Cartilage Diseases

软骨疾病
  • 文章类型: Case Reports
    在10岁的雄性博洛尼亚犬中,怀疑原因不明的耳廓软骨炎,有五个月的双侧结节性疼痛性和溃疡性脓性肉芽肿性皮炎的病史,并有推定的耳廓软骨破坏。用免疫抑制剂量的泼尼松龙解决疼痛和病变,然而,这种情况导致耳廓和外部运河畸形。
    Auricular chondritis of unknown cause was suspected in a 10-year-old male Bolognese dog with a five-month history of painful bilateral nodular and ulcerative pyogranulomatous dermatitis of the pinnae with putative auricular cartilage destruction. Pain and lesions resolved with immunosuppressive doses of prednisolone, yet the condition resulted in deformity of both pinnae and external canals.
    怀疑一只10岁的雄性波伦亚犬患有不明原因的耳廓软骨炎,该犬有5个月的双侧耳廓结节性和溃疡性脓性肉芽肿性皮炎病史,并假定耳廓软骨破坏。使用免疫抑制剂量的泼尼松缓解疼痛和病变,但病因导致耳廓和外耳道畸形。.
    Une chondrite auriculaire d’étiologie inconnue est suspectée chez un bichon bolonais mâle de 10 ans qui présente depuis 5 mois une dermatite pyogranulomateuse nodulaire et ulcéreuse bilatérale douloureuse du pavillon de l\'oreille avec une destruction présumée du cartilage auriculaire. La douleur et les lésions disparaissent avec des doses immunosuppressives de prednisolone, mais l\'affection entraîne une déformation des deux pavillons et des conduits auriculaires externes.
    Bei einem 10 Jahre alten männlichen Bologneser mit einer 5 Monate lang andauernden Anamnese einer schmerzhaften bilateralen nodulären und ulzerativen pyogranulomatösen Dermatitis der Pinnae mit vermeintlicher aurikulärer Knorpeldestruktion unbekannter Ursache wurde eine aurikuläre Chondritis vermutet. Die Schmerzen und die Veränderungen verschwanden mit immunsuppressiven Dosen von Prednisolon, aber die Ätiologie verursachte dennoch eine Deformierung beider Pinnae und der äußeren Gehörkanäle.
    耳介軟骨の破壊を伴う有痛性の両側結節性および潰瘍性肉芽腫性皮膚炎を5ヵ月間認めた10歳の雄のボロニーズ犬において、原因不明の耳介軟骨炎が疑われた。痛みや病変は免疫抑制量のプレドニゾロン投与で消失したが、病因は両側耳介および外耳道の変形であった。.
    Suspeitou‐se de condrite auricular de causa desconhecida em um cão macho Bolonhês de 10 anos de idade com um histórico de cinco meses de dermatite piogranulomatosa ulcerativa e nodular bilateral no pavilhão auricular com suposta destruição de cartilagem auricular. A dor e as lesões resolveram com doses imunossupressoras de prednisolona apesar de a etiologia ter resultado na deformidade de ambas as orelhas e condutos auditivos.
    Se sospechó la existencia de una condritis auricular de causa desconocida en un perro boloñés de 10 años con historia de 5 meses de duración de una dermatitis nodular ulcerativa piogramulomatosa y bilateral en las orejas con posible destrucción del cartílago auricular. El dolor y las lesiones se resolvieron con dosis inmunosupresoras de prednisolona pero la enfermedad produjo deformación de ambas orejas y de los canales auriculares externos.
