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Liu J, Lin C, Li B, Huang Q, Chen X, Tang S, Luo X, Lu R, Liu Y, Liao S, Ding X. Biochanin A inhibits endothelial dysfunction induced by IL‑6‑stimulated endothelial microparticles in Perthes disease via the NFκB pathway. Exp Ther Med 2024; 27:137. [PMID: 38476892 PMCID: PMC10928846 DOI: 10.3892/etm.2024.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 12/15/2023] [Indexed: 03/14/2024] Open
Abstract
Endothelial dysfunction caused by the stimulation of endothelial microparticles (EMPs) by the inflammatory factor IL-6 is one of the pathogenic pathways associated with Perthes disease. The natural active product biochanin A (BCA) has an anti-inflammatory effect; however, whether it can alleviate endothelial dysfunction in Perthes disease is not known. The present in vitro experiments on human umbilical vein endothelial cells showed that 0-100 pg/ml IL-6-EMPs could induce endothelial dysfunction in a concentration-dependent manner, and the results of the Cell Counting Kit 8 assay revealed that, at concentrations of <20 µM, BCA had no cytotoxic effect. Reverse transcription-quantitative PCR demonstrated that BCA reduced the expression levels of the endothelial dysfunction indexes E-selectin and intercellular cell adhesion molecule-1 (ICAM-1) in a concentration-dependent manner. Immunofluorescence and western blotting illustrated that BCA increased the expression levels of zonula occludens-1 and decreased those of ICAM-1. Mechanistic studies showed that BCA inhibited activation of the NFκB pathway. In vivo experiments demonstrated that IL-6 was significantly increased in the rat model of ischemic necrosis of the femoral head, whereas BCA inhibited IL-6 production. Therefore, in Perthes disease, BCA may inhibit the NFκB pathway to suppress IL-6-EMP-induced endothelial dysfunction, and could thus be regarded as a potential treatment for Perthes disease.
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Affiliation(s)
- Jianhong Liu
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Chengsen Lin
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Boxiang Li
- Department of Orthopedics, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530001, P.R. China
| | - Qian Huang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xianxiang Chen
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Shengping Tang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xiaolin Luo
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Rongbin Lu
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Yun Liu
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Shijie Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
- Guangxi Key Laboratory of Regenerative Medicine, Research Centre for Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xiaofei Ding
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
- Guangxi Key Laboratory of Regenerative Medicine, Research Centre for Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
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de Angeli LRA, Serafim BLC, Cordeiro FG, Bessa FS, Maranho DAC. OSTEOCHONDRITIS DISSECANS OF THE HIP IN LEGG-CALVÉ-PERTHES DISEASE: CASE REPORT AND REVIEW. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e277177. [PMID: 38532867 PMCID: PMC10962086 DOI: 10.1590/1413-785220243201e277177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 03/28/2024]
Abstract
Introduction Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping. Case report We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively. Discussion The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.
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Affiliation(s)
- Luiz Renato Agrizzi de Angeli
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Núcleo de Ortopedia Especializada de São Paulo, São Paulo, SP, Brazil
| | - Bárbara Lívia Corrêa Serafim
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - Felippi Guizardi Cordeiro
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil
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Myszka A, Mańkowska-Pliszka H, Rzeźnicka E, Dąbkowska A, Tomczyk J. Case study of Legg-Calvé-Perthes disease observed in Radom (Poland, 18th–19th century) with literature review. ANTHROPOLOGICAL REVIEW 2023. [DOI: 10.18778/1898-6773.86.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
The aim of this study is to present the pathological lesions observed in a skeleton (male, about 35–38 years old) from Radom (Poland), dated to the 18th–19th century. Bone changes were observed in both femurs and both pelvic bones. The head of the femur is enlarged and deformed, described as “mushroom-shaped”, with areas of smooth cortex and cavities, or possible cystic residues. The neck of femur is short and thick. The bone shaft and distal epiphysis do not show any changes. The changes were also observed in both acetabularies of the hip joint (marginal bone formation, subchondral bone remodelling). Radiographic images show bilateral necrosis of the femoral head. There is a significant sclerotization of the femoral head, with a discrete visible crescent sign. These macroscopic and radiological changes match the symptoms associated with Legg-Calvé-Perthes disease. This is the first case of the disease described in bioarchaeological materials from Poland.
