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Launonen AP, Sumrein BO, Reito A, Lepola V, Paloneva J, Berg HE, Felländer-Tsai L, Kask K, Rahnel T, Tootsi K, Märtson A, Jonsson KB, Wolf O, Ström P, Døssing K, Østergaard HK, Mechlenburg I, Mattila VM, Laitinen MK. Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial. PLoS Med 2023; 20:e1004308. [PMID: 38015877 PMCID: PMC10683994 DOI: 10.1371/journal.pmed.1004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. METHODS AND FINDINGS The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely. CONCLUSIONS In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT01246167.
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Affiliation(s)
- Antti P. Launonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Bakir O. Sumrein
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Vesa Lepola
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Hans E. Berg
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Li Felländer-Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Kristo Kask
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Timo Rahnel
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Kenneth B. Jonsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Peter Ström
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Kaj Døssing
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Helle K. Østergaard
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Minna K. Laitinen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
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2
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Storoni S, Celli L, Zhytnik L, Maasalu K, Märtson A, Kõks S, Khmyzov S, Pashenko A, Maugeri A, Zambrano A, Celli M, Eekhoff EMW, Micha D. Novel pathogenic variants in SPARC as cause of osteogenesis imperfecta: Two case reports. Eur J Med Genet 2023; 66:104857. [PMID: 37758164 DOI: 10.1016/j.ejmg.2023.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
Pathogenic variants in SPARC cause a rare autosomal recessive form of osteogenesis imperfecta (OI), classified as OI type XVII, which was first reported in 2015. Only six patient cases with this specific form of OI have been reported to date. The SPARC protein plays a crucial role in the calcification of collagen in bone, synthesis of the extracellular matrix, and the regulation of cell shape. In this case report, we describe the phenotype of two patients with SPARC-related OI, including a patient with two novel pathogenic variants in the SPARC gene. Targeted Next Generation Sequencing revealed new compound heterozygous variants (c.484G > A p.(Glu162Lys)) and c.496C > T p.(Arg166Cys)) in one patient and a homozygous nonsense pathogenic variant (c.145C > T p.(Gln49*)) in the other. In line with previously reported cases, the two OI patients presented delayed motor development, muscular weakness, scoliosis, and multiple fractures. Interestingly, our study reports for the first time the occurrence of dentinogenesis imperfecta. The study also reports the effectiveness of bisphosphonate treatment for OI type XVII. This article enhances the genetic, clinical, therapeutic, and radiological understanding of SPARC-related OI.
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Affiliation(s)
- Silvia Storoni
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Rare Bone Disease Center Amsterdam, ERN BOND, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Luca Celli
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Rare Bone Disease Center Amsterdam, ERN BOND, Amsterdam, the Netherlands
| | - Lidiia Zhytnik
- Department of Human Genetics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; University of Tartu, Department of Traumatology and Orthopaedics, Tartu, Estonia
| | - Katre Maasalu
- University of Tartu, Department of Traumatology and Orthopaedics, Tartu, Estonia; Tartu University Hospital, Clinic of Traumatology and Orthopaedics, Tartu, Estonia
| | - Aare Märtson
- University of Tartu, Department of Traumatology and Orthopaedics, Tartu, Estonia; Tartu University Hospital, Clinic of Traumatology and Orthopaedics, Tartu, Estonia
| | - Sulev Kõks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Sergey Khmyzov
- Sytenko Institute of Spine and Joint Pathology, National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Andrei Pashenko
- Sytenko Institute of Spine and Joint Pathology, National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Alessandra Maugeri
- Department of Human Genetics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anna Zambrano
- Center for Rare Diseases and Skeletal Dysplasias, Sapienza University of Rome, Italy
| | - Mauro Celli
- Center for Rare Diseases and Skeletal Dysplasias, Sapienza University of Rome, Italy.
| | - Elisabeth M W Eekhoff
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Rare Bone Disease Center Amsterdam, ERN BOND, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Dimitra Micha
- Rare Bone Disease Center Amsterdam, ERN BOND, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Human Genetics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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3
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Prommik P, Tootsi K, Veske K, Strauss E, Saluse T, Kolk H, Märtson A. Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet Disord 2022; 23:394. [PMID: 35477499 PMCID: PMC9044808 DOI: 10.1186/s12891-022-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT’s effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009–2017. The fracture populations’ acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients’ acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients’ mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients’ survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration Retrospectively registered.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Karin Veske
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
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4
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Prommik P, Tootsi K, Saluse T, Strauss E, Kolk H, Märtson A. Simple Excel and ICD-10 based dataset calculator for the Charlson and Elixhauser comorbidity indices. BMC Med Res Methodol 2022; 22:4. [PMID: 34996364 PMCID: PMC8742382 DOI: 10.1186/s12874-021-01492-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background The Charlson and Elixhauser Comorbidity Indices are the most widely used comorbidity assessment methods in medical research. Both methods are adapted for use with the International Classification of Diseases, which 10th revision (ICD-10) is used by over a hundred countries in the world. Available Charlson and Elixhauser Comorbidity Index calculating methods are limited to a few applications with command-line user interfaces, all requiring specific programming language skills. This study aims to use Microsoft Excel to develop a non-programming and ICD-10 based dataset calculator for Charlson and Elixhauser Comorbidity Index and to validate its results with R- and SAS-based methods. Methods The Excel-based dataset calculator was developed using the program’s formulae, ICD-10 coding algorithms, and different weights of the Charlson and Elixhauser Comorbidity Index. Real, population-wide, nine-year spanning, index hip fracture data from the Estonian Health Insurance Fund was used for validating the calculator. The Excel-based calculator’s output values and processing speed were compared to R- and SAS-based methods. Results A total of 11,491 hip fracture patients’ comorbidities were used for validating the Excel-based calculator. The Excel-based calculator’s results were consistent, revealing no discrepancies, with R- and SAS-based methods while comparing 192,690 and 353,265 output values of Charlson and Elixhauser Comorbidity Index, respectively. The Excel-based calculator’s processing speed was slower but differing only from a few seconds up to four minutes with datasets including 6250–200,000 patients. Conclusions This study proposes a novel, validated, and non-programming-based method for calculating Charlson and Elixhauser Comorbidity Index scores. As the comorbidity calculations can be conducted in Microsoft Excel’s simple graphical point-and-click interface, the new method lowers the threshold for calculating these two widely used indices. Trial registration retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01492-7.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia. .,Institute of Sport Sciences and Physiotherapy, University of Tartu, Ujula 4, 51008, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
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Rothzerg E, Ho XD, Xu J, Wood D, Märtson A, Kõks S. Upregulation of 15 Antisense Long Non-Coding RNAs in Osteosarcoma. Genes (Basel) 2021; 12:genes12081132. [PMID: 34440306 PMCID: PMC8394133 DOI: 10.3390/genes12081132] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
The human genome encodes thousands of natural antisense long noncoding RNAs (lncRNAs); they play the essential role in regulation of gene expression at multiple levels, including replication, transcription and translation. Dysregulation of antisense lncRNAs plays indispensable roles in numerous biological progress, such as tumour progression, metastasis and resistance to therapeutic agents. To date, there have been several studies analysing antisense lncRNAs expression profiles in cancer, but not enough to highlight the complexity of the disease. In this study, we investigated the expression patterns of antisense lncRNAs from osteosarcoma and healthy bone samples (24 tumour-16 bone samples) using RNA sequencing. We identified 15 antisense lncRNAs (RUSC1-AS1, TBX2-AS1, PTOV1-AS1, UBE2D3-AS1, ERCC8-AS1, ZMIZ1-AS1, RNF144A-AS1, RDH10-AS1, TRG-AS1, GSN-AS1, HMGA2-AS1, ZNF528-AS1, OTUD6B-AS1, COX10-AS1 and SLC16A1-AS1) that were upregulated in tumour samples compared to bone sample controls. Further, we performed real-time polymerase chain reaction (RT-qPCR) to validate the expressions of the antisense lncRNAs in 8 different osteosarcoma cell lines (SaOS-2, G-292, HOS, U2-OS, 143B, SJSA-1, MG-63, and MNNG/HOS) compared to hFOB (human osteoblast cell line). These differentially expressed IncRNAs can be considered biomarkers and potential therapeutic targets for osteosarcoma.
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Affiliation(s)
- Emel Rothzerg
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia; (E.R.); (J.X.); (D.W.)
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia
| | - Xuan Dung Ho
- Department of Oncology, College of Medicine and Pharmacy, Hue University, Hue 53000, Vietnam;
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia; (E.R.); (J.X.); (D.W.)
| | - David Wood
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia; (E.R.); (J.X.); (D.W.)
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu University Hospital, 50411 Tartu, Estonia;
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA 6150, Australia
- Correspondence: ; Tel.: +61-(0)-8-6457-0313
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Prommik P, Tootsi K, Saluse T, Märtson A, Kolk H. Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data. Arch Osteoporos 2021; 16:101. [PMID: 34173061 DOI: 10.1007/s11657-021-00973-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option. PURPOSE Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients' survival compared with those treated with operative management (OM). METHODS This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically. RESULTS From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient's refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%). CONCLUSION Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM's superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question - well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia.