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  • 文章类型: Journal Article
    目的:确定MRI是否改变了≥60岁慢性膝关节疼痛患者的治疗。
    方法:纳入90天内连续60岁以上膝关节MRI和X线照片的患者。排除标准包括肿块/恶性肿瘤,最近的创伤,和感染。使用Kellgren-Lawrence(KL)和国际膝关节文献委员会(IKDC)量表评估了站立的AP和PA屈曲视图。记录相关的临床病史。如果确定了软骨下骨折或由于MRI发现而进行了后续关节镜检查,则认为MRI会改变治疗方法。
    结果:回顾了85次膝关节MRI/X光检查;平均68.2年(60-88年),47:38F:M.20个膝关节MRI(24%)有软骨下骨折(n=9)或半月板撕裂(n=11)提示关节镜检查。从PA弯曲的角度来看,与具有15.4%(10/65)KL等级4和38.5%(25/65)KL等级0-1(p=0.03)的其余MRI相比,这些研究中的0/20具有KL等级4和70%(14/20)具有KL等级0-1(p=0.03)。10年的烟草历史,38%vs18%,与软骨下骨折或关节镜检查有关(p=0.06)。软骨下骨折在老年患者中更为普遍(平均72.4vs67.7岁;p=0.03)。
    结论:在≥60岁的慢性膝关节疼痛患者中,MRI改变了约24%的病例的管理;KL0-1级患者为70%,KL4级患者则无。MRI可能使患有轻度骨关节炎的老年患者受益,但对终末期疾病患者不利。吸烟≥10包年的患者也可以从MRI中受益。
    OBJECTIVE: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.
    METHODS: Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.
    RESULTS: Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60-88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0-1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0-1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).
    CONCLUSIONS: In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0-1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI.
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  • 文章类型: Journal Article
    在过去的几十年中,我们对与软骨疾病和关节炎进展相关的生物分子途径的理解取得了实质性进展。在与脚和脚踝相关的领域内,干细胞的基因改造,增强骨髓刺激技术,以及对现有支架的改进,用于递送矫正生物制剂有望改善软骨损伤的治疗。这篇综述总结了在理解软骨损伤的分子途径方面的新进展,以及相关疗法的一些最新进展。
    The last several decades have brought about substantial development in our understanding of the biomolecular pathways associated with chondral disease and progression to arthritis. Within domains relevant to foot and ankle, genetic modification of stem cells, augmentation of bone marrow stimulation techniques, and improvement on existing scaffolds for delivery of orthobiologic agents hold promise in improving treatment of chondral injuries. This review summarizes novel developments in the understanding of the molecular pathways underlying chondral damage and some of the recent advancements within related therapeutics.
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  • 文章类型: Systematic Review
    生长因子等生物制剂(即,富含血小板的血浆)和间充质干细胞在骨科中越来越受欢迎。直管生物学疗法旨在填补传统的保守疗法如透明质酸和手术之间的空白,尤其是软骨疾病。踝关节软骨缺损非常有症状,可能导致患者生活质量严重下降,因为疼痛,肿胀,不能没有疼痛地行走。在这种情况下,本文旨在系统回顾目前有关踝关节软骨生物治疗的文献。
    Biological agents like growth factors (ie, platelet rich plasma) and mesenchymal stem cells are rising in popularity among orthopedics. Orthobiologics therapy aims to fill the gap between conventional conservative therapies like hyaluronic acid and surgery, especially for cartilage disease. Ankle cartilage defects are very symptomatic and could lead to a severe decrease of quality of life in patients, because of pain, swelling, and inability to walk without pain. In this scenario, this paper aims to systematically review the current literature available about biological therapies for ankle cartilage.
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  • 文章类型: Journal Article
    当前的概念彻底突出了踝关节软骨级联,重点是可以将患者引入级联的不同阶段和不同病因。此外,作者将为读者提供可能表现为症状的病变类型的全面概述,无症状,并有可能发展为骨关节炎,作者为读者提供了未来临床意义和科学努力的考虑和方向。
    The current concepts thoroughly highlight the ankle cartilage cascade focusing on the different stages and the different etiologic factors that can introduce a patient into the cascade. Moreover, the authors will provide the reader with a comprehensive overview of the types of lesions that may present as symptomatic, asymptomatic, and dangerous for progression into osteoarthritis, and the authors supply the reader with considerations and directions for future clinical implications and scientific endeavors.