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Laurentino MDF, Lindoso L, Astley C, Lavorato SSM, Ihara BP, Lima DCCD, Gualano B, Queiroz LB, Pereira RMR, Polanczyk GV, Camargo OPD, Silva CA, Grangeiro PM. Impact of COVID-19 on physical and mental functioning in adolescents with disabilities in a sports nongovernmental organization. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021334. [DOI: 10.1590/1984-0462/2023/41/2021334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
Abstract
Abstract Objective: This study aimed to assess physical and mental health, and health-related quality of life (HRQL) parameters in adolescents with physical disabilities enrolled in a sports nongovernmental organization (NGO) versus adolescents without disabilities during coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study included 30 adolescents with disabilities and 86 adolescents without disabilities who responded to an online questionnaire with sociodemographic data and self-rated healthcare routine information during the COVID-19 quarantine. Validated self-report versions of the Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Outcome Data Collection Instrument (PODCI) were also applied. Results: The median of emotional [4 (0–10) vs. 5 (0–10), p=0.018] and prosocial [7 (0–10) vs. 9 (3–10), p=0.006] problems was lower in adolescents with disabilities versus adolescents without disabilities. Adolescents with disabilities had significantly lower global function [68 (21–99) vs. 94 (67–100), p<0.001] and higher happiness scores in the PODCI scale [90 (65–100) vs. 80 (0–100), p=0.016] compared to controls. Logistic regression analysis demonstrated that physical activity/week (OR=1.03; 95%CI 1.01–1.05, p=0.002) was higher in adolescents with disabilities compared to adolescents without disabilities. However, housework activities (OR=0.14; 95%CI 0.04–0.43, p=0.001) and screen time ≥3 h/day (OR=0.09; 95%CI 0.02–0.38, p=0.001) were lower in adolescents with disabilities compared to adolescents without disabilities. Conclusion: Adolescents with disabilities attending a sports NGO were not at higher risk of adverse health-related indicators; despite showing reduced physical function, they reported more physical activity, higher happiness, and less screen time compared to adolescents without disabilities during the COVID-19 pandemic.
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Armstrong AR, Bhave S, Buko EO, Chase KL, Tóth F, Carlson CS, Ellermann JM, Kim HKW, Johnson CP. Quantitative T2 and T1ρ mapping are sensitive to ischemic injury to the epiphyseal cartilage in an in vivo piglet model of Legg-Calvé-Perthes disease. Osteoarthritis Cartilage 2022; 30:1244-1253. [PMID: 35644462 PMCID: PMC9378508 DOI: 10.1016/j.joca.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if the quantitative MRI techniques T2 and T1ρ mapping are sensitive to ischemic injury to epiphyseal cartilage in vivo in a piglet model of Legg-Calvé-Perthes disease using a clinical 3T MRI scanner. We hypothesized that T2 and T1ρ relaxation times would be increased in the epiphyseal cartilage of operated vs contralateral-control femoral heads 1 week following onset of ischemia. DESIGN Unilateral femoral head ischemia was surgically induced in eight piglets. Piglets were imaged 1 week post-operatively in vivo at 3T MRI using a magnetization-prepared 3D fast spin echo sequence for T2 and T1ρ mapping and a 3D gradient echo sequence for cartilage segmentation. Ischemia was confirmed in all piglets using gadolinium contrast-enhanced MRI. Median T2 and T1ρ relaxation times were measured in the epiphyseal cartilage of the ischemic and control femoral heads and compared using paired t-tests. Histological assessment was performed on a subset of five piglets. RESULTS T2 and T1ρ relaxation times were significantly increased in the epiphyseal cartilage of the operated vs control femoral heads (ΔT2 = 11.9 ± 3.7 ms, 95% CI = [8.8, 15.0] ms, P < 0.0001; ΔT1ρ = 12.8 ± 4.1 ms, 95% CI = [9.4, 16.2] ms, P < 0.0001). Histological assessment identified chondronecrosis in the hypertrophic and deep proliferative zones within ischemic epiphyseal cartilage. CONCLUSIONS T2 and T1ρ mapping are sensitive to ischemic injury to the epiphyseal cartilage in vivo at clinical 3T MRI. These techniques may be clinically useful to assess injury and repair to the epiphyseal cartilage to better stage the extent of ischemic damage in Legg-Calvé-Perthes disease.
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Affiliation(s)
- A R Armstrong
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.
| | - S Bhave
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.
| | - E O Buko
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.
| | - K L Chase
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.
| | - F Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.
| | - C S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.
| | - J M Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA; Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
| | - H K W Kim
- Center for Excellence in Hip, Scottish Rite for Children, Dallas, TX, USA; Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
| | - C P Johnson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.
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Caldaci A, Testa G, Dell’Agli E, Sapienza M, Vescio A, Lucenti L, Pavone V. Mid–Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review. CHILDREN 2022; 9:children9081121. [PMID: 36010012 PMCID: PMC9406809 DOI: 10.3390/children9081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
Abstract
Background: Legg–Calvè–Perthes disease (LCPD) is a common childhood disease that usually occurs in 4- to 12-year-old children. Surgical treatment consists of femoral, pelvic, or combined osteotomies. This comprehensive review aimed to investigate the mid- and long-term outcome of the surgical treatment. Methods: A systematic review of PubMed, Science Direct, and MEDLINE databases was performed by two independent authors, using the keywords “outcome”, “surgical treatment”, “pelvic osteotomy”, “femoral osteotomy”, and “Legg–Calvè–Perthes disease” to evaluate studies of any level of evidence that reported the surgical outcome of LCPD. The result of every stage was reviewed and approved by two senior investigators. Results: A total of 2153 articles were found. At the end of the screening, we selected 23 articles eligible for full-text reading according to the inclusion and exclusion criteria. Our analysis showed that the main prognostic factors for surgical outcome in patients with LCPD are the age at onset and the degree of initial disease severity. Conclusions: Surgical treatment in patients older than 6 years has excellent results in Herring B and B/C hips and poor results in Herring C hips, with a slight advantage for patients between 6 and 8 years old.
