 SB and 30 DB ACL reconstruction were reviewed by two examiners who measured tunnel positioning with the quadrant method on the femur (a=depth, b=height) and the Amis and Jakob method on the tibia. Intra- and inter-observer reliability were evaluated with intra-class correlation coefficient (ICC). Results A radiographic analysis was completed in all patients in a SB-group and in 27 in a DB-group (p>0.05). Intra-observer reliability was almost perfect on femoral (ICC: a=0.85, b=0.83) and tibial (ICC=0.87) side in the SB-group. In the DB-group, it was almost perfect for tibial anteromedial (AM) and posterolateral (PL) bundles (ICC: AM=0.84, PL=0.81) and for femoral PL bundle (ICC: a=0.83, b=0.82), and substantial for femoral AM bundle (ICC: a=0.78, b=0.74). Inter-observer reliability was almost perfect on tibial (ICC=0.81) and femoral (ICC: a=0.81, b=0.87) side in the SB-group, and substantial on tibial (ICC: AM=0.71, PL=0.77) and femoral (ICC: AM a=0.73, b=0.78; PL a=0.74, b=0.76) side in the DB-group. Standard deviation (SD) was low (±9%) with respect to the centre of tunnel(s). Conclusion The quadrant method and the Amis and Jakob method are accurate and reproducible measurement methods. Also, as SD was low, an outside-in approach with a front-entry guide, which is free-hand positioned, can be postulated as a reliable method to locate the femoral tunnel in SB reconstruction and the AM bundle in DB reconstruction.

O objetivo do presente estudo foi avaliar uso da terapia por fotobiomodulação a LED (diodo emissor de luz) na atividade funcional da marcha em animais com OA em joelhos. Para isso, 20 ratos da linhagem Wistar, machos, com dois meses de idade e massa corpórea média de 150 g foram utilizados. A indução da OA (osteoartrite) foi realizada no joelho esquerdo de todos os animais por meio da transecção do ligamento cruzado anterior (TLCA). 4 semanas após a indução da OA os ratos foram divididos aleatoriamente em grupo OA controle (OAC): animais sem nenhuma intervenção terapêutica e grupo OA LED (OAL): animais irradiados com LED. A avaliação da marcha foi realizada antes do início do tratamento com LED e após 4 semanas de tratamento com LED (850 nm, 200 mW, 30 seg, 6 J, 3 vezes por semana). A análise da marcha não demonstrou diferença significativa entre o grupo OAC e OAL. Assim, sugere-se que a terapia por fotobiomodulação a LED não foi capaz de promover alteração da marcha em animais. O objetivo do presente estudo foi avaliar uso da terapia por fotobiomodulação a LED (diodo emissor de luz) na atividade funcional da marcha em animais com OA em joelhos. Para isso, 20 ratos da linhagem Wistar, machos, com dois meses de idade e massa corpórea média de 150 g foram utilizados. A indução da OA (osteoartrite) foi realizada no joelho esquerdo de todos os animais por meio da transecção do ligamento cruzado anterior (TLCA). 4 semanas após a indução da OA os ratos foram divididos aleatoriamente em grupo OA controle (OAC): animais sem nenhuma intervenção terapêutica e grupo OA LED (OAL): animais irradiados com LED. A avaliação da marcha foi realizada antes do início do tratamento com LED e após 4 semanas de tratamento com LED (850 nm, 200 mW, 30 seg, 6 J, 3 vezes por semana). A análise da marcha não demonstrou diferença significativa entre o grupo OAC e OAL. Assim, sugere-se que a terapia por fotobiomodulação a LED não foi capaz de promover alteração da marcha em animais.

Our study investigated the effects of acacetin, a natural flavonoid compound, on the survival and expression of inflammatory related cytokines in lipopolysaccharide (LPS)-stimulated human periodontal ligament (PDL) cells. Treatment with acacetin significantly promoted survival and suppressed apoptosis in LPS-stimulated PDL cells in a dose-dependent manner, as shown by CCK-8 and flow cytometry assays, respectively. Moreover, ELISA assay showed that acacetin dose-dependently attenuated LPS-induced increases of TNF-α, IL-6 and IL-1β in PDL cells. Western blot analysis showed that administration of acacetin dose-dependently increased the ratio of LC3II/LC3I, as well as the expression of beclin-1, as compared to LPS-stimulated PDL cells. Inhibition of autophagy by rapamycin, an autophagy inhibitor, increased the production of pro-inflammatory cytokines and decreased survival, abolishing the beneficial role of acacetin in LPS-stimulated PDL cells. In addition, the expression of GSK-3β, a regulator of autophagy, was suppressed by administration with acacetin in a dose-dependent manner. Acacetin treatment promotes survival and suppresses inflammation in LPS-stimulated PDL cells via regulating autophagy and GSK-3β signal in PDL cells, suggesting that acacetin may be a potential novel agent for the treatment of chronic periodontitis.