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
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Prommik P, Maiväli Ü, Kolk H, Märtson A. Causal variation modelling identifies large inter- and intra-regional disparities in physical therapy offered to hip fracture patients in Estonia. Disabil Rehabil 2021; 44:4729-4737. [PMID: 33929920 DOI: 10.1080/09638288.2021.1918772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE An essential measure of hip fracture (HF) rehabilitation, the amount of physical therapy (PT) used per patient, has been severely understudied. This study (1) evaluates post-acute PT use after HF in Estonia, (2) presents causal variation modelling for examining inter- and intra-regional disparities, and (3) analyses its temporal trends. MATERIALS AND METHODS This retrospective cohort study used validated population-wide health data, including patients aged ≥50 years, with an index HF diagnosed between January 2009 and September 2017. Patients' 6-month PT use was analysed and reported separately for acute and post-acute phases. RESULTS While most of the included 11,461 patients received acute rehabilitation, only 40% of them received post-acute PT by a median of 6 h. Analyses based on measures of central tendency revealed 2.5 to 2.6-fold inter-regional differences in HF post-acute rehabilitation. Variation modelling additionally detected intra-regional disparities, showing imbalances in the fairness of allocating local rehabilitation resources between a county's patients. CONCLUSIONS This study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation. The analyses revealed persisting large multi-level disparities and accompanying overall inaccessibility of PT in HF rehabilitation in Estonia, showing an urgent need for system-wide improvements.Implications for rehabilitationThis study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation, using an essential outcome measure - used physical therapy hours.The study revealed large multi-level disparities and overall inaccessibility of physical therapy in hip fracture rehabilitation in Estonia, showing an urgent need for system-wide improvements.This study expands our knowledge on unstudied topics - hip fracture post-acute care and long-term physical therapy use.This regional analysis provides the first evidence-based regional-level basis for improving the rehabilitation system in Estonia.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia.,Institute of Sport Sciences and Physiotherapy, Tartu, Estonia
| | - Ülo Maiväli
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
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Bollmann M, Pinno K, Ehnold LI, Märtens N, Märtson A, Pap T, Stärke C, Lohmann CH, Bertrand J. MMP-9 mediated Syndecan-4 shedding correlates with osteoarthritis severity. Osteoarthritis Cartilage 2021; 29:280-289. [PMID: 33246160 DOI: 10.1016/j.joca.2020.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a degenerative joint disease inducing the degradation of the articular cartilage. Syndecan-4 (Sdc4) is a heparan sulfate proteoglycan, expressed under inflammatory conditions and by chondrocytes during OA. Little is known about Sdc4 shedding and its regulation in OA. Therefore, we investigated the regulation of Sdc4 shedding and underlying shedding mechanisms under OA conditions. DESIGN Articular cartilage, serum, synovial fluid and synovial membrane from OA patients with different radiological severity were analyzed. ELISA, RT-qPCR and IHC for Sdc4, MMP-2 and -9 were performed. MMP inhibitors and siRNA were evaluated for their effect on Sdc4 shedding by ELISA and on IL-1 signaling by western blot (pERK/ERK). RESULTS Shed Sdc4 was increased in synovial fluid of OA patients, but not in the serum and is a good predictor (AUC = 0.72) for OA severity with a sensitivity of 67.5% and specificity 65.2%. MMP-9, but not MMP-2, was increased in cartilage and synovial membrane at mRNA levels and in the synovial fluid at protein levels. Shed Sdc4 correlated with the amount of MMP-9 in synovial fluid. Further, the inhibition and knock-down of MMP-9 decreased the amount of shed Sdc4 in vitro. Increased Sdc4 shedding resulted in less phosphorylation of ERK upon IL-1β stimulation. CONCLUSION Shed Sdc4 might be a good prognostic biomarker for OA mediated cartilage degradation. MMP-9 seems to be the relevant sheddase for Sdc4 under OA conditions, desensitizing chondrocytes towards IL-1 signaling.
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Affiliation(s)
- M Bollmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - K Pinno
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - L I Ehnold
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - N Märtens
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - A Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - T Pap
- Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
| | - C Stärke
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - C H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - J Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
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9
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Zhytnik L, Maasalu K, Reimann E, Märtson A, Kõks S. RNA sequencing analysis reveals increased expression of interferon signaling genes and dysregulation of bone metabolism affecting pathways in the whole blood of patients with osteogenesis imperfecta. BMC Med Genomics 2020; 13:177. [PMID: 33228694 PMCID: PMC7684725 DOI: 10.1186/s12920-020-00825-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare genetic disorder in which the patients suffer from numerous fractures, skeletal deformities and bluish sclera. The disorder ranges from a mild form to severe and lethal cases. The main objective of this pilot study was to compare the blood transcriptional landscape of OI patients with COL1A1 pathogenic variants and their healthy relatives, in order to find out different gene expression and dysregulated molecular pathways in OI. METHODS We performed RNA sequencing analysis of whole blood in seven individuals affected with different OI severity and their five unaffected relatives from the three families. The data was analyzed using edgeR package of R Bioconductor. Functional profiling and pathway analysis of the identified differently expressed genes was performed with g:GOSt and MinePath web-based tools. RESULTS We identified 114 differently expressed genes. The expression of 79 genes was up-regulated, while 35 genes were down-regulated. The functional analysis identified a presence of dysregulated interferon signaling pathways (IFI27, IFITM3, RSAD12, GBP7). Additionally, the expressions of the genes related to extracellular matrix organization, Wnt signaling, vitamin D metabolism and MAPK-ERK 1/2 pathways were also altered. CONCLUSIONS The current pilot study successfully captured the differential expression of inflammation and bone metabolism pathways in OI patients. This work can contribute to future research of transcriptional bloodomics in OI. Transcriptional bloodomics has a strong potential to become a major contributor to the understanding of OI pathological mechanisms, the discovery of phenotype modifying factors, and the identification of new therapeutic targets. However, further studies in bigger cohorts of OI patients are needed to confirm the findings of the current work.
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Affiliation(s)
- Lidiia Zhytnik
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Katre Maasalu
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
- Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Ene Reimann
- Estonian Genome Centre, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
- Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
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10
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Rothzerg E, Ho XD, Xu J, Wood D, Märtson A, Maasalu K, Kõks S. Alternative splicing of leptin receptor overlapping transcript in osteosarcoma. Exp Biol Med (Maywood) 2020; 245:1437-1443. [PMID: 32787464 DOI: 10.1177/1535370220949139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPACT STATEMENT Osteosarcoma (OS, also known as osteogenic sarcoma) is the most common primary malignancy of bone in children and adolescents. The molecular mechanisms of OS are extremely complicated and its molecular mediators remain to be elucidated. We sequenced total RNA from 18 OS bone samples (paired normal-tumor biopsies). We found statistically significant (FDR <0.05) 26 differentially expressed transcript variants of LEPROT gene with different expressions in normal and tumor samples. These findings contribute to the understanding of molecular mechanisms of OS development and provide encouragement to pursue further research.
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Affiliation(s)
- Emel Rothzerg
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia.,Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia
| | - Xuan D Ho
- Department of Oncology, College of Medicine and Pharmacy, Hue University, Hue 53000, Vietnam
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia
| | - David Wood
- School of Biomedical Sciences, The University of Western Australia, Perth, WA 6009, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu University Hospital, Tartu 50411, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu University Hospital, Tartu 50411, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA 6150, Australia
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11
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Zhytnik L, Simm K, Salumets A, Peters M, Märtson A, Maasalu K. Reproductive options for families at risk of Osteogenesis Imperfecta: a review. Orphanet J Rare Dis 2020; 15:128. [PMID: 32460820 PMCID: PMC7251694 DOI: 10.1186/s13023-020-01404-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Osteogenesis Imperfecta (OI) is a rare genetic disorder involving bone fragility. OI patients typically suffer from numerous fractures, skeletal deformities, shortness of stature and hearing loss. The disorder is characterised by genetic and clinical heterogeneity. Pathogenic variants in more than 20 different genes can lead to OI, and phenotypes can range from mild to lethal forms. As a genetic disorder which undoubtedly affects quality of life, OI significantly alters the reproductive confidence of families at risk. The current review describes a selection of the latest reproductive approaches which may be suitable for prospective parents faced with a risk of OI. The aim of the review is to alleviate suffering in relation to family planning around OI, by enabling prospective parents to make informed and independent decisions. Main body The current review provides a comprehensive overview of possible reproductive options for people with OI and for unaffected carriers of OI pathogenic genetic variants. The review considers reproductive options across all phases of family planning, including pre-pregnancy, fertilisation, pregnancy, and post-pregnancy. Special attention is given to the more modern techniques of assisted reproduction, such as preconception carrier screening, preimplantation genetic testing for monogenic diseases and non-invasive prenatal testing. The review outlines the methodologies of the different reproductive approaches available to OI families and highlights their advantages and disadvantages. These are presented as a decision tree, which takes into account the autosomal dominant and autosomal recessive nature of the OI variants, and the OI-related risks of people without OI. The complex process of decision-making around OI reproductive options is also discussed from an ethical perspective. Conclusion The rapid development of molecular techniques has led to the availability of a wide variety of reproductive options for prospective parents faced with a risk of OI. However, such options may raise ethical concerns in terms of methodologies, choice management and good clinical practice in reproductive care, which are yet to be fully addressed.
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Affiliation(s)
- Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.
| | - Kadri Simm
- Institute of Philosophy and Semiotics, Faculty of Arts and Humanities, University of Tartu, Tartu, Estonia.,Centre of Ethics, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia.,COMBIVET ERA Chair, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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12
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Tootsi K, Lees L, Geiko B, Märtson A. Intraoperative complications in total hip arthroplasty using a new cementless femoral implant (SP-CL ®). J Orthop Traumatol 2020; 21:8. [PMID: 32451636 PMCID: PMC7248161 DOI: 10.1186/s10195-020-00548-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Considering the excellent results already achieved in total hip arthroplasty (THA), new implants must be at least as safe as currently used implants and lead to longer survival. A new cementless femoral stem, SP-CL®, has been introduced. The aim of this study is to evaluate intraoperative complications and assess the risk factors of THA with the SP-CL® implant. MATERIALS AND METHODS All THA patients who were operated on using the SP-CL® (LINK, Hamburg, Germany) implant between 2015 and 2018 were included in the analysis. Data were collected from medical records from national and hospital electronic databases. Radiological measurements were made from standard pre- and postoperative radiographs. RESULTS A total of 222 THA were performed using the SP-CL® implant. The average age of the patients was 56 years (14-77 years). There were 1 transient sciatic nerve injury, 1 acetabular fracture, and 11 (5.0%) intraoperative femoral fractures (IFF), of which 7 were treated with cerclage wire or titanium band during the operation while the other fractures were treated conservatively. None of the IFF patients were revised due to fracture during the follow-up period (one revision due to infection). The radiographic morphology of proximal femur was associated with increased risk of IFF (p = 0.02). CONCLUSIONS The results of the current study demonstrate a 5% incidence of IFF when using the LINK SP-CL® femoral stem in THA. The radiographic morphology of the proximal femur was an important predictor of IFF and should be assessed when using SP-CL®. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Puusepa 8, Tartu, 51014, Estonia.