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Hong P, Zhao X, Liu R, Rai S, Song Y, Xu R, Li J. Perthes Disease in a Child With Osteogenesis Imperfecta From a Rare Genetic Variant: A Case Report. Front Genet 2022; 13:920950. [PMID: 35873455 PMCID: PMC9304686 DOI: 10.3389/fgene.2022.920950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Although certain genetic components have been reported as contributing factors for Perthes disease, its etiology remains unclear. We present a rare case of Perthes disease in a child with osteogenesis imperfecta (OI) caused by a mutation in the COL1A1 gene (NM_000088):exon25:c.1726C>T, (p.Gln576X). Case presentations: A 7-year-old boy was initially treated at our medical facility in March 2016 with a history of chronic pain in right hip joint and limping for a year. He was diagnosed as Perthes disease in the right hip joint. He underwent acetabular osteotomy and ipsilateral proximal femoral varus osteotomy for better containment. During the follow-ups, the right hip demonstrated a normal range of motion without pain, and the pelvic X-ray demonstrated Stulberg Type II hip joint with a round femoral head. In the latest admission in 2022, he suffered from a right femoral shaft fracture after petty violence. After reviewing his medical history, he was suspected of having OI. The whole exome sequencing demonstrated a gene mutation in COL1A1 (OMIM 166200) and confirmed the diagnosis of OI. Telescopic nailing was used to treat the femoral shaft fracture. After the nailing of the right femur, the appearance of the lower extremity seemed normal and symmetrical. Conclusion: This study revealed that there might be an association between OI and Perthes disease. Our case report enriches the phenotypes of osteogenesis imperfecta and provides insight into the pathogenesis of LCPD.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolong Zhao
- Department of Orthopaedics, First Hospital of Wuhan, Wuhan, China
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai, United Arab Emirates
| | - Yingying Song
- Medical Department of Hubei University of Science and Technology, Xianning, China
| | - Ruijing Xu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ruijing Xu, ; Jin Li,
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ruijing Xu, ; Jin Li,
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Bae K, Park SS, Park J, Kang MS. Analysis of Tertiary Hospital Utilization in Pediatric Orthopaedics: a Study Using Nationwide Sample Data from Korea. J Korean Med Sci 2021; 36:e289. [PMID: 34811973 PMCID: PMC8608919 DOI: 10.3346/jkms.2021.36.e289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the Korean medical system, the severity classification for a specific disease depends primarily on its nationwide admission rate in tertiary hospitals. Inversely, one of the important designation criteria for a tertiary hospital is the hospital's treatment ratio of patients classified as having a specific severe disease. Most diseases requiring pediatric orthopaedic surgery (POS) are not currently classified as high severity in terms of disease severity. We investigated the admission rates for the representative POS diseases in tertiary hospitals and compared these rates with those for adult orthopaedic surgery (AOS) diseases. METHODS Seven POS diagnoses and three AOS diagnoses were selected based on frequency of admission. Nationwide sample data were used to investigate the admission rates for these representative diagnoses from 2008 to 2017. RESULTS Six of the seven frequent POS diagnoses presented high admission rates in tertiary hospitals (62.5-92.3%). In contrast, all frequent AOS diagnoses presented low admission rates in tertiary hospitals. CONCLUSION The admission rates of frequent POS diagnoses in tertiary hospitals are high. Considering that these rates are the most important factors for the classification of disease severity, POS diseases seem to be underestimated in terms of severity. This may lead to a tendency for tertiary hospitals to intentionally reduce the admission of children with POS diseases. As a result, these children may not receive appropriate professional care. Therefore, for the disease severity, POS diseases should be classified differently from general AOS diseases by using different criteria reflecting the patient's age.