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  • 文章类型: Journal Article
    目的:为“髌股疼痛”(PFP)/“髌骨软化症”的诊断价值确定最适当的功能评估方法,(有效性,可靠性,灵敏度,特异性,预测价值和临床适用性);概述问卷的初步解释及其适当性,通过根据体格检查和磁共振成像(MRI)在其分数中确定的截止点;确定应将哪些方法相互结合使用以获得可靠有效和高效的临床诊断。
    方法:(1)验证了观察者内部和观察者之间的可靠性以及PFP问卷/物理测试之间的关系。(2)问卷的预测能力。主题:113膝盖患有PFP,使用“膝关节损伤和骨关节炎结果评分-髌股疼痛和骨关节炎”(KOOS-PF)进行评估,“Kujala-髌股评分”(KPS),“维多利亚-体育研究所-髌骨肌腱评估问卷”(VISA-P),和身体检查:“髌骨触诊”,“髌骨倾斜”,\“髌骨忧虑\”,“克拉克”和“蹲下”。
    结果:问卷本身的相关性为0.78结论:KOOS-PF,KPS和VISA-P证明了它们在PFP/软骨软化症中的诊断价值(有效性,可靠性,灵敏度,特异性,预测价值和临床适用性)。KOOS-PF是最通用的,最适合轻度病例和早期发现和预防。深蹲是最好的,因为它的可靠性和与问卷的临床关系,正确地预测了它。所讨论的功能评估工具应通过相互结合来应用。
    OBJECTIVE: To determine the most appropriate method of functional assessment for \"patellofemoral pain\" (PFP)/\"chondromalacia patella\" for its diagnostic value, (validity, reliability, sensitivity, specificity, predictive value and clinical applicability); to outline initial interpretations of the questionnaires and their appropriateness, through the cut-off points determined in their scores based on physical test and Magnetic Resonance Imaging (MRI); to establish which methods should be used in conjunction with each other to obtain clinical diagnoses that are robust effective and efficient.
    METHODS: (1)Intra- and inter-observer reliability and of the relationship among PFP questionnaires/physical tests validated. (2)Predictive capacity of the questionnaires. Subject: 113 knees with PFP, assessed using \"Knee-injury-and-Osteoarthritis Outcome-Score-for-Patellofemoral-pain-and-osteoarthritis\" (KOOS-PF), \"Kujala-Patellofemoral-Score\" (KPS), \"Victorian-Institute-of-Sports-Assessment-for-Patellar-tendons-questionnaire\" (VISA-P), and the physical tests: \"patellar-palpation\", \"patellar-tilt\", \"patellar-apprehension\", \"Clarke\" and \"squat\".
    RESULTS: Questionnaires correlations themselves was 0.78CONCLUSIONS: KOOS-PF, KPS and VISA-P demonstrated their diagnostic value in PFP/chondromalacia (validity, reliability, sensitivity, specificity, predictive value and clinical applicability). KOOS-PF was the most versatile, and the most appropriate in mild cases and for early detection and prevention. Squat was the best due to its reliability and clinical relationship with the questionnaires, which predicted it correctly. The functional assessment tools discussed should be applied by combining them with each other.
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  • 文章类型: Case Reports
    鼻塞是耳鼻咽喉科门诊部常见的问题。在这种情况下,一名青少年男孩从小就长期患有右侧鼻塞问题,寻求咨询。诊断性鼻内窥镜检查显示鼻中隔向左偏曲,再加上右下鼻甲肥大,全部覆盖健康粘膜。鼻和鼻旁窦的CT扫描进一步确定了骨性高密度病变,毛玻璃衰减,局限在右下鼻甲。随后的活检证实了青少年小梁骨化性纤维瘤(JTOF)。患者接受了内窥镜右内侧上颌骨切除术,最后的组织学证实了JTOF的诊断。
    Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT scan of the nose and paranasal sinuses further identified a bony hyperdense lesion with ground glass attenuation, confined to the right inferior turbinate. Subsequent biopsy confirmed juvenile trabecular ossifying fibroma (JTOF). The patient underwent endoscopic right medial maxillectomy, and the final histology affirmed the diagnosis of JTOF.