| | - Loviisa Lees
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia
| | - Boris Geiko
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Puusepa 8, Tartu, 51014, Estonia
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13
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Zhytnik L, Maasalu K, Reimand T, Duy BH, Kõks S, Märtson A. Inter- and Intrafamilial Phenotypic Variability in Individuals with Collagen-Related Osteogenesis Imperfecta. Clin Transl Sci 2020; 13:960-971. [PMID: 32166892 PMCID: PMC7485955 DOI: 10.1111/cts.12783] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/15/2020] [Indexed: 12/15/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder also known as a “brittle bone disease.” Around 90% of patients with OI harbor loss‐of‐function or dominant negative pathogenic variants in the COL1A1 and COL1A2 genes, which code for collagen type I α1 and α2 chains. Collagen‐related forms of the disorder are classified as Sillence OI types I–IV. OI phenotype expression ranges from mild to lethal. The current study aims to evaluate associations between interfamilial and intrafamilial phenotypic variability and genotype characteristics of patients with collagen‐related OI. The study was based on a systematic review of collagen‐related OI cases from the University of Tartu OI database (n = 137 individuals from 81 families) and the Dalgleish database (n = 479 individuals). Interfamilial variability analysis has shown that 17.74% of all studied OI‐related variants were associated with the same phenotype. The remaining 82.26% of pathogenic variants were associated with variable phenotypes. Additionally, higher interfamilial variability correlated with the COL1A1 gene (P value = 0.001) and dominant‐negative variants (P value = 0.0007). Within intrafamilial variability, 32.81% families had increasing or decreasing OI phenotype severity across generations. Higher intrafamilial variability of phenotypes correlated with the collagen I dominant negative variants (P value = 0.0246). The current study shows that, in line with other phenotype modification factors, OI interfamilial and intrafamilial diversity potential is associated with the genotype characteristics of the OI‐causing pathogenic variants. The results of the current study may advance knowledge of OI phenotype modification as well as assist family planning and the evaluation of disease progression in subsequent generations.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Tiia Reimand
- Department of Clinical Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Department of Clinical Genetics, United Laboratories, Tartu University Hospital, Tartu, Estonia.,Department of Biomedicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Binh Ho Duy
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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14
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Koks S, Wood DJ, Reimann E, Awiszus F, Lohmann CH, Bertrand J, Prans E, Maasalu K, Märtson A. The Genetic Variations Associated With Time to Aseptic Loosening After Total Joint Arthroplasty. J Arthroplasty 2020; 35:981-988. [PMID: 31791832 DOI: 10.1016/j.arth.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/07/2019] [Accepted: 11/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) is one of the most frequent surgical procedures performed in modern hospitals, and aseptic loosening is the most common indication for revision surgeries. We conducted a systemic exploration of potential genetic determinants for early aseptic loosening. METHODS Data from 423 patients undergoing TJA were collected and analyzed. Three analytical groups were formed based on joint arthroplasty status. Group 1 were TJA patients without symptoms of aseptic loosening of at least 1 year, group 2 were patients with primary TJA, and group 3 were patients receiving revision surgery because of aseptic loosening. Genome-wide genotyping comparing genotype frequencies between patients with and without aseptic loosening (group 3 vs groups 1 and 2) was conducted. A case-control association analysis and linear modeling were applied to identify the impact of the identified genes on implant survival with time to the revision as an outcome measure. RESULTS We identified 52 single-nucleotide polymorphisms (SNPs) with a genome-wide suggestive P value less than 10-5 to be associated with the implant loosening. The most remarkable odds ratios (OR) were found with the variations in the IFIT2/IFIT3 (OR, 21.6), CERK (OR, 12.6), and PAPPA (OR, 14.0) genes. Variations in the genotypes of 4 SNPs-rs115871127, rs16823835, rs13275667, and rs2514486-predicted variability in the time to aseptic loosening. The time to aseptic loosening varied from 8 to 16 years depending on the genotype, indicating a substantial effect of genetic variance. CONCLUSION Development of the aseptic loosening is associated with several genetic variations and we identified at least 4 SNPs with a significant effect on the time for loosening. These data could help to develop a personalized approach for TJA and loosening management.
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Affiliation(s)
- Sulev Koks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia; The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - David J Wood
- Department of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Ene Reimann
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia; Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia; Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
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15
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Teder-Braschinsky A, Märtson A, Rosenthal M, Taba P. Parkinson's Disease and Symptomatic Osteoarthritis Are Independent Risk Factors of Falls in the Elderly. Clin Med Insights Arthritis Musculoskelet Disord 2019; 12:1179544119884936. [PMID: 31700249 PMCID: PMC6823975 DOI: 10.1177/1179544119884936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/01/2019] [Indexed: 01/06/2023]
Abstract
Objectives: Deteriorating functionality and loss of mobility, resulting from Parkinson’s disease, may be worsened by osteoarthritis, which is the most common form of joint disease causing pain and functional impairment. We assessed the association between symptomatic hip or knee osteoarthritis, falls, and the ability to walk among patients with Parkinson’s disease compared to a control group. Methods: A total of 136 patients with Parkinson’s disease in Southern Estonia and 142 controls with an average age of 76.8 and 76.3 years, respectively, were enrolled in a retrospective case-control study. Information on falls and related fractures during the previous year was collected from the patients with Parkinson’s disease and controls. Covariates included gender, age, mobility, duration of Parkinson’s disease, and fractures. Results: Patients with Parkinson’s disease were at an increased risk of falls compared to the control group, and for the higher risk of fractures. Symptomatic knee or hip osteoarthritis was a significant independent predictor of falls in both patients with Parkinson’s disease and controls. The higher risk for fractures during the previous year was demonstrated in symptomatic osteoarthritis. Risk factors for falls included also female gender, use of sleep pills, and the inability to walk 500 m. Conclusions: Symptomatic hip and knee osteoarthritis are risk factors for falls and related fractures among the elderly population with and without Parkinson’s disease. The inability to walk 500 m could be used as a simple predictive factor for the increased risk of falls among elderly populations.
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Affiliation(s)
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Marika Rosenthal
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
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16
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Zhytnik L, Maasalu K, Pashenko A, Khmyzov S, Reimann E, Prans E, Kõks S, Märtson A. COL1A1/2 Pathogenic Variants and Phenotype Characteristics in Ukrainian Osteogenesis Imperfecta Patients. Front Genet 2019; 10:722. [PMID: 31447884 PMCID: PMC6696896 DOI: 10.3389/fgene.2019.00722] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/10/2019] [Indexed: 11/25/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary bone disorder caused by defects of type I collagen. Although up to 90% of patients harbor pathogenic variants in the COL1A1/2 gene, which codes for collagen α1/2 chains, the spectrum of OI genotypes may differ between populations, and there is academic controversy around OI genotype-phenotype correlations. In the current study, 94 Ukrainian OI families were interviewed. Clinical and genealogical information was collected from patients in spoken form, and their phenotypes were described. To identify the spectrum of collagen I pathogenic variants, COL1A1/2 mutational analysis with Sanger sequencing was performed on the youngest affected individual of every family. Of the 143 patients investigated, 67 (46.85%) had type I OI, 24 (16.78%) had type III, 49 (34.27%) had type IV, and III (2.10%) had type V. The mean number of fractures suffered per patient per year was 1.32 ± 2.88 (type I 0.50 ± 0.43; type III 3.51 ± 6.18; type IV 1.44 ± 1.77; and type 5 0.77 ± 0.23). 87.23% of patients had skeletal deformations of different severity. Blue sclera, dentinogenesis imperfecta, and hearing loss were present in 87%, 55%, and 22% of patients, respectively. COL1A1/2 pathogenic variants were harbored by 60 patients (63.83%). 27 pathogenic variants are described herein for the first time. The majority of the pathogenic variants were located in the COL1A1 gene (76.19%). Half (49.21%) of the pathogenic variants were represented by structural variants. OI phenotype severity was highly correlated with type of collagen I defect. The current article presents an analysis of the clinical manifestations and COL1A1/2 mutational spectrum of 94 Ukrainian OI families with 27 novel COL1A1/2 pathogenic variants. It is hoped that this data and its analysis will contribute toward the increased understanding of the phenotype development and genetics of the disorder.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Andrey Pashenko
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Sergey Khmyzov
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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17
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Zhytnik L, Maasalu K, Duy BH, Pashenko A, Khmyzov S, Reimann E, Prans E, Kõks S, Märtson A. IFITM5 pathogenic variant causes osteogenesis imperfecta V with various phenotype severity in Ukrainian and Vietnamese patients. Hum Genomics 2019; 13:25. [PMID: 31159867 PMCID: PMC6547447 DOI: 10.1186/s40246-019-0209-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) covers a spectrum of bone fragility disorders. OI is classified into five types; however, the genetic causes of OI might hide in pathogenic variants of 20 different genes. Often clinical OI types mimic each other. This sometimes makes it impossible to identify the OI type clinically, which can be a risk for patients. Up to 90% of OI types I-IV are caused by pathogenic variants in the COL1A1/2 genes. OI type V is caused by the c.-14C > T pathogenic variant in the 5'UTR of the IFITM5 gene and is characterized by hyperplastic callus formation and the ossification of interosseous membranes. RESULTS In the current study, we performed IFITM5 5'UTR region mutational analysis using Sanger sequencing on 90 patients who were negative for COL1A1/2 pathogenic variants. We also investigated the phenotypes of five patients with genetically confirmed OI type V. The proportion of OI type V patients in our cohort of all OI patients was 1.48%. In one family, there was a history of OI in at least three generations. Phenotype severity differed from mild to extremely severe among patients, but all patients harbored the same typical pathogenic variant. One patient had no visible symptoms of OI type V and was suspected to have had OI type IV previously. We also identified a case of extremely severe hyperplastic callus in a 15-year-old male, who has hearing loss and brittleness of teeth. CONCLUSIONS OI type V is underlined with some unique clinical features; however, not all patients develop them. The phenotype spectrum might be even broader than previously suspected, including typical OI features: teeth brittleness, bluish sclera, hearing loss, long bones deformities, and joint laxity. We suggest that all patients negative for COL1A1/2 pathogenic variants be tested for the presence of an IFITM5 pathogenic variant, even if they are not expressing typical OI type V symptoms. Further studies on the pathological nature and hyperplastic callus formation mechanisms of OI type V are necessary.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopeadics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Katre Maasalu
- Department of Traumatology and Orthopeadics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopeadics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Binh Ho Duy
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Andrey Pashenko
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Pushkinska 80, Kharkiv, 61024, Ukraine
| | - Sergey Khmyzov
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Pushkinska 80, Kharkiv, 61024, Ukraine
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Ravila 14a, 50411, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopeadics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopeadics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
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Prommik P, Kolk H, Sarap P, Puuorg E, Harak E, Kukner A, Pääsuke M, Märtson A. Estonian hip fracture data from 2009 to 2017: high rates of non-operative management and high 1-year mortality. Acta Orthop 2019; 90:159-164. [PMID: 30669948 PMCID: PMC6461069 DOI: 10.1080/17453674.2018.1562816] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There are no national guidelines for treatment of hip fractures in Estonia and no studies on management. We assessed treatment methods and mortality rates for hip fracture patients in Estonia. Patients and methods - We studied a population-based retrospective cohort using validated data from the Estonian Health Insurance Fund's database. The cohort included patients aged 50 and over with an index hip fracture diagnosis between January 1, 2009 and September 30, 2017. The study generated descriptive statistics of hip fracture management methods and calculated in-hospital, 1-, 3, 6-, and 12-month unadjusted all-cause mortality rates. [CrossRef] Results - 91% (number of hips: 11,628/12,731) of the original data were included after data validation. Median patient age was 81 years, 83 years for women and 74 years for men. 28% were men. Treatment methods were: total hip arthroplasty 7%; hemiarthroplasty 25%; screws 6%; sliding hip screw 25%; intramedullary nail 27%; and nonoperative management 10%. Unadjusted all-cause mortality rates for in-hospital, 1, 3, 6, and 12 months were: 3%, 9%, 18%, 24%, and 31% respectively. The 12-month mortality rate for nonoperative management was 58%. [CrossRef] Interpretation - High rates of nonoperative management and overall high 1-year mortality rates after an index hip fracture indicate the need to review exclusion criteria for surgery and subacute care in Estonia.