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Affiliation(s)
- Kunhyung Bae
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Soo-Sung Park
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhee Park
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Michael Seungcheol Kang
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
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de Campos Pessoa AL, de Oliveira Araújo VHV, Rosa Nascimento AL, Elias N, de Carvalho JJ. Phosphodiesterase-5 inhibition improves bone regeneration at the early stages of ischemic osteonecrosis of the femoral head in rats. J Orthop Res 2021; 39:2077-2082. [PMID: 33270292 DOI: 10.1002/jor.24934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/28/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteonecrosis of the femoral head (ONFH) affects patients at different ages and may lead to functional limitation and joint replacement, with total hip arthroplasty, which is a costly procedure. Proposed methods to optimize ischemic tissue regeneration have been reported. Phosphodiesterase-5 inhibitors act by inhibiting the degradation of guanosine 3',5'-cyclic monophosphate in the nitric oxide pathway, increasing its bioavailability and promoting vascular endothelial growth factor (VEGF)-mediated neovascular recruitment and the induction of tissue regeneration in the traumatized bone. Thirty male Sprague-Dawley rats (6 months old) were subjected to an experimental model of traumatic ONFH divided into two groups, according to the administration of 5 mg/kg sildenafil or water (control group). Rats were then killed at 7, 14, and 21 days. Histological (Goldner's trichrome), histochemical (periodic acid-Schiff [PAS]), and immunohistochemical (VEGF and osteopontin [OPN]) techniques were used to quantify bone and vascular responses. Higher levels of VEGF (p < 0.01) and OPN (p < 0.01) immunostaining in the epiphysis, the greater formation of osteoid tissue (p < 0.01 on Day 7; p < 0.05 on Day 14), and higher levels of PAS staining (p < 0.01 on Day 7) were observed in the sildenafil-treated group. The present study demonstrated that sildenafil optimized bone tissue regeneration by increasing VEGF signaling and OPN expression, with increased bone formation (osteoid and carbohydrate macromolecule deposition) in the early stages following traumatic ischemic insult. Thus, sildenafil treatment may improve the prognosis of patients with osteonecrosis.
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Affiliation(s)
- André L de Campos Pessoa
- Departamento de Histologia e Embriologia, Laboratório de Ultraestrutura e Biologia Tecidual, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Victor H V de Oliveira Araújo
- Departamento de Histologia e Embriologia, Laboratório de Ultraestrutura e Biologia Tecidual, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana L Rosa Nascimento
- Departamento de Histologia e Embriologia, Laboratório de Ultraestrutura e Biologia Tecidual, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nelson Elias
- Departamento de Ortopedia e Traumatologia, Vila Velha Hospital, Vila Velha, Espírito Santo, Brazil
| | - Jorge J de Carvalho
- Departamento de Histologia e Embriologia, Laboratório de Ultraestrutura e Biologia Tecidual, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Bellova P, Goronzy J, Blum S, Bürger S, Hartmann A, Günther KP, Thielemann F. How does former Salter innominate osteotomy in patients with Legg–Calvé–Perthes disease influence acetabular orientation? An MRI-based study. J Hip Preserv Surg 2021; 8:240-248. [PMID: 35414952 PMCID: PMC8994115 DOI: 10.1093/jhps/hnab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Salter innominate osteotomy (SIO) has been successfully used in the treatment of Legg–Calvé–Perthes disease (LCPD). Recent studies that have raised concerns about acetabular retroversion after SIO have been based on plain radiographs. In order to assess the true acetabular orientation, the present study uses a specific magnetic resonance imaging (MRI) technique. In addition, the association between acetabular morphology and clinical function as well as health-related quality of life was assessed. Twenty-three patients with 24 operated hips who underwent SIO for LCPD between January 2004 and November 2014 were included. Mean age was 8.5 ± 2.2 years at surgery and 18.5 ± 2.9 years at follow-up. MRIs were conducted at 1.5 T using radial sequences. The analysis included the acetabular version, acetabular sector angles (ASAs) and alpha angles. Plain radiographs were used in order to obtain the Stulberg classification. Patient-related outcome measures included the international Hip Outcome Tool and Euroqol-5 dimensions scores. In comparison to the non-operated side, the MRI of previously operated hips showed no difference of version at the center of the femoral head but significantly decreased version just below the roof level. As a marker for posterior acetabular coverage, the ASAs between 9 and 11 o’clock were significantly decreased when compared with non-operated hips. In hips with a mild acetabular retroversion (<15°), the function was significantly decreased when compared with non-retroverted hips. The SIO is an effective tool in order to restore acetabular containment in LCPD. When compared with the non-operated hips, our collective displays only moderate changes of acetabular orientation and coverage.