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  • 文章类型: Journal Article
    骨重塑是成骨细胞和破骨细胞之间的平衡。骨疾病如骨质疏松症和骨关节炎与不平衡的骨重建有关。骨骼损伤导致有限的运动功能和疼痛。神经亲素最初是在轴突中发现的,以及它的各种配体和在骨重建、血管生成中的作用,后来发现了神经性疼痛和免疫调节。Neurophilin促进成骨细胞矿化并抑制破骨细胞分化及其功能。Neuropolin-1为免疫细胞趋化和细胞因子扩散提供通道并导致疼痛。Neuropolin-1调节17型T辅助细胞(Th17)和调节性T细胞(Treg细胞)的比例,影响骨骼免疫力.血管内皮生长因子(VEGF)与神经纤毛蛋白结合并促进血管生成。3类信号蛋白(Sema3a)与VEGF竞争结合神经纤毛蛋白,减少血管生成并排斥交感神经。本文综述了神经纤毛素的结构和一般生理功能,并对神经纤毛素及其配体在骨软骨疾病中的作用进行了综述。最后,提出了基于神经纤毛素的治疗策略和未来的研究方向。
    Bone remodeling is the balance between osteoblasts and osteoclasts. Bone diseases such as osteoporosis and osteoarthritis are associated with imbalanced bone remodeling. Skeletal injury leads to limited motor function and pain. Neurophilin was initially identified in axons, and its various ligands and roles in bone remodeling, angiogenesis, neuropathic pain and immune regulation were later discovered. Neurophilin promotes osteoblast mineralization and inhibits osteoclast differentiation and its function. Neuropolin-1 provides channels for immune cell chemotaxis and cytokine diffusion and leads to pain. Neuropolin-1 regulates the proportion of T helper type 17 (Th17) and regulatory T cells (Treg cells), and affects bone immunity. Vascular endothelial growth factors (VEGF) combine with neuropilin and promote angiogenesis. Class 3 semaphorins (Sema3a) compete with VEGF to bind neuropilin, which reduces angiogenesis and rejects sympathetic nerves. This review elaborates on the structure and general physiological functions of neuropilin and summarizes the role of neuropilin and its ligands in bone and cartilage diseases. Finally, treatment strategies and future research directions based on neuropilin are proposed.
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  • 文章类型: Evaluation Study
    目的:本研究旨在探讨两种手术方法的有效性,自体髌腱移植重建和胫骨平台拔出修复,使用猪模型。主要重点是评估内侧半月板后部(MMPP)缺陷的修复能力,弯月面的整体结构完整性,以及两个手术组之间股骨和胫骨软骨的保护。总体目标是使用这些发现为临床研究提供实验指南。
    方法:选择12头猪,建立距胫骨平台插入点10mm的MMPP损伤模型。他们被随机分为三组,每组四只动物:重建(MMPP的自体肌腱移植重建),拔出修复(通过胫骨平台骨隧道缝合修复MMPP),和对照(使用正常内侧半月板作为阴性对照)。术后12周对动物实施安乐死,以评估半月板,肌腱骨愈合评估,膝关节软骨的大体观察。使用国际软骨修复学会(ICRS)分级和Mankin评分评估胫骨和股骨软骨损伤。对半月板-肌腱连接区进行组织学和免疫组织化学染色,初生半月板,和肌腱。Ishida评分用于评估重建组的再生半月板。磁共振成像(MRI)用于评估半月板愈合。
    结果:所有12头猪手术后恢复良好;所有切口均愈合,无感染,无明显并发症发生。总体观察显示,与对照组相比,重建和拔出修复组的效果更好。在胫骨软骨中,重建组有ICRSI级损伤,而拔出修复组和对照组有ICRSII级和III级损伤,分别。Mankin评分在重建组和对照组之间有明显差异;组织学染色显示,重建组再生半月板的结构与原始半月板相似。免疫组化染色显示,重建组再生半月板与原始半月板的Ⅰ型和Ⅱ型胶原染色程度类似。在重建组中,再生半月板与正常初生半月板之间的Ishida评分没有显着差异。MRI显示重建和拔除修复组的MMPP已完全愈合,而对照组尚未愈合。
    结论:自体髌腱移植重建MMPP可产生纤维软骨样再生半月板。重建和拔出修复都可以保持半月板的结构完整性,促进MMPP的愈合,延迟半月板变性,保护膝盖软骨.
    OBJECTIVE: This study was performed to investigate the effectiveness of two surgical procedures, autologous patellar tendon graft reconstruction and trans-tibial plateau pull-out repair, using a pig model. The primary focus was to assess the repair capability of medial meniscus posterior portion (MMPP) deficiency, the overall structural integrity of the meniscus, and protection of the femoral and tibial cartilage between the two surgical groups. The overall aim was to provide experimental guidelines for clinical research using these findings.