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Affiliation(s)
- Pärt Prommik
- University of Tartu; ,Tartu University Hospital, Estonia,Correspondence:
| | - Helgi Kolk
- University of Tartu; ,Tartu University Hospital, Estonia
| | - Pirja Sarap
- University of Tartu; ,Tartu University Hospital, Estonia
| | | | - Eva Harak
- University of Tartu; ,Tartu University Hospital, Estonia
| | | | | | - Aare Märtson
- University of Tartu; ,Tartu University Hospital, Estonia
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19
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Zhytnik L, Maasalu K, Duy BH, Pashenko A, Khmyzov S, Reimann E, Prans E, Kõks S, Märtson A. De novo and inherited pathogenic variants in collagen-related osteogenesis imperfecta. Mol Genet Genomic Med 2019; 7:e559. [PMID: 30675999 PMCID: PMC6418448 DOI: 10.1002/mgg3.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 01/10/2023] Open
Abstract
Background Osteogenesis imperfecta (OI) is a rare genetic bone fragility disorder. In the current study, differences between the genotypes and phenotypes of de novo and inherited collagen‐related OI were investigated. Methods A comparative analysis was performed of the genotypes and phenotypes of 146 unrelated inherited and de novo collagen I OI cases from Estonia, Ukraine, and Vietnam. Mutational analysis of the subjects and all available parents were performed with Sanger sequencing. Results Results showed that 56.16% of the OI cases were caused by de novo pathogenic variants. The proportion of OI types OI1, OI4, and OI3 among subjects with inherited OI was 45.31%, 46.88%, and 7.81%, respectively. Among subjects with de novo OI, the proportions of OI types (OI1, OI4, and OI3) were almost equal. Both inherited and de novo OI pathogenic variants occurred more often in the COL1A1 gene than in the COL1A2. The majority of de novo cases were missense pathogenic variants, whereas inherited OI was mostly caused by loss of function pathogenic variants. Conclusion In summary, there were significant differences between the phenotypes and genotypes of subjects with de novo and inherited OI. These findings may promote the further understanding of OI etiology, and assist with diagnostics procedures, as well as with family planning.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Binh Ho Duy
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Andrey Pashenko
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Sergey Khmyzov
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Centre for Comparative Genomics, Murdoch University, Perth, Australia.,Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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Sumrein BO, Mattila VM, Lepola V, Laitinen MK, Launonen AP, Jonsson K, Wolf O, Ström P, Berg H, Felländer-Tsai L, Mechlenburg I, Døssing K, Østergaard H, Rahnel T, Märtson A. Intraobserver and interobserver reliability of recategorized Neer classification in differentiating 2-part surgical neck fractures from multi-fragmented proximal humeral fractures in 116 patients. J Shoulder Elbow Surg 2018; 27:1756-1761. [PMID: 29866397 DOI: 10.1016/j.jse.2018.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal fracture classification should be simple and reproducible and should guide treatment. For proximal humeral fractures, the Neer classification is commonly used. However, intraobserver and interobserver reliability of the Neer classification has been shown to be poor. In clinical practice, it is essential to differentiate 2-part surgical neck fractures from multi-fragmented fractures. Thus, the aim of this study was to evaluate whether surgeons can differentiate 2-part surgical neck fractures from multi-fragmented fractures using plain radiographs and/or computed tomography (CT). METHODS Three experienced upper limb specialists and trauma surgeons (B.O.S., A.P.L., and V.L.) independently reviewed and classified blinded plain radiographs and CT scans of 116 patients as showing 2-part surgical neck fractures or multi-fragmented fractures. Each imaging modality was reviewed and classified separately by each surgeon, after which each surgeon reviewed both modalities at the same time. This process was repeated by all surgeons after 24 weeks. Intraobserver and interobserver analyses were conducted using Cohen and Fleiss κ values, respectively. RESULTS The κ coefficient for interobserver reliability showed substantial correlation (0.61-0.73) and was as follows: 0.73 for radiographs alone, 0.61 for CT scans alone, and 0.72 for radiographs and CT scans viewed together. After 24 weeks, the process was repeated and intraobserver reliability was calculated.The κ coefficient for intraobserver reliability showed substantial correlation (0.62-0.75) and was as follows: 0.62 for radiographs alone, 0.64 for CT scans alone, and 0.75 for radiographs and CT scans viewed together. CONCLUSION Clinicians were able to differentiate 2-part surgical neck fractures from multi-fragmented fractures based on plain radiographs reliably.
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Affiliation(s)
- Bakir O Sumrein
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - Ville M Mattila
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - Vesa Lepola
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Minna K Laitinen
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
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21
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Laius O, Pisarev H, Volmer D, Kõks S, Märtson A, Maasalu K. Use of a national database as a tool to identify primary medication non-adherence: The Estonian ePrescription system. Res Social Adm Pharm 2018; 14:776-783. [DOI: 10.1016/j.sapharm.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
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22
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Tootsi K, Kals J, Zilmer M, Paapstel K, Ottas A, Märtson A. Medium- and long-chain acylcarnitines are associated with osteoarthritis severity and arterial stiffness in end-stage osteoarthritis patients: a case-control study. Int J Rheum Dis 2018; 21:1211-1218. [DOI: 10.1111/1756-185x.13251] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics; University of Tartu; Tartu Estonia
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Jaak Kals
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
- Department of Surgery; University of Tartu; Tartu Estonia
| | - Mihkel Zilmer
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Kaido Paapstel
- Endothelial Centre; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Aigar Ottas
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics; University of Tartu; Tartu Estonia
- Institute of Biomedicine and Translational Medicine; Department of Biochemistry; Centre of Excellence for Genomics and Translational Medicine; University of Tartu; Tartu Estonia
- Traumatology and Orthopaedics Clinic; Tartu University Hospital; Tartu Estonia
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23
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Laius O, Pisarev H, Maasalu K, Kõks S, Märtson A. Trends in and relation between hip fracture incidence and osteoporosis medication utilization and prices in Estonia in 2004-2015. Arch Osteoporos 2017; 12:48. [PMID: 28497319 DOI: 10.1007/s11657-017-0341-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis medicines reduce osteoporotic fractures. There is a very strong negative correlation between the consumption of medicines and the price of an average daily dose indicating that affordability is a key factor that could increase consumption of antiosteoporotic medicines and, through that, reduce fractures. PURPOSE Osteoporosis is a major cause of morbidity and mortality in the modern world. Our study aims to describe the trends in incidence of hip fractures in relation to drug utilization patterns and the average price of antiosteoporotic medicines in Estonia. METHODS Data on hip fractures was obtained from the medical claims database of Estonian Health Insurance Fund (EHIF). Consumption and price data was obtained from the Estonian State Agency of Medicines (SAM).Consumption is presented using WHO defined daily doses methodology, and the prices reflect the average wholesale price of medicines. RESULTS From 2004 to 2010 there was a non-significant increasing trend in standardized hip fracture incidence in Estonia, but from 2010 to 2015, the trend turned to a significant decrease of 4.5% per year. The consumption of osteoporosis medication increased significantly from 2004 to 2009 by yearly average of 41.2%. After 2009, the consumption levelled. On contrast, the average price of one daily dose of osteoporosis medication decreased significantly from 2004 to 2009 by 16.9% per year and the decrease also levelled after 2009. This gives a very strong negative correlation of -0.93 (p < 0.001) between the consumption of antiosteoporotic medication and the average price of a daily dose of medication during the study period. CONCLUSIONS The statistically significant decline of standardized incidence of hip fractures from 2010 onward could at least in part be the result of the high increase in consumption of antiosteoporotic medicines which in turn is strongly negatively correlated with the average price of osteoporosis medicines.
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Affiliation(s)
- Ott Laius
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia. .,Estonian State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, Department of Epidemiology and Biostatistics, University of Tartu, Ravila, 19, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, L. Puusepa 8, Tartu, Estonia
| | - Sulev Kõks
- Institute of Biomedicine and Translational Medicine, Department of Pathophysiology, University of Tartu, Ravila, 19, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, L. Puusepa 8, Tartu, Estonia
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24
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Abstract
UNLABELLED Some patients do not take medicines as they are supposed to. Our research showed that in Estonia, one fifth of patients did not start treatment with osteoporosis medicines and only 20% used the medicines for at least 3 years as they should. This induces unnecessary costs to the healthcare system. PURPOSE Medication non-adherence is the number one reason for not obtaining the expected clinical effect of medicines. With osteoporosis treatment, it has been shown that both implementation of treatment and persistence influence the risk of fractures significantly. Long-term adherence to medication in Estonia is to be determined with this study. METHODS A 15-year retrospective study was carried out in order to establish initiation, implementation, and persistence of Estonian patients. All new users of osteoporosis medicines were analyzed for all prescriptions they received during the study period. Sufficient adherence to treatment was defined as a patient being dispensed 80% or more prescribed doses for at least 1 year. RESULTS The study period was from 2001 to 2015. Patients (24,652) were included in the study. Of the patients, 93.7% (n = 23,091) were women and 6.3% (n = 1564) were men. Eighteen percent (4636) were dispensed only one prescription. Of the patients, 44.2% included in the study had medication possession ratio (MPR) ≥80% over follow-up period; 8922 (36.2%) who were prescribed from 2001 to 2015 persisted for 1 year with MPR ≥80% and 19.8% persisted for 3 years. Forty percent of expenditure on osteoporosis medication was made for treatment courses with insufficient adherence. CONCLUSIONS There is room for improvement in Estonia with medication adherence relating to all three aspects that determine adherence-initiation, implementation, and persistence. This means further efforts are to be made to educate patients and healthcare professionals on realizing the importance of good adherence.