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Affiliation(s)
| | - Jens Goronzy
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany
| | - Sophia Blum
- Department of Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany
| | - Simon Bürger
- Faculty of Medicine, TU Dresden, Helmholtzstr.10, Dresden 01069, Germany
| | - Albrecht Hartmann
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany
| | - Klaus-Peter Günther
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany
| | - Falk Thielemann
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany
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Matsumura T, Saito T, Watanabe H, Kikkawa I, Takeshita K. Legg-Calvé-Perthes disease following Ender nail fixation of a pediatric femoral fracture. Int J Surg Case Rep 2021; 85:106209. [PMID: 34293655 PMCID: PMC8319750 DOI: 10.1016/j.ijscr.2021.106209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/03/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Legg–Calvé–Perthes disease (LCPD) sometimes occur in children, however it is difficult to diagnose it at the early stage especially in the cases there are no complaints of symptoms. Femoral shaft fractures in children cause various complications such as leg-length discrepancy, nonunion and malunion, refracture, and osteonecrosis of the femoral head. We presented a rare case in which a pediatric patient developed LCPD after femoral shaft fracture. Case presentation A healthy 8-year-old boy sustained a left femoral diaphyseal fracture following a pedestrian car accident. Fixation was achieved using retrograde Ender nails; bone union was confirmed at 3 months postoperatively, and the Ender nails were removed at 8 months postoperatively without any problems. Unfortunately, the morphological change of the ipsilateral femoral head and subtle symptoms were missed until the femoral head collapsed. LCPD was successfully treated with intertrochanteric varus osteotomy, which achieved a good clinical result. Clinical discussion Although the reason for the ipsilateral LCPD after the femoral shaft fracture is unclear, this case highlights the need for close postoperative follow-up of pediatric femoral fractures resulting from high-energy trauma to prevent the misdiagnosis of this coincidental complication. Conclusion This case report describes a missed ipsilateral LCPD after a femoral diaphyseal fracture caused by high-energy trauma. Close postoperative follow-up with a detailed assessment and vigilant interpretation of postoperative radiography is imperative to avoid delayed/missed diagnosis of conditions for which early management may provide better outcomes. Legg–Calvé–Perthes disease after femoral shaft fracture Close postoperative radiographic follow-up is necessary to avoid misdiagnosis. Legg–Calvé–Perthes disease was successfully treated with intertrochanteric varus osteotomy.
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Affiliation(s)
| | - Tomohiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan.
| | | | | | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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Chen X, Chen K, Su Y. Comparison of the inner side and two-sided approaches for iliac crest bone graft harvesting for pediatric pelvic osteotomy. J Orthop Surg Res 2021; 16:169. [PMID: 33658060 PMCID: PMC7927372 DOI: 10.1186/s13018-021-02318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background The iliac crest is one of the most used bone graft sources. In this study, we aimed to identify the effects of inner side and two-sided approaches for iliac crest bone harvesting on post-surgery ilium growth in children. Materials and methods We retrospectively analyzed 47 patients who underwent pelvic osteotomy and iliac crest bone graft (ICBG) procedures from January 2015 to September 2018. The patients were divided into an inner table ilium exposure group (group A) and the inner-outer table ilium exposure group (group B) and were followed up with radiography in postoperative months 1, 3, 6, and 12, and the growth areas were measured using PACS software. Complications such as damage to the arteries or nerves, ureteral injury, gastrointestinal hernia, ileus, abnormal cosmetic appearance, sensory disturbances, and functional limitations were recorded based on clinical records. Results There were 22 patients aged 5.3±1.5 years in group A and 25 patients aged 5.9±1.8 years in group B. There were no significant differences in demographics between the two groups, or in growth in the first month. However, bone graft growth at months 3, 6, and 12 was significantly better in group A than in group B. There was no significant difference in complications between the two groups. Conclusion Exposure of only the inner table of the ilium resulted in faster recovery of the bone defect than two-sided exposure in pelvic osteotomy. Therefore, we suggest protecting the outer side of the ilium during surgery. Level of evidence Level III
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Affiliation(s)
- Xin Chen
- Department of Radiology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Kai Chen
- Department II of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, China
| | - Yuxi Su
- Department II of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, China.
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Fuchs K, Atabiev BC, Witzmann F, Gresky J. Towards a definition of Ancient Rare Diseases (ARD): Presenting a complex case of probable Legg-Calvé-Perthes Disease from the North Caucasian Bronze Age (2200-1650 cal BCE). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 32:61-73. [PMID: 33360164 DOI: 10.1016/j.ijpp.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study discusses the challenges and possibilities of establishing a definition for Ancient Rare Diseases (ARD) in a probable case of Legg-Calvé-Perthes Disease (LCPD) from the Bronze Age cemetery Kudachurt 14, situated in the Northern Caucasus. MATERIALS We investigated the skeletal remains of a male aged 35-45 years at death. For comparison we examined other males buried at Kudachurt 14 (n = 24) and reviewed 22 LCPD cases from the paleopathological literature. METHODS We use macroscopic as well as osteometric examination methods and imaging techniques. RESULTS The morphology of the left hip joint corresponds to skeletal characteristics for LCPD. Co-occurring osteochondrosis dissecans, femoral anteversion, and atrophy of the left femoral shaft suggest a complex disease course. CONCLUSIONS Modern criteria of rare diseases applied on ancient skeletal remains are either non-transferable or require completion. We conclude that rarity is dynamic, etiological uncertainty has to be accepted, and the respective socioeconomic context is crucial. Degree of disability and level of sociomedical investment are not defining criteria for ARD. SIGNIFICANCE Dating 2200-1650 cal BCE, this study currently presents the earliest case of probable LCPD. This is the first attempt to transform modern characteristics of rare diseases for establishing a paleopathological concept of ARD. LIMITATIONS As this study is limited to LCPD, our conclusions are not directly applicable to other ARD in question. SUGGESTIONS FOR FURTHER RESEARCH More focused paleopathological research on skeletal populations from different cultures and time periods is needed, enabling an evolutionary perspective on the comparability of ancient, modern and future rare diseases.