    METHODS: Twelve pigs were selected to establish a model of injury to the MMPP 10 mm from the insertion point of the tibial plateau. They were randomly divided into three groups of four animals each: reconstruction (autologous tendon graft reconstruction of the MMPP), pull-out repair (suture repair of the MMPP via a trans-tibial plateau bone tunnel), and control (use of a normal medial meniscus as the negative control). The animals were euthanized 12 weeks postoperatively for evaluation of the meniscus, assessment of tendon bone healing, and gross observation of knee joint cartilage. The tibial and femoral cartilage injuries were evaluated using the International Society for Cartilage Repair (ICRS) grade and Mankin score. Histological and immunohistochemical staining was conducted on the meniscus-tendon junction area, primary meniscus, and tendons. The Ishida score was used to evaluate the regenerated meniscus in the reconstruction group. Magnetic resonance imaging (MRI) was used to evaluate meniscal healing.
    RESULTS: All 12 pigs recovered well after surgery; all incisions healed without infection, and no obvious complications occurred. Gross observation revealed superior results in the reconstruction and pull-out repair groups compared with the control group. In the tibial cartilage, the reconstruction group had ICRS grade I injury whereas the pull-out repair and control groups had ICRS grade II and III injury, respectively. The Mankin score was significantly different between the reconstruction and control groups; histological staining showed that the structure of the regenerated meniscus in the reconstruction group was similar to that of the original meniscus. Immunohistochemical staining showed that the degree of type I and II collagen staining was similar between the regenerated meniscus and the original meniscus in the reconstruction group. The Ishida score was not significantly different between the regenerated meniscus and the normal primary meniscus in the reconstruction group. MRI showed that the MMPP in the reconstruction and pull-out repair groups had fully healed, whereas that in the control group had not healed.
    CONCLUSIONS: Autologous patellar tendon graft reconstruction of the MMPP can generate a fibrocartilage-like regenerative meniscus. Both reconstruction and pull-out repair can preserve the structural integrity of the meniscus, promote healing of the MMPP, delay meniscal degeneration, and protect the knee cartilage.
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  • 文章类型: Journal Article
    IVA型粘多糖贮积症(MPSIVA;MorquioA综合征)是一种罕见的常染色体隐性遗传溶酶体贮积症(LSD),由水解酶缺乏引起,N-乙酰半乳糖胺-6-硫酸盐硫酸酯酶,临床特征主要是肌肉骨骼表现。人类骨骼受累的机制通常是使用侵入性技术如骨活检来探索的。这使得人类的分析变得复杂。我们在野生型和MPSIVA敲除小鼠(UNT)中使用DDA和SWATH-MS比较了骨蛋白质组,以获得有关该疾病的机制信息。我们的发现揭示了基因敲除小鼠中超过1000种失调的蛋白质,包括那些与氧化磷酸化有关的,氧化应激(活性氧),DNA损伤,和铁运输,并提示乳酸脱氢酶可能是一个有用的预后和随访生物标志物。确定反映MPSIVA临床过程的生物标志物,严重程度,和进展对疾病管理有重要意义。
    Mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome) is a rare autosomal recessive lysosomal storage disease (LSD) caused by deficiency of a hydrolase enzyme, N-acetylgalactosamine-6-sulfate sulfatase, and characterized clinically by mainly musculoskeletal manifestations. The mechanisms underlying bone involvement in humans are typically explored using invasive techniques such as bone biopsy, which complicates analysis in humans. We compared bone proteomes using DDA and SWATH-MS in wild-type and MPS IVA knockout mice (UNT) to obtain mechanistic information about the disease. Our findings reveal over 1000 dysregulated proteins in knockout mice, including those implicated in oxidative phosphorylation, oxidative stress (reactive oxygen species), DNA damage, and iron transport, and suggest that lactate dehydrogenase may constitute a useful prognostic and follow-up biomarker. Identifying biomarkers that reflect MPS IVA clinical course, severity, and progression have important implications for disease management.
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