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Affiliation(s)
- Ott Laius
- Department of Traumatology and Orthopedics, University of Tartu, Institute of Clinical Medicine, L.Puusepa 8, Tartu, Estonia. .,Estonian State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Department of Epidemiology and Biostatistics, University of Tartu, Institute of Family Medicine and Public Health, Ravila 19, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Institute of Clinical Medicine, L.Puusepa 8, Tartu, Estonia.,Tartu University Hospital, Traumatology and Orthopaedics Clinic, L. Puusepa 8, Tartu, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Institute of Biomedicine and Translational Medicine, Ravila 19, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Institute of Clinical Medicine, L.Puusepa 8, Tartu, Estonia.,Tartu University Hospital, Traumatology and Orthopaedics Clinic, L. Puusepa 8, Tartu, Estonia
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25
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Ho XD, Nguyen HG, Trinh LH, Reimann E, Prans E, Kõks G, Maasalu K, Le VQ, Nguyen VH, Le NTN, Phung P, Märtson A, Lattekivi F, Kõks S. Analysis of the Expression of Repetitive DNA Elements in Osteosarcoma. Front Genet 2017; 8:193. [PMID: 29250102 PMCID: PMC5714928 DOI: 10.3389/fgene.2017.00193] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/15/2017] [Indexed: 02/05/2023] Open
Abstract
Osteosarcoma (OS) is a rare malignant bone tumor. It affects mostly young persons and has poor outcome with the present treatment. No improvement was observed since the introduction of chemotherapy. The better understanding of osteosarcoma development could indicate better management strategy. Repetitive DNA elements were found to play a role in cancer mechanism especially in epithelial tumors but not yet analyzed in osteosarcoma. We conducted the study to analyse the expression profile of repetitive elements (RE) in osteosarcoma. Methods: Fresh bone paired (tumor and normal bone) samples were obtained from excised parts of tumors of 18 patients with osteosarcoma. We performed sequencing of RNA extracted from 36 samples (18 tumor tissues and 18 normal bone for controls), mapped raw reads to the human genome and identified the REs. EdgeR package was used to analyse the difference in expression of REs between osteosarcoma and normal bone. Results: 82 REs were found differentially expressed (FDR < 0.05) between osteosarcoma and normal bone. Out of all significantly changed REs, 35 were upregulated and 47 were downregulated. HERVs (THE1C-int, LTR5, MER57F and MER87B) and satellite elements (HSATII, ALR-alpha) were the most significantly differential expressed elements between osteosarcoma and normal tissues. These results suggest significant impact of REs in the osteosarcoma. The role of REs should be further studied to understand the mechanism they have in the genesis of osteosarcoma.
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Affiliation(s)
- Xuan D Ho
- Department of Oncology, College of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Hoang G Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Le H Trinh
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Ene Reimann
- Department of Pathophysiology, University of Tartu, Tartu, Estonia.,Department of Reproductive Biology, Estonian University of Life Sciences, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Gea Kõks
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics of Tartu University Hospital, Tartu, Estonia
| | - Van Q Le
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Van H Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Nghi T N Le
- Department of Orthopedics, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Phuong Phung
- Department of Oncology, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics of Tartu University Hospital, Tartu, Estonia
| | - Freddy Lattekivi
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Tartu, Estonia.,Department of Reproductive Biology, Estonian University of Life Sciences, Tartu, Estonia
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Ottas A, Fishman D, Okas TL, Püssa T, Toomik P, Märtson A, Kingo K, Soomets U. Blood serum metabolome of atopic dermatitis: Altered energy cycle and the markers of systemic inflammation. PLoS One 2017; 12:e0188580. [PMID: 29176763 PMCID: PMC5703555 DOI: 10.1371/journal.pone.0188580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/09/2017] [Indexed: 12/19/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory disease which usually starts in the early childhood and ends before adulthood. However up to 3% of adults remain affected by the disease. The onset and course of the disease is influenced by various genetic and environmental factors. Although the immune system has a great effect on the outcome of the disease, metabolic markers can also try to explain the background of atopic dermatitis. In this study we analyzed the serum of patients with atopic dermatitis using both targeted and untargeted metabolomics approaches. We found the most significant changes to be related to phosphatidylcholines, acylcarnitines and their ratios and a cleavage peptide of Fibrinogen A-α. These findings that have not been reported before will further help to understand this complex disease.
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Affiliation(s)
- Aigar Ottas
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Dmytro Fishman
- Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
- Quretec OÜ, Tartu, Estonia
| | | | - Tõnu Püssa
- Department of Food Hygiene, Estonian University of Life Sciences, Tartu, Estonia
| | - Peeter Toomik
- Department of Food Hygiene, Estonian University of Life Sciences, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Külli Kingo
- Department of Dermatology, University of Tartu; Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
| | - Ursel Soomets
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
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Ho XD, Phung P, Q Le V, H Nguyen V, Reimann E, Prans E, Kõks G, Maasalu K, Le NT, H Trinh L, G Nguyen H, Märtson A, Kõks S. Whole transcriptome analysis identifies differentially regulated networks between osteosarcoma and normal bone samples. Exp Biol Med (Maywood) 2017; 242:1802-1811. [PMID: 29050494 DOI: 10.1177/1535370217736512] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We performed whole transcriptome analysis of osteosarcoma bone samples. Initially, we sequenced total RNA from 36 fresh-frozen samples (18 tumoral bone samples and 18 non-tumoral paired samples) matching in pairs for each osteosarcoma patient. We also performed independent gene expression analysis of formalin-fixed paraffin-embedded samples to verify the RNAseq results. Formalin-fixed paraffin-embedded samples allowed us to analyze the effect of chemotherapy. Data were analyzed with DESeq2, edgeR and Reactome packages of R. We found 5365 genes expressed differentially between the normal bone and osteosarcoma tissues with an FDR below 0.05, of which 3399 genes were upregulated and 1966 were downregulated. Among those genes, BTNL9, MMP14, ABCA10, ACACB, COL11A1, and PKM2 were expressed differentially with the highest significance between tumor and normal bone. Functional annotation with the reactome identified significant changes in the pathways related to the extracellular matrix degradation and collagen biosynthesis. It was suggested that chemotherapy may induce the modification of ECM with important collagen biosynthesis. Taken together, our results indicate that changes in the degradation of extracellular matrix seem to be an important mechanism of osteosarcoma and efficient chemotherapy induces the genes related to bone formation. Impact statement Osteosarcoma is a rare disease but it is of interest to many scientists all over the world because the current standard treatment still has poor results. We sequenced total RNA from 36 fresh-frozen paired samples (18 tumoral bone samples and 18 non-tumoral paired samples) from osteosarcoma patients. We found that differences in the gene expressions between the normal and affected bones reflected the changes in the regulation of the degradation of collagen and extracellular matrix. We believe that these findings contribute to the understanding of OS and suggest ideas for further studies.
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Affiliation(s)
- Xuan Dung Ho
- 1 Department of Oncology, 155407 College of Medicine and Pharmacy , Hue University, Hue 53000, Vietnam.,2 Department of Pathophysiology, 37546 University of Tartu , Tartu 50411, Estonia
| | - Phuong Phung
- 1 Department of Oncology, 155407 College of Medicine and Pharmacy , Hue University, Hue 53000, Vietnam
| | - Van Q Le
- 3 Department of Oncology, Hanoi Medical University, Hanoi 15000, Vietnam
| | - Van H Nguyen
- 3 Department of Oncology, Hanoi Medical University, Hanoi 15000, Vietnam
| | - Ene Reimann
- 2 Department of Pathophysiology, 37546 University of Tartu , Tartu 50411, Estonia.,4 Department of Reproductive Biology, 85334 Estonian University of Life Sciences , Tartu 51014, Estonia
| | - Ele Prans
- 2 Department of Pathophysiology, 37546 University of Tartu , Tartu 50411, Estonia
| | - Gea Kõks
- 2 Department of Pathophysiology, 37546 University of Tartu , Tartu 50411, Estonia
| | - Katre Maasalu
- 5 Department of Traumatology and Orthopedics, 37546 University of Tartu , Tartu 50411, Estonia.,6 Clinic of Traumatology and Orthopaedics of Tartu University Hospital, Tartu 50406, Estonia
| | - Nghi Tn Le
- 7 Department of Orthopedics, 155407 College of Medicine and Pharmacy , Hue University, Hue 53000, Vietnam
| | - Le H Trinh
- 3 Department of Oncology, Hanoi Medical University, Hanoi 15000, Vietnam
| | - Hoang G Nguyen
- 3 Department of Oncology, Hanoi Medical University, Hanoi 15000, Vietnam
| | - Aare Märtson
- 5 Department of Traumatology and Orthopedics, 37546 University of Tartu , Tartu 50411, Estonia.,6 Clinic of Traumatology and Orthopaedics of Tartu University Hospital, Tartu 50406, Estonia
| | - Sulev Kõks
- 2 Department of Pathophysiology, 37546 University of Tartu , Tartu 50411, Estonia.,4 Department of Reproductive Biology, 85334 Estonian University of Life Sciences , Tartu 51014, Estonia
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Zhytnik L, Maasalu K, Reimann E, Prans E, Kõks S, Märtson A. Mutational analysis of COL1A1 and COL1A2 genes among Estonian osteogenesis imperfecta patients. Hum Genomics 2017; 11:19. [PMID: 28810924 PMCID: PMC5558703 DOI: 10.1186/s40246-017-0115-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/31/2017] [Indexed: 12/15/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) is a rare bone disorder. In 90% of cases, OI is caused by mutations in the COL1A1/2 genes, which code procollagen α1 and α2 chains. The main aim of the current research was to identify the mutational spectrum of COL1A1/2 genes in Estonian patients. The small population size of Estonia provides a unique chance to explore the collagen I mutational profile of 100% of OI families in the country. Methods We performed mutational analysis of peripheral blood gDNA of 30 unrelated Estonian OI patients using Sanger sequencing of COL1A1 and COL1A2 genes, including all intron-exon junctions and 5′UTR and 3′UTR regions, to identify causative OI mutations. Results We identified COL1A1/2 mutations in 86.67% of patients (26/30). 76.92% of discovered mutations were located in the COL1A1 (n = 20) and 23.08% in the COL1A2 (n = 6) gene. Half of the COL1A1/2 mutations appeared to be novel. The percentage of quantitative COL1A1/2 mutations was 69.23%. Glycine substitution with serine was the most prevalent among missense mutations. All qualitative mutations were situated in the chain domain of pro-α1/2 chains. Conclusion Our study shows that among the Estonian OI population, the range of collagen I mutations is quite high, which agrees with other described OI cohorts of Northern Europe. The Estonian OI cohort differs due to the high number of quantitative variants and simple missense variants, which are mostly Gly to Ser substitutions and do not extend the chain domain of COL1A1/2 products.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Ravila 14a, 50411, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Sulev Kõks
- Centre of Translational Medicine, University of Tartu, Ravila 14a, 50411, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
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Tootsi K, Märtson A, Kals J, Paapstel K, Zilmer M. Metabolic factors and oxidative stress in osteoarthritis: a case–control study. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:520-526. [DOI: 10.1080/00365513.2017.1354255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Endothelial Centre, University of Tartu, Tartu, Estonia
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Jaak Kals
- Endothelial Centre, University of Tartu, Tartu, Estonia
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
- Department of Surgery, University of Tartu, Tartu, Estonia
| | - Kaido Paapstel
- Endothelial Centre, University of Tartu, Tartu, Estonia
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
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Nguyen MS, Binh HD, Nguyen KM, Maasalu K, Kõks S, Märtson A, Saag M, Jagomägi T. Occlusal features and need for orthodontic treatment in persons with osteogenesis imperfecta. Clin Exp Dent Res 2017; 3:19-24. [PMID: 29744175 PMCID: PMC5839216 DOI: 10.1002/cre2.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to (a) analyse dental occlusion and determine the need for orthodontic treatment of persons with osteogenesis imperfecta (OI) in comparison with the healthy population and (b) investigate the associations between OI and malocclusion. A case-control study included 26 OI persons and 400 healthy participants (control group). Occlusal features and the need for orthodontic treatment were defined according to Dental Health Component-Index of Orthodontic Treatment Need and Dental Aesthetic Index. Results showed that Angle Class I, II, and III relationship was found in 23.1%, 3.8%, and 73.1% of OI group, and in the control group, it was 67%, 17.5%, and 15.5%, respectively. OI group had significantly higher prevalence of reverse overjet >1 mm (76.9%), missing teeth (42.3%), posterior crossbite (34.6%), and open bite >2 mm (19.2%) compared to the control group (8.5%, 2.2%, 6.2%, and 3.5%, respectively). OI group had less incisal segment crowding and more incisal segment spacing than the control group (p < 0.05). The need for orthodontic treatment of OI group according to Dental Health Component-Index of Orthodontic Treatment Need and Dental Aesthetic Index was 88.5% and 61.5%, respectively, while in the control group, it was 24.8% and 51.8%. The malocclusion in OI persons was associated with reverse overjet > 1 mm (OR = 13.3, 95% CI = 3.9-44.7, p < .001), Angle Class III malocclusion (OR = 8.0, 95% CI = 2.0-30.8, p = .003), and missing teeth (OR = 4.7, 95% CI = 1.0-22.4, p = .049). In conclusion, there is the high probability of malocclusion in OI persons. Persons with OI require early orthodontic treatment because of significant correlation of OI disease with Angle Class III malocclusion, reverse overjet, and missing teeth.