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Affiliation(s)
- Katharina Fuchs
- Institute of Clinical Molecular Biology, Kiel University, Rosalind-Franklin-Str. 12, 24105, Kiel, Germany.
| | - Biaslan Ch Atabiev
- Institute of Caucasian Archaeology, Kathkanova 30, 361401, Nalchik, Republic Kabardino-Balkaria, Russian Federation.
| | - Florian Witzmann
- Museum für Naturkunde, Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany.
| | - Julia Gresky
- German Archaeological Institute, Department of Natural Sciences, Im Dol 2-6, 14195, Berlin, Germany.
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Does Early Proximal Femoral Varus Osteotomy Shorten the Duration of Fragmentation in Perthes Disease? Lessons From a Prospective Multicenter Cohort. J Pediatr Orthop 2020; 40:e322-e328. [PMID: 31524767 DOI: 10.1097/bpo.0000000000001451] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognosis of Legg-Calvé-Perthes disease (LCPD) is dependent upon several factors, with the length and severity of the fragmentation stage among the most important. Previous retrospectively collected data from a single center have suggested that early proximal femoral varus osteotomy (PFO) may shorten the length of fragmentation and allow 34% of patients to bypass fragmentation altogether resulting in less femoral head deformity. The purpose of this study was to validate these findings in a prospectively collected multicenter cohort. METHODS Patients with LCPD treated with early PFO (during Waldenström stage I) were prospectively followed with serial radiographs at 3-month intervals until a minimum of 2-year follow-up. Waldenström stages and lateral pillar class were determined by mode assessments from 3 pediatric orthopaedic surgeons. The duration of fragmentation was defined as the interval between the first radiographs demonstrating features of stage IIa and stage IIIa. "Complete" bypass was defined as the absence of stage IIa or IIb findings on sequential radiographs with no development of femoral head deformity or collapse. "Partial" bypass was defined as the absence of advanced features of fragmentation and femoral head collapse (stage IIb). RESULTS Forty-six patients (80% male individuals) with initial stage LCPD and a mean age of 8.2±1.2 years were identified. The weighted kappa statistics for Waldenström staging and lateral pillar classifications showed excellent (0.833) and substantial (0.707) agreement, respectively. Ninety-eight percent of patients (45/46) underwent some period of fragmentation lasting between 91 and 518 days; the median duration was 206 days (interquartile range, 181 to 280). One patient (2%) bypassed fragmentation completely; 8 patients (17%) demonstrated partial bypass. Patients who completely or partially bypassed fragmentation experienced significantly less severe lateral pillar collapse (P=0.016) and shorter fragmentation duration (P=0.001). CONCLUSIONS In this prospective multicenter cohort, we found a lower rate of fragmentation bypass than previously reported. Nonetheless, our data support the previous contention that early PFO may shorten fragmentation and minimize collapse in LCPD compared with historical controls. Further study with larger cohorts and a more rigorous definition of what constitutes bypass is warranted to clarify the effect of early PFO on the reparative biology of LCPD. LEVEL OF EVIDENCE Level IV-therapeutic study.
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The Effect of Clinical Knowledge and Surgical Experience on Treatment Choice in Legg-Calve-Perthes Disease: Intra-observer and Inter-observer Reliability Study. Indian J Orthop 2020; 54:477-485. [PMID: 32549963 PMCID: PMC7270382 DOI: 10.1007/s43465-020-00047-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/18/2020] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to evaluate standardized hip radiographs, arthographs, demographic characteristics, physical examination findings, and their effects on treatment choices in leg-calve-perthes disease (LCPD). Intraobserver and interobserver realibility between orthopaedic residents, orthopaedic surgeons, and paediatric orthopaedic surgeons were also investigated. MATERIALS AND METHODS 47 LCPD patients were included this cross-sectional study. Six separate presentations including different variabilities (clinical findings, standard radiographs, and arthrographs) were evaluated by three different groups (residents, surgeons, paediatric orthopaedic surgeons) and were sent to the observers every other month by hiding patients' personal information. Seven different treatment modalities were introduced for the best treatment modality. Intraobserver and interobserver reliability in these three groups were examined. Percentage aggreement (PA) and intraclass correlation coefficients (ICC) tests were used for this purpose. RESULTS Treatment PA rates between presentations were 29.5-53.6% in residents, 38.3-60.4% in surgeons, and 39.1-59.8% in pediatric orthopaedic surgeons. Conservative methods were mostly preferred as treatment modality in all groups; followed by proximal femoral osteotomies. Pediatric orthopaedic surgeons preferred safe dislocation and femur head and/or neck reconstruction surgery 5-18 times more than residents and orthopaedic surgeons. Intraobserver reliability of treatment modalities was higher among the paediatric orthopaedic surgeons; the results were fair-good (0.483-0.763). Among residents and orthopaedic surgeons, ICC values were poor to good, respectively (- 0.080 to 0.636 and 0.263-0.643). Interobserver reliability among three groups was meanly good. CONCLUSION As surgical experience increases, both the compliance rates of the treatment modalities and the intra- and inter-group reliability are increased. Knowledge of the demographic data and clinical findings of patients besides hip radiographs or arthrographs increase treatment compliance in paediatric orthopaedic surgeons, however, cause changes in treatment modalities in residents. As surgical experience increases, more difficult surgeries such as safe dislocation and femoral head/neck reconstruction are preferred.