The aim of the research is identification of complex structural changes of the fox’s knee joint ligaments to ensure its high biomechanical potencies. A promising approach for the study of adaptive and compensatory changes of the joint as a multicomponent biomechanical system is to evaluate the structural transformations of its ligaments under conditions of a new functional load. The research was carried out on the basis of the Department of Animal Anatomy and Histology named after Professor A. F. Klimov «Moscow state Academy of Veterinary Medicine and Biotechnology - MBA named after K. I. Scryabin» and on the basis of JSC «Breeding animal farm «Saltykovsky». The article presents information about morphological transformations of the lateral and median ligaments of the knee joint that determine its reliable stability. Numerous structural changes of the fox ligaments during cage housing is reflected, which decrease in the thickness of bundles of collagen fibers and their compositional density compared to the standard structure (in wild individuals). Morphological transformations that can significantly reduce the strength and elasticity resistance of the ligaments and the biomechanical potential of the joint are shown. 23 fox individuals, including 15 individuals of the cage housing and 8 representatives of the natural habitat were studied. The research used a comprehensive methodological approach, including anatomical preparation, light microscopy of histological sections, scanning electron microscopy, micromorphometry and statistical analysis of the obtained digital data. According to the results of the study, it was found that fox individuals from natural biocenosis, have collagen structures of the lateral ligaments different in waving and packing density from ones of cage housing, which can contribute to ensuring their biomechanical domination.

Supplemental material, DS_10.1177_0363546520933622 for Utility of Neuromuscular Electrical Stimulation to Preserve Quadriceps Muscle Fiber Size and Contractility After Anterior Cruciate Ligament Injuries and Reconstruction: A Randomized, Sham-Controlled, Blinded Trial by Michael J. Toth, Timothy W. Tourville, Thomas B. Voigt, Rebecca H. Choquette, Bradley M. Anair, Michael J. Falcone, Mathew J. Failla, Jennifer E. Stevens-Lapslaey, Nathan K. Endres, James R. Slauterbeck and Bruce D. Beynnon in The American Journal of Sports Medicine

Purpose “Return-to-sport” (RTS) criteria following anterior cruciate ligament (ACL) reconstruction lacks standardization. In addition to functional strength and knee joint stability, psychological factors may also affect readiness to RTS. The present study aimed to assess the association between perceived levels of social support and confidence in RTS among adolescent athletes prior to undergoing ACL reconstruction. We hypothesized that youth athletes who perceived higher levels of social support would have greater confidence in ultimate ability to return to previous level of play …

Orthopaedic and trauma is a broad term describing all kinds of injuries affecting the bones, joints, muscles, tendons, and ligaments in any part of the body that are caused by trauma. The term is wideranging and may refer to minor fractures or severely broken bones with a direct threat to the patient’s life. It is considered as a subspecialty of orthopaedic surgery and is focused on treating fractured bones and making sure the injured part of the body regains its original strength and maximum function it used to have prior to the injury.

Periodontal disease is associated with progressive loss of bone and soft periodontal tissue. The use of biodegradable hydrogel with vascular endothelial growth factor (VEGF) contributing to the settlement of scaff old by fi broblasts with the subsequent formation of Mature connective tissue of the periodontal ligament is promising. Examined and treated 10 patients in the Department of maxillofacial surgery UKH № 4. Comprehensive treatment included standard drug therapy and based on carboxymethylcellulose and VEGF. As a result of treatment, the concentration of pathogenic microflora of periodontium was signifi cantly reduced. The concentration of VEGF in the periodontal pocket decreases after the treatment and normal histoarchitectonics of the gingival mucosa was found. Immunohistochemical methods showed a decrease in extracellular secretion of VEGF, as well as the construction of fi bers not only from “young” collagen type III, but also collagen type I. This indicates a decrease in the activity of inflammation and activation of the plastic processes of the fi brous component, leading to the strengthening of the periodontal structures on the background of the treatment. Thus, not only stimulation of regeneration was noted, but also a pronounced anti-inflammatory eff ect of hydrogel with a vascular endothelial growth factor having the potential to stimulate regeneration of periodontal tissues.

ABSTRACT The rate of production in single point incremental forming (SPIF) approach for the sheet metals is comparatively low when comparing to multiple sheet incremental forming process (MSSPIF). This increase in production rate comes with a trade-off of reduced formability in MSSPIF. The aspiration of the current paper is to analyze the formability, the strain distribution, and the void coalescence variables as per the strain triaxiality during the MSSPIF process of the available commercially pure (CP) titanium sheets. The forming limit diagrams (FLDs) and the strain distribution analysis have been carried out for multiple sheets of two, three, and four sheets bunch while they were formed together. The outcomes proved that the uppermost sheets achieved the higher limiting principal true strain and the limiting values of the principal true strain of bottom sheets decreased in accordance with the position of the sheet and the same was reported in FLDs. The void coalescence in the fractured specimen exhibited an enhanced fracture resistance for CP sheets of titanium. The size of void (µm), thickness of ligament (LT), void (L/W) ratio, d-factor, strain triaxiality, and other void coalescence parameters also have been compared when two, three, and four sheets were formed together during MSSPIF process.