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Affiliation(s)
- Minh Son Nguyen
- Institute of DentistryUniversity of TartuTartuEstonia
- Danang University of Medical Technology and PharmacyDanangVietnam
| | - Ho Duy Binh
- Hue University of Medicine and PharmacyHueVietnam
- Clinic of Traumatology and OrthopaedicsUniversity of TartuTartuEstonia
| | - Khac Minh Nguyen
- Danang University of Medical Technology and PharmacyDanangVietnam
| | - Katre Maasalu
- Clinic of Traumatology and OrthopaedicsUniversity of TartuTartuEstonia
| | - Sulev Kõks
- Department of PathophysiologyUniversity of TartuTartuEstonia
| | - Aare Märtson
- Clinic of Traumatology and OrthopaedicsUniversity of TartuTartuEstonia
| | - Mare Saag
- Institute of DentistryUniversity of TartuTartuEstonia
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Maasalu K, Laius O, Zhytnik L, Kõks S, Prans E, Reimann E, Märtson A. Featured Article: Transcriptional landscape analysis identifies differently expressed genes involved in follicle-stimulating hormone induced postmenopausal osteoporosis. Exp Biol Med (Maywood) 2017; 242:203-213. [PMID: 27856519 PMCID: PMC5167124 DOI: 10.1177/1535370216679899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/08/2016] [Indexed: 11/16/2022] Open
Abstract
Osteoporosis is a disorder associated with bone tissue reorganization, bone mass, and mineral density. Osteoporosis can severely affect postmenopausal women, causing bone fragility and osteoporotic fractures. The aim of the current study was to compare blood mRNA profiles of postmenopausal women with and without osteoporosis, with the aim of finding different gene expressions and thus targets for future osteoporosis biomarker studies. Our study consisted of transcriptome analysis of whole blood serum from 12 elderly female osteoporotic patients and 12 non-osteoporotic elderly female controls. The transcriptome analysis was performed with RNA sequencing technology. For data analysis, the edgeR package of R Bioconductor was used. Two hundred and fourteen genes were expressed differently in osteoporotic compared with non-osteoporotic patients. Statistical analysis revealed 20 differently expressed genes with a false discovery rate of less than 1.47 × 10-4 among osteoporotic patients. The expression of 10 genes were up-regulated and 10 down-regulated. Further statistical analysis identified a potential osteoporosis mRNA biomarker pattern consisting of six genes: CACNA1G, ALG13, SBK1, GGT7, MBNL3, and RIOK3. Functional ingenuity pathway analysis identified the strongest candidate genes with regard to potential involvement in a follicle-stimulating hormone activated network of increased osteoclast activity and hypogonadal bone loss. The differentially expressed genes identified in this study may contribute to future research of postmenopausal osteoporosis blood biomarkers.
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Affiliation(s)
- Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu 51014, Estonia
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu 51014, Estonia
| | - Ott Laius
- Department of Traumatology and Orthopedics, University of Tartu, Tartu 51014, Estonia
| | - Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Tartu 51014, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Tartu 50411, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu 50411, Estonia
| | - Ene Reimann
- Department of Pathophysiology, University of Tartu, Tartu 50411, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu 51014, Estonia
- Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu 51014, Estonia
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Binh HD, Maasalu K, Dung VC, Ngoc CTB, Hung TT, Nam TV, Nhan LNT, Prans E, Reimann E, Zhytnik L, Kõks S, Märtson A. The clinical features of osteogenesis imperfecta in Vietnam. Int Orthop 2016; 41:21-29. [PMID: 27807717 DOI: 10.1007/s00264-016-3315-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Osteogenesis imperfecta (OI) has not been studied in a Vietnamese population before. The aim of this study was to systematically collect epidemiological information, investigate clinical features and create a clinical database of OI patients in Vietnam for future research and treatment strategy development. METHOD Participants underwent clinical and physical examinations; also medical records were reviewed. Genealogical information was collected and family members' phenotypical manifestations recorded. Cases were classified according to the Sillence classification. RESULTS In total, 146 OI patients from 120 families were studied: 46 with OI Type I, 46 with Type III and 54 with Type IV. Almost patients had skeletal deformations. One hundred and forty-two had a history of fractures, 117 blue sclera, 89 dentinogenesis imperfecta and 26 hearing loss. The total number of fractures was 1,932. Thirty-four patients had intra-uterine fractures and nine had perinatal fractures. Surgery was performed 163 times in 58 patients; 100 osteosyntheses and 63 osteotomies. Bisphosphonate treatment was used in 37 patients. The number of affected individuals and predominance of severe forms of OI indicate that the disease is under diagnosed in Vietnam, especially in cases without a family history or with mild form of OI. Deformities appeared in all patients with different severity and localisation, affecting mostly the lower limbs. OI medical and surgical treatment rates are low and in most cases surgery was performed due to fractures. CONCLUSIONS Compared to previous studies, our results indicate a lower OI prevalence and greater severity of symptoms in the Vietnamese population when compared with other areas. Further investigation, improved diagnosis and treatment are needed to increase the patients' quality of life.
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Affiliation(s)
- Ho Duy Binh
- Hue University of Medicine and Pharmacy, Hue University, 06 ngo Quyen, Hue, 530000, Vietnam. .,Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Katre Maasalu
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Vu Chi Dung
- National Hospital of Pediatrics, 18/879 La Thanh, Dong Da, 100000, Hanoi, Vietnam
| | - Can T Bich Ngoc
- National Hospital of Pediatrics, 18/879 La Thanh, Dong Da, 100000, Hanoi, Vietnam
| | - Ton That Hung
- OI Booming Diamond Center, 303/38 Ha Huy Giap, 12th District, 700000, Ho Chi Minh City, Vietnam
| | - Tran V Nam
- Traditional Medicine Institute, 273 Nguyen Van Troi, Phu Nhuan, 700000, Ho Chi Minh City, Vietnam
| | - Le N Thanh Nhan
- Hue University of Medicine and Pharmacy, Hue University, 06 ngo Quyen, Hue, 530000, Vietnam
| | - Ele Prans
- Pathophysiology Department, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Ene Reimann
- Pathophysiology Department, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
| | - Sulev Kõks
- Pathophysiology Department, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
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Laius O, Maasalu K, Kõks S, Märtson A. Use of drugs against osteoporosis in the Baltic countries during 2010-2014. Medicina (Kaunas) 2016; 52:315-320. [PMID: 27789081 DOI: 10.1016/j.medici.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 09/20/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Osteoporosis is a major health threat nowadays. Aging of the population and changes in peoples' lifestyle result in a constant increase in the number of fractures all over the world. Our study aimed at describing the drug utilization pattern and choice of active substances of antiosteoporotic medicines in the Baltic countries. MATERIALS AND METHODS Sales data of the antiosteoporotic medicines was obtained from the internet. These are available on the website of medicines regulatory agencies. The World Health Organization (WHO) methodology of Anatomical Therapeutic Chemical (ATC) classification and defined daily dose (DDD) was used to compare the data among countries. RESULTS During the study period the consumption of antiosteoporotic medicines was rather stable in all the countries. The overall choice of active substances used to treat osteoporosis is similar in all the Baltic countries but the market shares of substances were different. Estonia stands out with high use of combination product of alendronic acid and colecalciferol. In Latvia the highest consumption was of risedronic acid. In Lithuania the most used active substance in 2014 was ibandronic acid and second was denosumab with 0.8 daily doses per 1000 inhabitants per day (DID) and 25% of the total share. CONCLUSIONS The differences in consumption of drugs against osteoporosis in the Baltic countries are not very big. The consumption of antiosteoporotic drugs is not to be regarded as sufficient though. The generally low consumption of osteoporotic medicines in the Baltic countries can be attributed to the overall less than EU average wealth of the countries and less than optimal expenditure on healthcare out of the GDP.
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Affiliation(s)
- Ott Laius
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia; Estonian State Agency of Medicines, Tartu, Estonia.
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia; Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia; Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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Ho Duy B, Zhytnik L, Maasalu K, Kändla I, Prans E, Reimann E, Märtson A, Kõks S. Mutation analysis of the COL1A1 and COL1A2 genes in Vietnamese patients with osteogenesis imperfecta. Hum Genomics 2016; 10:27. [PMID: 27519266 PMCID: PMC4983065 DOI: 10.1186/s40246-016-0083-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/30/2016] [Indexed: 11/14/2022] Open
Abstract
Background The genetics of osteogenesis imperfecta (OI) have not been studied in a Vietnamese population before. We performed mutational analysis of the COL1A1 and COL1A2 genes in 91 unrelated OI patients of Vietnamese origin. We then systematically characterized the mutation profiles of these two genes which are most commonly related to OI. Methods Genomic DNA was extracted from EDTA-preserved blood according to standard high-salt extraction methods. Sequence analysis and pathogenic variant identification was performed with Mutation Surveyor DNA variant analysis software. Prediction of the pathogenicity of mutations was conducted using Alamut Visual software. The presence of variants was checked against Dalgleish’s osteogenesis imperfecta mutation database. Results The sample consisted of 91 unrelated osteogenesis imperfecta patients. We identified 54 patients with COL1A1/2 pathogenic variants; 33 with COL1A1 and 21 with COL1A2. Two patients had multiple pathogenic variants. Seventeen novel COL1A1 and 10 novel COL1A2 variants were identified. The majority of identified COL1A1/2 pathogenic variants occurred in a glycine substitution (36/56, 64.3 %), usually serine (23/36, 63.9 %). We found two pathogenic variants of the COL1A1 gene c.2461G > A (p.Gly821Ser) in four unrelated patients and one, c.2005G > A (p.Ala669Thr), in two unrelated patients. Conclusion Our data showed a lower number of collagen OI pathogenic variants in Vietnamese patients compared to reported rates for Asian populations. The OI mutational profile of the Vietnamese population is unique and related to the presence of a high number of recessive mutations in non-collagenous OI genes. Further analysis of OI patients negative for collagen mutations, is required.