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Zhu H, Qi X, Liu Y, Liao W, Sun X, Tang Y. The role and underlying mechanisms of microRNA‑214 in Legg‑Calvé‑Perthes disease. Mol Med Rep 2019; 20:685-692. [PMID: 31180556 DOI: 10.3892/mmr.2019.10271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 01/03/2019] [Indexed: 11/06/2022] Open
Abstract
Legg‑Calvé‑Perthes disease (LCPD) is a pediatric form of femoral head osteonecrosis with unknown etiology. MicroRNAs (miRs) have been revealed to serve an important role in LCPD. MiR‑214 serves an important role in chondrogenesis. The aim of the present study was to investigate the potential role of miR‑214 in LCPD and the underlying mechanisms. The expression levels of miR‑214 and B‑cell lymphoma 2 (Bcl‑2)‑associated X protein (Bax) in dexamethasone (DEX)‑treated TC28 cells, and the femoral head cartilage tissues, serum and primary chondrocytes of patients with LCPD, and healthy individuals were determined via reverse transcription quantitative polymerase chain reaction and western blot analysis. A luciferase reporter assay was conducted to investigate the association between miR‑214 and Bax, while cell viability was determined via an MTT assay, and flow cytometry was performed to investigate cell apoptosis. The results revealed that miR‑214 was downregulated and Bax was upregulated in DEX‑treated TC28 cells and tissues obtained from patients with LCPD. MiR‑214 was demonstrated to directly target Bax and negatively regulate its expression. DEX administration significantly suppressed cell proliferation, promoted apoptosis and decreased the Bcl‑2/Bax ratio in TC28 cells; overexpression of miR‑214 induced opposing effects, which were reversed by Bax overexpression. In conclusion, the results indicated that miR‑214 and Bax may be potential therapeutic targets for the future clinical treatment of LCPD.
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Affiliation(s)
- Hui Zhu
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Xinyue Qi
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Yuehe Liu
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Wei Liao
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Xiangshui Sun
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Yuping Tang
- Department of Orthopedics, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
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Leo DG, Murphy R, Gambling T, Long A, Jones H, Perry DC. Perspectives on the Social, Physical, and Emotional Impact of Living With Perthes' Disease in Children and Their Family: A Mixed Methods Study. Glob Pediatr Health 2019; 6:2333794X19835235. [PMID: 30993152 PMCID: PMC6449807 DOI: 10.1177/2333794x19835235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022] Open
Abstract
Aim. To determine the social, physical, and emotional impact of
living with Perthes’ disease on affected children and their family (caregivers).
Patients and Methods. Through a mixed methods approach, we
interviewed 18 parents and explored the perspectives of 12 children affected by
Perthes’ disease (mean = 7.1 years, SD = ±4.1 years) using a survey tool.
Thematic analysis of parents’ interviews provided an insight into
disease-specific factors influencing patients and family’s daily life
activities. Using the childhood survey tool, good and bad day scores were
analyzed using MANOVA (multivariate analysis of variance).
Results. Thematic analysis of the parent interviews (main
themes n = 4) identified a marked effect of the disease on many facets of the
child’s life, particularly pain and the impact on sleep, play, and school
attendance. In addition, the interviews identified a negative effect on the
family life of the parents and siblings. Children indicated that activities of
daily living were affected even during “good days” (P <
.05), but pain was the key limiting factor. Conclusion.
Perthes’ disease negatively affects the social, physical, and emotional
well-being of children and their family. These findings provide outcome domains
that are important to measure in day-to-day care and add in-depth insight into
the challenges caused by this disease for health care professionals involved in
clinical management.
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Affiliation(s)
| | | | | | | | - Helen Jones
- Liverpool John Moores University,
Liverpool, UK
| | - Daniel C. Perry
- University of Liverpool, Liverpool,
UK
- Daniel C. Perry, University of Liverpool,
Alder Hey Hospital, Eaton Road, Liverpool, L12 2AP, UK.