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Affiliation(s)
- Binh Ho Duy
- Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen, Hue city, 530000, Vietnam. .,Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Lidiia Zhytnik
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Ivo Kändla
- Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Ene Reimann
- Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Sulev Kõks
- Centre of Translational Medicine, University of Tartu, Ravila 14a, Tartu, 50411, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia
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Tootsi K, Märtson A, Zilmer M, Paapstel K, Kals J. Increased arterial stiffness in patients with end-stage osteoarthritis: a case-control study. BMC Musculoskelet Disord 2016; 17:335. [PMID: 27515421 PMCID: PMC4982219 DOI: 10.1186/s12891-016-1201-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/03/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Both osteoarthritis (OA) and cardiovascular diseases (CVD) are prevalent conditions which often co-exist. Vascular involvement in the pathogenesis of these diseases, as well as increased cardiovascular risk in OA patients give occasion to investigate arterial stiffness in OA. The aim of this study was to establish associations between OA and arterial stiffness. METHODS The characteristics of arterial stiffness were measured with Sphygmocor and HDI devices in 48 patients (age 63 ± 7 years (mean ± SD)) with end-stage OA awaiting knee and hip replacement and in 49 age and gender matched controls (61 ± 7 years). Independent Student's t-test or the Mann-Whitney U test was used to compare means between the groups. Correlation between variables was determined using Pearson's or Spearman's correlation analysis and stepwise multiple regression analysis. RESULTS Carotid-femoral pulse wave velocity (car-fem PWV) was increased in the patients with OA compared to the controls (9.6 ± 2.4 and 8.4 ± 1.9 m/s, p = 0.015 respectively). High-sensitivity C-reactive protein and white blood cells count were significantly higher in the OA patients compared with the controls (1.80 ± 1.10 and 1.48 ± 1.32 mg/l, p = 0.042; 6.5 ± 1.5 and 5.6 ± 1.9 10(9)/l, p = 0.001 respectively). In multiple regression analysis age (p < 0.001), mean arterial blood pressure (p = <0.001) and OA status (p = 0.029) were found to be independent predictors of car-fem PWV. CONCLUSIONS This study showed that patients with OA had increased aortic stiffness compared to non-OA controls. The potential link between arterial stiffening and OA suggests that vascular alterations are involved in OA pathogenesis and could be responsible for increased cardiovascular risk in end-stage OA patients.
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Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa street 8, Tartu, Estonia.
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa street 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Mihkel Zilmer
- Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kaido Paapstel
- Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia
| | - Jaak Kals
- Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia.,Department of Surgery, University of Tartu, Tartu, Estonia
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Ho XD, Phung P, LE VQ, Nguyen VH, Reimann E, Prans E, Kõks G, Maasalu K, Märtson A, Le NTN, Trinh LH, Nguyen HG, Kõks S. Whole transcriptome analysis to reveal differentially expressed genes between paired osteosarcoma and normal bone samples. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e22508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Xuan Dung Ho
- College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Phuong Phung
- Oncology Department, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | | | | | - Ene Reimann
- Department of pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of pathophysiology, University of Tartu, Tartu, Estonia
| | - Gea Kõks
- Department of pathophysiology, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Estonia, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Estonia, Tartu, Estonia
| | - nghi Thanh Nhan Le
- Department of Orthopedics, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Le Huy Trinh
- department of oncology, Hanoi medical university, Hanoi, Viet Nam
| | | | - Sulev Kõks
- Department of pathophysiology, University of Tartu, Tartu, Estonia
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Viil J, Maasalu K, Mäemets-Allas K, Tamming L, Lõhmussaar K, Tooming M, Ingerpuu S, Märtson A, Jaks V. Laminin-rich blood vessels display activated growth factor signaling and act as the proliferation centers in Dupuytren's contracture. Arthritis Res Ther 2015; 17:144. [PMID: 26018562 PMCID: PMC4475288 DOI: 10.1186/s13075-015-0661-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/22/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Dupuytren's contracture (DC) is a chronic fibroproliferative disease of the hand, which is characterized by uncontrolled proliferation of atypical myofibroblasts at the cellular level. We hypothesized that specific areas of the DC tissue are sustaining the cell proliferation and studied the potential molecular determinants that might contribute to the formation of such niches. METHODS We studied the expression pattern of cell proliferation marker Ki67, phosphorylated AKT (Ak mouse strain thymoma) kinase, DC-associated growth factors (connective tissue growth factor (CTGF), basic fibroblast growth factor (bFGF), insulin-like growth factor 2 (IGF-2)) and extracellular matrix components (laminins, fibronectin, collagen IV) in DC tissue and normal palmar fascia using immunofluorescence microscopy and quantitative real-time polymerase chain reaction (qPCR). RESULTS We found that proliferative cells in the DC nodules were concentrated in the immediate vicinity of small blood vessels and localized predominantly in the myofibroblast layer. Correspondingly, the DC-associated blood vessels contained increased levels of phosphorylated AKT, a hallmark of activated growth factor signaling. When studying the expression of potential activators of AKT signaling we found that the expression of bFGF was confined to the endothelium of the small blood vessels, IGF-2 was present uniformly in the DC tissue and CTGF was expressed in the DC-associated sweat gland acini. In addition, the blood vessels in DC nodules contained increased amounts of laminins 511 and 521, which have been previously shown to promote the proliferation and stem cell properties of different cell types. CONCLUSIONS Based on our findings, we propose that in the DC-associated small blood vessels the presence of growth factors in combination with favorable extracellular matrix composition provide a supportive environment for sustained proliferation of myofibroblasts and thus the blood vessels play an important role in DC pathogenesis.
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Affiliation(s)
- Janeli Viil
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Kristina Mäemets-Allas
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Liis Tamming
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Kadi Lõhmussaar
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Mikk Tooming
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Sulev Ingerpuu
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia.
| | - Aare Märtson
- Department of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Viljar Jaks
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010, Tartu, Estonia. .,Department of Biosciences and Nutrition, Karolinska Institutet, Hälsovägen 7, 141 83, Huddinge, Sweden.
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Maasalu K, Nikopensius T, Kõks S, Nõukas M, Kals M, Prans E, Zhytnik L, Metspalu A, Märtson A. Whole-exome sequencing identifies de novo mutation in the COL1A1 gene to underlie the severe osteogenesis imperfecta. Hum Genomics 2015; 9:6. [PMID: 25958000 PMCID: PMC4429824 DOI: 10.1186/s40246-015-0028-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) comprises a clinically and genetically heterogeneous group of connective tissue disorders, characterized by low bone mass, increased bone fragility, and blue-gray eye sclera. OI often results from missense mutations in one of the conserved glycine residues present in the Gly-X-Y sequence repeats of the triple helical region of the collagen type I α chain, which is encoded by the COL1A1 gene. The aim of the present study is to describe the phenotype of OI II patient and a novel mutation, causing current phenotype. Results We report an undescribed de novo COL1A1 mutation in a patient affected by severe OI. After performing the whole-exome sequencing in a case parent–child trio, we identified a novel heterozygous c.2317G > T missense mutation in the COL1A1 gene, which leads to p.Gly773Cys transversion in the triple helical domain of the collagen type I α chain. The presence of the missense mutation was confirmed with the Sanger sequencing. Conclusions Hereby, we report a novel mutation in the COL1A1 gene causing severe, life threatening OI and indicate the role of de novo mutation in the pathogenesis of rare familial diseases. Our study underlines the importance of exome sequencing in disease gene discovery for families where conventional genetic testing does not give conclusive evidence.
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Affiliation(s)
- Katre Maasalu
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Tiit Nikopensius
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia.
| | - Margit Nõukas
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Mart Kals
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Ele Prans
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Andres Metspalu
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Estonian Biocentre, Riia 23b, 51010, Tartu, Estonia.
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
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Prommik P, Kolk H, Kalda R, Kree S, Tiit EM, Märtson A, Pääsuke M, Saks K. Do hip fracture patients have lower prefracture functional performance compared to other elderly traumatic patients? Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tootsi* K, Märtson A, Zilmer M, Paapstel K, Kals J. P2.14 PARAMETERS OF ARTERIAL STIFFNESS IN OSTEOARTHRITIS PATIENTS AND IN HEALTHY CONTROLS. Artery Res 2015. [DOI: 10.1016/j.artres.2015.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reimann E, Kõks S, Ho XD, Maasalu K, Märtson A. Whole exome sequencing of a single osteosarcoma case--integrative analysis with whole transcriptome RNA-seq data. Hum Genomics 2014; 8:20. [PMID: 25496518 PMCID: PMC4272536 DOI: 10.1186/s40246-014-0020-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/10/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Osteosarcoma (OS) is a prevalent primary malignant bone tumour with unknown etiology. These highly metastasizing tumours are among the most frequent causes of cancer-related deaths. Thus, there is an urgent need for different markers, and with our study, we were aiming towards finding novel biomarkers for OS. METHODS For that, we analysed the whole exome of the tumorous and non-tumour bone tissue from the same patient with OS applying next-generation sequencing. For data analysis, we used several softwares and combined the exome data with RNA-seq data from our previous study. RESULTS In the tumour exome, we found wide genomic rearrangements, which should qualify as chromotripsis-we detected almost 3,000 somatic single nucleotide variants (SNVs) and small indels and more than 2,000 copy number variants (CNVs) in different chromosomes. Furthermore, the somatic changes seem to be associated to bone tumours, whereas germline mutations to cancer in general. We confirmed the previous findings that the most significant pathway involved in OS pathogenesis is probably the WNT/β-catenin signalling pathway. Also, the IGF1/IGF2 and IGF1R homodimer signalling and TP53 (including downstream tumour suppressor gene EI24) pathways may have a role. Additionally, the mucin family genes, especially MUC4 and cell cycle controlling gene CDC27 may be considered as potential biomarkers for OS. CONCLUSIONS The genes, in which the mutations were detected, may be considered as targets for finding biomarkers for OS. As the study is based on a single case and only DNA and RNA analysis, further confirmative studies are required.