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Azarpira MR, Ghilian MM, Sobhan MR, Mahdinezhad-Yazdi M, Aghili K, Ahrar H, Neamatzadeh H. Association of eNOS 27-bp VNTR, 894G>T and 786T>C polymorphisms with susceptibility to Legg-Calve-Perthes Disease in Iranian children. J Orthop 2019; 16:137-140. [PMID: 30890857 DOI: 10.1016/j.jor.2019.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/17/2019] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to analyze the association of eNOS polymorphisms with risk of Legg-Calve-Perthes Disease (LCPD). Methods The study comprised of 45 LCPD patients and 55 controls. The eNOS polymorphisms were genotyped with PCR and by PCR-RFLP. Results The eNOS 894G > T and -786T > C polymorphisms were significantly associated with an increased risk of LCPD. However, there was no significant association between eNOS 27-bp VNTR polymorphism and LCPD risk. Conclusion Our results suggest that the eNOS 894G > T and -786T > C polymorphisms may be a risk factor for LCPD in Iranian children, but not 27-bp VNTR polymorphism.
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Affiliation(s)
- Mohammad Reza Azarpira
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Ghilian
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Sobhan
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Kazem Aghili
- Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Ahrar
- Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System? Clin Orthop Relat Res 2018; 476:2344-2350. [PMID: 30211706 PMCID: PMC6259889 DOI: 10.1097/corr.0000000000000490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many authors have reported the incidence of Legg-Calvé-Perthes disease (LCPD), there have been few incidence studies in the United States on large, self-contained populations such as those within an integrated health system. Understanding the epidemiology and demographics of LCPD in this setting may help clinicians identify patients at the greatest risk and aid in diagnosis and subsequent treatment. QUESTIONS/PURPOSES In this study we sought (1) to determine the incidence and demographics of LCPD in a large cohort of children and adolescents in a Southern California integrated healthcare system, and (2) to identify any demographic or clinical factors (such as age, sex, race/ethnicity, or BMI) that are independently associated with LCPD. METHODS A retrospective chart analysis was done on patients diagnosed with LCPD within our integrated healthcare system in patients aged 2 to 12 years over a 3-year period between 2010-2012. There were nearly 800,000 children in this cohort. Patient demographics were recorded; the incidence of LCPD was determined for the entire group and by sex, age, and race/ethnicity. Odds ratios for an association with LCPD based on age, sex, BMI and race/ethnicity were determined using logistic regression models. RESULTS The LCPD incidence per 100,000 for all children was 2.84, with the highest incidence in 2- to 5-year-old children (3.05; 95% CI, 1.51-4.59) and the lowest in 9- to 12-year-old children (1.06; 95% CI, 0.21-1.91). Incidence varied markedly among ethnicities, with the highest incidence in whites (5.69; 95% CI, 3.13-8.24) and the lowest in Asians (0.78; 95% CI, 0.00-2.32). Data analysis revealed a 3.13-times increased odds ratio (OR) of LCPD in 2- to 5-year-old patients versus 9- to 12-year-olds (p = 0.011), and boys had a 12.44 times greater OR of LCPD than girls (p < 0.001). Data analysis showed an increased OR for LCPD (3.41; 95% CI, 1.28-9.09) in patients with extreme obesity (BMI-for-age ≥ 1.2 × 95th percentile or a BMI ≥ 35 kg/m) compared with patients with a normal BMI. CONCLUSIONS Our study of a large integrated healthcare system in Southern California revealed an increased association of male sex and young age (2 to 5 years old) with LCPD. The overall incidence was lower overall than previously reported, although the incidence seen in white patients was similar to that in prior studies. The finding that patients with extreme obesity may have an increased association with LCPD merits further study. These findings may increase providers' awareness of the risk of the disease in younger patients and in extremely obese patients, and it also merits further future investigation as to whether there is a cause or effect relationship between extreme obesity and LCPD. LEVEL OF EVIDENCE Level IV, prognostic study.
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Azarpira MR, Ghilian MM, Sobhan MR, Mehdinezhad-Yazdi M, Aghili K, Miresmaeili SM, Neamatzadeh H. Association of MTHFR and TNF-α genes polymorphisms with susceptibility to Legg-Calve-Perthes disease in Iranian children: A case-control study. J Orthop 2018; 15:984-987. [PMID: 30224855 DOI: 10.1016/j.jor.2018.08.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/25/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to assess the association of MTHFR and TNF-α genes polymorphisms with Legg-Calvé-Perthes' disease (LCPD) risk in the Iranian children. Methods A total of 45 children with LCPD and 55 healthy controls were recruited to the study. Genotyping was performed via the RFLP-PCR method and genetic risk was calculated by odds ratio (OR) with its corresponding 95% confidence interval (CI). Results & conclusion Our case-control study failed to determine any association of MTHFR (677C > T and 1298A > C) and TNF-α (-308G > A and -238G > A) polymorphisms with LCPD risk. More studies with larger sample size are warranted to validate our findings.
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Affiliation(s)
- Mohammad Reza Azarpira
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Ghilian
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Sobhan
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Kazem Aghili
- Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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M. Perthes – Diagnostik, Klassifikation und Therapie anhand des Aachen-Dortmunder Therapiealgorithmus. DER ORTHOPADE 2018; 47:722-728. [DOI: 10.1007/s00132-018-3609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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