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Affiliation(s)
- Ene Reimann
- Department of Pathophysiology, University of Tartu, 19 Ravila Street, Tartu, 50411, Estonia. .,Department of Reproductive Biology, Estonian University of Life Sciences, 64 Kreutzwaldi Street, Tartu, Estonia.
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, 19 Ravila Street, Tartu, 50411, Estonia. .,Department of Reproductive Biology, Estonian University of Life Sciences, 64 Kreutzwaldi Street, Tartu, Estonia.
| | - Xuan Dung Ho
- Department of Traumatology and Orthopaedics, University of Tartu, 8 Puusepa Street, Tartu, Estonia. .,Department of Oncology, Hue University of Medicine and Pharmacy, 6 Ngo Quyen Street, Hue, Vietnam.
| | - Katre Maasalu
- Department of Traumatology and Orthopaedics, University of Tartu, 8 Puusepa Street, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, 8 Puusepa Street, Tartu, Estonia.
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, 8 Puusepa Street, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, 8 Puusepa Street, Tartu, Estonia.
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Abstract
BACKGROUND Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. PATIENTS AND METHODS We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. RESULTS 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6-20) and that of patients with AKP was 15 (6-20) (p = 0.04). Patients with OARSI scores of 13-24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0-2.3) than patients with OARSI scores of 0-12. INTERPRETATION The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.
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Affiliation(s)
- Vahur Metsna
- University of Tartu, Tartu,Department of Orthopedics, East-Tallinn Central Hospital, Tallin
| | | | - Katrin Lepik
- Department of Pathology, East-Tallinn Central Hospital, Tallinn
| | - Aare Märtson
- University of Tartu, Tartu,Department of Orthopedics, Tartu University Hospital, Tartu, Estonia
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Reimann E, Kõks S, Ho X, Maasalu K, Märtson A. Whole exome sequencing of a single osteosarcoma case¿integrative analysis with whole transcriptome RNA-seq data. Hum Genomics 2014. [DOI: 10.1186/preaccept-1873296159134645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Märtson A, Kõks S, Reimann E, Prans E, Erm T, Maasalu K. Transcriptome analysis of osteosarcoma identifies suppression of wnt pathway and up-regulation of adiponectin as potential biomarker. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2052-7993-1-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vahtrik D, Gapeyeva H, Aibast H, Ereline J, Kums T, Haviko T, Märtson A, Schneider G, Pääsuke M. Quadriceps femoris muscle function prior and after total knee arthroplasty in women with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012; 20:2017-25. [PMID: 22139408 DOI: 10.1007/s00167-011-1808-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of the present study was to evaluate an isometric voluntary force generation and relaxation capacity of the quadriceps femoris (QF) muscle prior and after total knee arthroplasty (TKA). METHODS Isometric maximal voluntary contraction force, rate of force development, voluntary activation, half-relaxation time, and latency of contraction of the QF muscle were recorded in 12 female patients (aged 49-68 years) with knee osteoarthritis one day before, 3 and 6 months following TKA in the operated and nonoperated leg. Knee pain intensity was assessed by visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used to assess knee problems during daily living. RESULTS A significant decrease in knee pain and significant increase in KOOS were established after TKA. Maximal voluntary isometric force in the operated leg was lower (P < 0.05) before, 3 and 6 months after TKA as compared to the nonoperated leg. Rate of force development of the QF muscle in the operated leg compared to the nonoperated leg was significantly lower (P < 0.05) 3 and 6 months after TKA. Voluntary activation, latency of contraction, and half-relaxation time of the QF muscle did not differ significantly before, 3 and 6 months after TKA. CONCLUSIONS The present study indicated reduced maximal and explosive strength of quadriceps femoris muscle in the operated leg 3 and 6 months after TKA with no significant changes in voluntary activation, and capacity for rapid contraction and relaxation. LEVEL OF EVIDENCE Prospective comparative study, Level II.
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Affiliation(s)
- Doris Vahtrik
- Institute of Exercise Biology and Physiotherapy, University of Tartu, 5 Jakobi Street, 51014, Tartu, Estonia.
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Toom A, Suutre S, Märtson A, Haviko T, Selstam G, Arend A. Lack of a central role for osteoprogenitor cells from the femoral canal in heterotopic ossification of the hip: an experimental study in a rat model. ACTA ACUST UNITED AC 2010; 92:298-303. [PMID: 20130328 DOI: 10.1302/0301-620x.92b2.22630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have developed an animal model to examine the formation of heterotopic ossification using standardised muscular damage and implantation of a beta-tricalcium phosphate block into a hip capsulotomy wound in Wistar rats. The aim was to investigate how cells originating from drilled femoral canals and damaged muscles influence the formation of heterotopic bone. The femoral canal was either drilled or left untouched and a tricalcium phosphate block, immersed either in saline or a rhBMP-2 solution, was implanted. These implants were removed at three and 21 days after the operation and examined histologically, histomorphometrically and immunohistochemically. Bone formation was seen in all implants in rhBMP-2-immersed, whereas in those immersed in saline the process was minimal, irrespective of drilling of the femoral canals. Bone mineralisation was somewhat greater in the absence of drilling with a mean mineralised volume to mean total volume of 18.2% (sd 4.5) versus 12.7% (sd 2.9, p < 0.019), respectively. Our findings suggest that osteoinductive signalling is an early event in the formation of ectopic bone. If applicable to man the results indicate that careful tissue handling is more important than the prevention of the dissemination of bone cells in order to avoid heterotopic ossification.
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Affiliation(s)
- A Toom
- Department of Traumatology and Orthopaedics University of Tartu, Puusepa 8, Tartu 51014, Estonia.
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Toom A, Fischer K, Märtson A, Rips L, Haviko T. Inter-observer reliability in the assessment of heterotopic ossification: proposal of a combined classification. Int Orthop 2005; 29:156-9. [PMID: 15827750 PMCID: PMC3456889 DOI: 10.1007/s00264-004-0603-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Accepted: 09/20/2004] [Indexed: 10/25/2022]
Abstract
We applied four published classifications for assessment of heterotopic ossification after total hip arthroplasty (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. The average incidence of heterotopic ossification varied from 19.8% to 27.7%. The inter-observer reliability of the various classifications was determined by Cohen's Kappa statistic. Kappa values ranged from 0.897 for Arcq's to 0.814 for Brooker's classification. In order to increase the reliability and consistency, we propose a new classification system combining Brooker's and Della Valle's classifications. This new classification preserves the high reliability of Della Valle's system and is comparable to previous publications since it includes Brooker's criteria.
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Affiliation(s)
- A Toom
- Clinic of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.
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Märtson A, Haviko T, Kirjanen K. Extensive limb lengthening in Ollier's disease: 25-year follow-up. Medicina (Kaunas) 2005; 41:861-6. [PMID: 16272834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A case of extensive lower limb lengthening (32 cm) in a 14-year-old male patient with Ollier's disease is reported. A varus deformity of the femur and a valgus deformity of the tibia were evident. The femur was successfully lengthened 22 cm by metaphyseal distraction, and the tibia was lengthened 10 cm by two-stage distraction-compression method with a cylindrical bone allograft. Ilizarov's distraction device was used. Radiologically, a good bone regenerate was formed. Host bone has incorporated (like sarcophagi) the allograft of tibia. No evidence of vascular or neural disturbances was found. The lengthening indices were counted for femur 22.5 days per centimeter and for tibia 21 days per centimeter, altogether 15.5 days per centimeter. Bone lengthening was performed through the Ollier's disease foci. Fine needle biopsy investigation showed that most embryonic cartilage cells had been replaced with bone tissue. After five years and a 25-year follow-up the patient was satisfied with the result. The function of the knee joint was limited, but the limb was fully weight-bearing. Signs of knee osteoarthritis were found.
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Affiliation(s)
- Aare Märtson
- Clinic of Traumatology and Orthopedics, Tartu University Clinics, Tartu, Estonia.
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Abstract
AIM To analyse the changes in fracture rate, bone density and histology in children with Osteogenesis imperfecta receiving treatment with alendronate (oral bisphosphonate) and calcitriol. METHODS Children treated at Tartu University Hospital from 1995 to 2001 were examined for Osteogenesis imperfecta. Radiographs and bone density measurements were obtained for all patients at the beginning of the study. Four patients also had bone biopsies prior to and one year after beginning treatment. The children were then given alendronate in weight-dependent dosages and also calcitriol. The number of fractures during the treatment period was recorded and follow-up bone density measurements were made. RESULTS Fifteen patients were treated during the 6-y period; mean follow-up approximately 3 y. It was found that the number of bone fractures had decreased significantly (p < 0.0001). Bone density improved in all 15 patients. Histologic studies revealed an increased number of osteoblasts and thickness of bone trabeculae as well as a more regular bone lamellar structure at the time of the second operation. CONCLUSION The complex treatment of Osteogenesis imperfecta should include alendronate and calcitriol to decrease fractures and improve bone mineral density.
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Affiliation(s)
- K Maasalu
- Department of Traumatology and Orthopaedics, Tartu University Clinics, Tartu, Estonia
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Hussar P, Piirsoo A, Märtson A, Toom A, Haviko T, Hussar U. Bone healing models in rat tibia after different injuries. Ann Chir Gynaecol 2002; 90:271-9. [PMID: 11820416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
AIMS Gradual elaboration of an adequate and efficient multistage method for experimental remodelling of specific wound healing process--bone repair. Comparison of clinical characteristics with the results of microanatomy, histology, electronmicroscopy and computer morphometry. MATERIAL AND METHODS An investigation of posttraumatic bone repair after internal fracture, excision and cortical perforation was carried out on 142 young adult male Wistar rats. The repair was studied in normal and affected animals (exercises, immobilization, isolation of periost) at 1-42 days after operation. RESULTS The posttraumatic bone callus development and the related soft tissue repair, likewise the continuous remodelling, is an ordinary process of osteohisto- and organogenese. In trained rats the blood supply and bone formation is increased, whereas in immobilized animals it is inhibited and destroyed (osteoporose, pseudoarthrosis). After the injury some characteristics of bone repair histogenese will be became evident (after the perforation the primary endosteal and secondary periosteal ossification, inhibition of endosteal bone repair after the isolation of periost etc.). CONCLUSION The posttraumatic bone healing, like embryohistogenese, has similar repair stages in all models of the experiments as well as similar tissue and cell responses (callus formation, its replacement, bone remodelling, etc.). However, the repair process in general (order of chondrous and/or bone callus stages, etc.) is variable and dependent on the mode and degree of injury. The use of bone cortex perforation in wound healing study is more recommendable as compared to internal fracture and excision (possibility of in situ study the periost and callus tissue compartments in bone repair machinery separately).
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Affiliation(s)
- P Hussar
- The Institute of Anatomy, University of Tartu, Estonia
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